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Optimizing Claims: 5 Predictive Models to Augment Claims Processing

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Model 3 – Claims Duration Forecasting An important objective is to bring consistency to the claims settlement process. Claims managers face on-going pressure to settle faster, with transparent fairness, while at the same time using fewer resources and reducing loss adjustment expenses. Key factors that heavily influence the settlement amount are the duration of a claim and reporting lag time. For example, let's consider the number of days between when the loss happens and when it was reported. Research has shown that cost of claim is nearly 40% greater if the claimant delays reporting the claim by as few as four days. By using analytics, organizations can shorten the claims cycle times. Not only does this lead to higher customer satisfaction, but they can reduce labor costs as claims adjusters will now be able to close claims more quickly and therefore process more claims each year. Thus also ensuring significant expense savings on such things as rental cars for automobile repair claims. Model 4 – Subrogation Propensity Opportunities for recovery, whether it be from salvage, subrogation or third-party recovery, are very often obscured by the sheer volume of claims data available. Many recovery opportunities are missed simply because the indicator for a possible recovery is hidden in the claim narrative. However, these missed opportunities can have considerable financial implications. Subrogation optimization scores a claim at each stage in the claims lifecycle based on known characteristics, identifying unknown characteristics and optimizing associated activities. Predictive analytics can be used to determine cost effectiveness of the recovery opportunity, by answering questions around worth and timeliness, as well as optimizing the subrogation amount if the insurer cannot recover the whole amount. Finally, by using text analytics and Natural Language Processing (NLP), insurers can analyze adjuster notes, medical records or other unstructured data looking for phrases that typically indicate a subrogation case. Pinpointing likely subrogation opportunities earlier in the life of a claim maximizes loss recovery and ultimately lowers loss expenses. OPTIMIZING CLAIMS | 5

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