Proving SIU Value

Insurance Special Investigation Units (SIUs), as much as any other business unit, are under constant pressure to prove their value to company stakeholders and budget-setters. Things like ROI and value are not always made clearly apparent to people in charge of allocating resources, and the justification for devoting more budget to anti-fraud resources can sometimes be vague. To that end, data and measurement can become a valuable tool for SIU leadership. An important use of your data may be to prove the value of the unit itself, to justify its usefulness and procure resources. What, then, are some of the best ways we can accomplish this?
Let’s think about your internal stakeholders – senior leadership and the claims department. What are some of the things most important to them? Can they be measured and reported?

Protecting the brand

For leadership and the wider business, protecting the company’s brand is a principal concern.

As an SIU tasked with investigating and reducing fraud losses, this may seem like a duty more suited to customer service, public relations, or marketing. However, fraud investigations are sensitive topics for customers, particularly if they are the subject of a perceived or alleged false accusation. Your SIU is challenged with minimizing fraud losses without negatively affecting the overall claims experience for normal customers. What happens when these negative interactions with SIUs occur? Well, here’s what can happen sometimes:

A Yelp rating of an insurance company. This is the experience of one customer dealing with a company that may have lost the balance between catching fraud and the claims experience for the rest of their customers. In any case, it’s a bad optic for the insurer.
This is a tweet from a customer of a company whose investigations may have blown out the overall claims
processing time.

While we need to be forthright in hunting fraud, a hostile claims process and a long cycle time on claims that turn out to be genuine can be seriously damaging to your brand, possibly leading to social media complaints, bad press, and complaints to regulators.

The question is: How do we demonstrate to our leadership and our claims department that we are fighting fraud while keeping the cycle times reasonable and the overall customer experience positive?

In later parts of this series, we’ll talk about how to reduce false positives so customers with genuine claims don’t experience claim delays, and how we can use metrics to reduce cycle times even on claims that are genuine.

We’ve seen a couple of social media complaints that are essentially about claim cycle times. What statistics can we track that will help us with brand protection? Let’s take a look at this graph of average claim settlement time:

You can see on this hypothetical chart for an SIU, that the average claim settlement time is going up over recent periods. According to a 2014 Coalition Against Insurance Fraud survey, most investigations on commercial line files are concluded within 60 days. This unit is trending above the norm which could raise concerns. On the other hand, if you’re lowering cycle time, you can clearly demonstrate this to management and prove some of your value.

Tracking customer complaints, tracking compliance, and measuring claims unit satisfaction are some other ways of showing your commitment to brand protection. By using these metrics, you can demonstrate that you are upholding, and even improving, the brand value. The next question is likely to be “What are the outcomes of your claim, and how efficiently are we achieving them?”

In Part 2 of this series, we’ll continue to explore metrics with a discussion about return on investment.

Polonious Case Management Solutions | 888-650-7656| Polonious-Systems.com

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