Is customer satisfaction important in the claims process? Think back to a time when you weren’t an insurance agent. How would you have felt if you had to file a claim after an accident? Maybe you’ve experienced it yourself. Do you remember the uncertainty and fear of not knowing what to do? Who do you call? What are the next steps? This is exactly what our clients go through. How often do customers actually “use” our product? This is why customer satisfaction is so crucial during the claims process.
It’s essential to have a clear insurance claim workflow in your agency to ensure every customer is treated consistently and that all agents know what to do when a customer files a claim. Think about your worst customer service experience—none of us want to repeat that. So, how can we make sure our agency excels in handling claims? Just today, I saw an agency post on social media giving customers step-by-step instructions on what to do after filing a claim. A few days later, they shared guidance for handling a home claim as a Category 4 hurricane approached the east coast of Florida, affecting several southeastern states.
Many agencies ask customers to call them when filing a claim, and this is a great option. The goal isn’t to discuss coverage but to guide them through the process. Each state has its own rules, so it’s important to know how your state operates. For example, where I live, it’s an at-fault state, meaning the claim is filed with the at-fault party’s insurance. This can be tricky to explain to customers and takes longer since the at-fault carrier must accept responsibility before covering costs. In states like New York, which are not at-fault states, everyone files a claim with their own insurance, regardless of who was at fault.
Let’s review the ideal insurance claim workflow or claims process.
It’s important to remember that there are many types of insurance, carriers, and claims. Our agency staff needs to be well-versed in the most common types, which are typically auto and home, followed by life and health insurance. Commercial and life insurance claims are more complex and often require additional resources. Health insurance, in particular, tends to fall into a category of its own due to its distinct processes and regulations.
The General Steps for an Insurance Claim Workflow
The insurance claim workflow involves several key steps, ensuring that the claimant is compensated appropriately while adhering to policy guidelines.
Here’s a general overview of the steps:
- Notification of Claim/Claim Filed – This can be with the carrier or with the agent.
Agents need to know how each carrier they write handles claims!!!
- If the call is to an agent, the agent will give client instructions and assist them in filing the claim with the carrier.
- If the customer does not call an agent, agents should be doing proactive outbound claims call lists of anyone who filed a claim with all the carriers the agency writes with.
Claims are excellent touch points with clients. A claim call can help build relationships, find coverage needs, and bring in referrals.
- Claim Acknowledgment by the insurance company acknowledges receipt of the claim and provides the claimant with a claim number for tracking.
- A Claim List should be run daily and the Claim advocate should reach out to everyone who has had an accident/claim. If you do not have a claims advocate, it is a good idea to determine who in your office can make these calls. For the free download of Claim Advocate Job description, click here.
- Follow up – Make sure to make frequent follow ups with the carrier and the customer to make sure the claim is on track and the customer doesn’t have further questions.
- Documentation Request: The insurer requests necessary documentation (e.g., police reports, medical records, photos of damages) and provides instructions on next steps.
- Investigation and Assessment – Behind the scenes the carrier/calis adjuster will look at coverages and investigate and verify details of the claim.
- Settlement and Payment – Payments are typically paid directly to repair shops, restoration companies and the like, but can be reimbursement payments if a customer has any out of pocket expenses. Don’t forget things like lost wages, medical bills (injuries), and diminished value concerns. Some of these need to be handled by lawyers, but staff should know about them. There are companies/Individuals out there that do diminished value evaluations.
You can find our claim process pack here.
Clear, prompt communication can make all the difference in handling claims with clients. All communications with a customer need to be documented, especially about claims.
NOTE: Be very careful about having delicate conversations with the client involving coverage and who is at fault. These conversations can cause Errors and Emissions (E & O) issues for your agency if you are not careful. Pointing the customer to the claims adjuster may be the best answer.
You may notice they do not have the coverage they need, you have to be professional enough and knowledgeable enough to know when the timing is right to have those discussions. Sometimes you may need to pull in leadership or agency owners to help sort things out. If you notice a coverage is missing, check and see when their last review was and if there is any sign of coverage declination forms or discussions in system notes about them declining it. This will help you be better prepared for the call and not caught off guard.
The more thorough and knowledgeable you are in these cases, the better you will be able to control the conversation. Whoever deals with these calls normally, a “Claims Advocate”, needs to have good de-escalation skills, be able to use empathy, and be well versed in coverage explanations. For the free download of Claim Advocate Job description, click here.
Agents and brokers can advocate for clients during the claims process. This makes you become the hero for the client, it helps you retain business and get referrals, so don’t underestimate it.
The value an agent brings with their knowledge in navigating claims efficiently is priceless for the clients.
A Poor Claims Experience Can Also Be a Reason a Customer Leaves, Don’t Let That Happen!
Utilizing Technology for Efficiency
The digital tools that we have at our fingertips that can help us with insurance claim workflow is far better than it used to be. Agents used to have to dig through files and paperwork to get to the information, if they had it at all. But now, you can login to your management system and maybe an external carrier website and you have mostly everything you need. Make sure the Insurance Claims Advocate has all the latest tech tools that will help make their job easier and help them give better answers to the customers.
Automation in the claims process.
You could also set up automation, that when your management system gets the claims lists from the carrier, it sends an automated email to you and to the customer as a follow up. This gets to the customer immediately and gets to you so you can do a follow-up call. Systems today have a wide variety of tech and automation possibilities; we just need to have the skill and ability to use them.
You may not, but I bet you can find an IT person from your management system provider who can assist with this. You can download claims lists from carriers and automate an email—one to the customer and one to the agent—to remind them to call. Things like this have never been easier.
Keep optimizing the processes to meet client expectations.
Explore resources that can help improve this process in your office. It is not one size fits all, and you will have to find what works for your agency and your staff. One of my favorite things to do is to talk through situations and claims with other agents, carriers, and claims adjusters, it is one of the best ways to learn.
When I was an agent, I really enjoyed working with Ken Little as one of my favorite adjusters. He always answered my calls about claims, and we had some great discussions, but then one day, he disappeared.
A couple years later he showed up working at an agency that purchased my agency and it was neat to be able to connect with him again and ask him questions. Shout out to Ken if he is out there…
So, make friends with others who are good at claims and, when in doubt, talk it out with them, which will not only improve your client’s experience but your knowledge of claims and the process.
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