Beyond the integration buzz | BenefitsPRO

If “complaint integration” was a topic on social media, it would be “trendy” right now.

Integration is becoming more commonplace and creating a lot of buzz in claims practices these days. According to a recent study by Eastbridge Consulting Group, the majority of insurers offer some type of claims integration service between medical, traditional group and voluntary product lines. In fact, claims integration is quickly becoming an expectation rather than a “nice to have” service. Carriers we interviewed say it’s important to have claims integration capabilities now, and even more so in the near future.

Related: 6 Ways to Encourage Greater Participation in Voluntary Benefits

Nick Rockwell, Eastbridge Consulting Group, Inc.

But integration is far from the only, if not the most important, capability you should look for in the carriers you partner with. Stop with the hot topic of the day and you could deprive your customers and their employees of services essential to a great customer experience. It is important to look for “employee-centric” insurers, as the claims experience of a single employee could dictate the future of the entire case.

Thumbs up: deposit methods and turnaround times

Making it easy to submit a complaint and resolving complaints quickly are two of the most important elements of great customer service. And carriers report fairly high standards for claim filing options and payment times. This means you and your customers can expect consistent thresholds and options across the industry.

All of the carriers we interviewed offer multiple ways to file a voluntary claim. Paper and fax are universal methods, but most also offer online, email, and phone quotes. Unlike other financial services industries, mobile apps for submitting claims in the voluntary space are still rare, but likely to grow. If your client has a large percentage of younger or remote employees, this option could be important to them.

In other good news, most carriers consistently pay claims quickly, resolving at least 80% of claims within 10 days. Of course, this can vary by product (critical illness claims can be more complicated) and how complete the information is when first submitted. About half of insurers automatically adjudicate at least some claims, particularly claims related to wellness, dental and vision.

Points of friction: communication and follow-up

The areas with the greatest disparity between carriers – and possibly between carrier and customer expectations – relate to communication and complaint tracking. These areas are also the most likely to trigger issues in your accounts, causing unnecessary questions from employees that end up landing on your plate and negatively affecting customer satisfaction. This means it’s important for you to ask questions and understand the capabilities of your carrier partners.

Notify employees of receipt of claim — Paper mail is a carrier’s method of choice for notifying employees that they have received their claim. Carriers say they usually send these letters in five days or less, but it can take up to 10 days. Some carriers also use email notification for online submissions and phone calls or text messages, either automatically or within 24 hours, and several carriers send multiple communications, such as an email or phone call followed by a letter sent by post. However, these processes may vary by product. For example, most insurers acknowledge receipt of dental claims only through the explanation of benefits they send once the claim is resolved. Insurers are more likely to use phone notifications for life insurance and disability claims.

Follow-up of complaints for employees — Almost all of the carriers surveyed offer multiple ways to track claims, such as toll-free numbers and online portals. But only half offer email tracking and only a handful have a mobile app, and some carriers offer complaint tracking only for certain products or product platforms. Most of these methods are not proactive and require the employee to initiate the process.

Claims tracking for you and your customers — About two-thirds of carriers allow brokers, employers, or both to track the status of an employee’s claim, but they generally only provide high-level information such as receipt of claim, status in waiting and whether it has been paid or refused. Additionally, some carriers do not allow employers or brokers to track employee claims information, and some only allow access if employees give them permission. A lack of status updates obviously makes it difficult for you to respond appropriately to your customers’ questions.

Telephone call response times — Not all carriers can provide data on their call response times, but those who can report 82% get a response in a minute or less. However, it is less clear whether these calls are effective. Less than half of operators are able to report the percentage of calls resolved after the first call. Having to make multiple calls for the same issue reduces customer satisfaction.

Stay focused on the essentials

Our research shows that carriers are very aware of the importance of these issues. They say the main concerns they will face in the future stem from increased customer expectations for faster turnaround times as well as easy-to-use, technology-driven customer service capabilities. In response, they are looking at ways to streamline the claims process to make it easier for claimants, increase digital communication capabilities to meet customer preferences and shorten response times, and develop a easy-to-navigate claim and a consistent experience for customers. with any product.

And while carriers also say they prioritize claims onboarding, it’s important that you stay focused on the basics and the big picture of claims and customer service. Understanding the level of communication you, your clients and their employees will encounter is a key factor in the overall longevity of your records.

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