Claims in the digital

age: How insurers can

get started
Attackers are transforming the competitive landscape and elevating
customer expectations, so insurance companies must integrate
digital technologies into their operations to keep pace. Claims should
be a top priority.

Pia Brüggemann
Tanguy Catlin
Jonas Chinczewski
Johannes-Tobias Lorenz
Samantha Prymaka

Insurance Practice April 2018

 The insurance industry is in the midst of a radical, digitally infused shake-up. Customers are
embracing digital channels, and technologies such as the connected car, smart home solutions,
and artificial intelligence (AI) have ushered in an era of new products built on data and analytics.
Attackers—insurers with pure-play digital business models, such as Lemonade in the United States,
Youse in Latin America, or Nexible in Europe—are using digital applications such as chatbots to
turn the process of buying a policy or filing a claim into a fast, simple, and satisfying experience.
This approach is a far cry from the analog, and often frustrating, processes of traditional insurers.

With new attackers on the hunt for customers, incumbents must move quickly to integrate digital
technologies into their operations. For the property and casualty (P&C) industry, digitizing the
claims function holds tremendous potential. To capture the value of digital,1 P&C claims functions
must embark on a transformation to become a customer-centric, digitally enabled organization that
excels in the three foundational areas of claims—customer experience, efficiency, and effectiveness.
In our experience, a digital claims function can boost performance on all three KPIs and generate
significant value (Exhibit 1).

1 In this article, digital refers to an organization’s efforts to use technology to digitize customer journeys and

interfaces as well as automate back-end processes.

Exhibit 1 Digital claims transformations—impact along claim’s foundational KPIs

Customer experience Efficiency

Increase customer Reduce claims expenses by
satisfaction score by
25–30%
~20%points

Effectiveness
Improve claims handling
accuracy2

Improved employee and intermediary satisfaction

2 Improving accuracy aims at reducing both overpayments and underpayments of indemnity obligations. Next to

reducing overpayments, also reducing underpayments can lead to an overall reduction of loss costs through
reduced processing times, higher customer satisfaction, and lower incidence of claim disputes and litigation.

2
 So where to start? A true digital redesign of claims integrates a relentless focus on the customer
with a value-driven approach. Insurers should adopt a customer-centric mind-set and undertake an
end-to-end reassessment of their customer interactions—starting with the most relevant customer
journeys (see sidebar “The claims customer journey”). For maximum impact, claims functions
should develop a digital value proposition and an aspirational future state for a digital claims
function first and then prioritize into a transformation road map. This article examines the five
essential elements needed to digitize and transform claims.

Elements of a successful digital claims transformation

In our experience, successful digital transformations in claims begin with developing a new
value proposition that sets a high-level aspiration and pursuing an end-to-end digitization of the
claims customer journey.3 The development of a truly innovative customer journey can be achieved
by integrating with three other areas—AI and digital technologies, the digital integration of the
claims ecosystem, and a new digital operating model (Exhibit 2). Together, these five elements give

3 Tanguy Catlin, Johannes-Tobias Lorenz, Bob Sternfels, and Paul Willmott, “A roadmap for a digital transformation,”

March 2017, McKinsey.com.

The claims customer journey

As companies have attempted to understand the process flow from the customer perspective
the succession of customer interactions across and applying technology to facilitate each step in
traditional and digital channels, the concept of the the back-end of the customer journey. In this way,
customer journey has gained more prominence.1 insurers can be more responsive to customer
Customer journeys comprise a succession requests, automate low-value transactions, and
of touch points and are typically defined by expedite the claims process. Throughout this
a specific customer objective. Examining article, we will revisit this customer journey to
interactions with customers as part of a journey demonstrate how the enabling elements support
rather than a series of individual touch points it at each step.
allows insurers to better understand how different
parts of the organization must work together to 1 Nicolas Maechler, Kevin Neher, and Robert Park,
provide a seamless experience. “From touch points to journeys: Seeing the world as
customers do,” March 2016, McKinsey.com.
In the insurance industry, discrete customer
journeys can be triggered, for example, by the
need to buy a policy, change an address, or
submit and resolve a claim. For submitting and
resolving a claim, the journey starts even before
the claim is submitted, as an insurer can take
steps to prevent an accident or damage. When a
customer does submit a claim, the first notification
of loss (FNOL) initiates the claims process, which Watch the video feature,
further consists of claims management, loss “What is customer journey?,”
assessment and repair, and claims settlement. on mckinsey.com.
Digitizing the claims process involves redesigning

3
 Exhibit 2 Elements of a successful digital claims transformation

New digital value proposition

• Customer experience excellence

• Analytics-driven claims handling and automation

• Claims prevention services

• Value-added services

• Continuous improvement from customer feedback

End-to-end digitization of the customer journey

Digital claims Digital first Automated Digital Automated

prevention notification of claims loss assessment settlement
loss (FNOL) management and repair

A
B

AI

Artificial Digital New

intelligence and digital claims ecosystem digital operating
technologies integration model

4
 management the strategy and tools to both transform claims into a digital function and improve
performance on all of the three foundational KPIs.

New digital value proposition for claims

For the digital age, the claims value proposition—that is, the value an insurer can provide to its
customers through the claims process—needs to go beyond traditional after-the-fact claims
management. The value proposition sets the aspirational goal of offering excellent omnichannel
customer experience supported by intuitive digital processes.4 Insurers should aim to adopt a faster,
analytics-driven approach to claims handling and fully automate the claims handling processes for
clear and simple cases. For example, Lemonade has worked to redefine the customer experience
with an innovative, chatbot-based FNOL system that creates automated claims payouts within
seconds.5 In addition to working actively with customers to prevent claims, insurers should provide
services that add value for and delight customers and draw on customer feedback to continually
improve service offerings, usability, and performance.

Instilling this upgraded value proposition within the organization is an often-underestimated

element of a digital transformation. Top and middle management in claims should become
champions for the new value proposition; otherwise, they risk finding themselves halfway through
the digital transformation without the necessary company-wide buy-in to stay the course.

End-to-end digitization of the claims customer journey

At the core of the claim function’s digital transformation is a redesign of the claims customer journey.
There is no silver bullet interaction that ensures customer satisfaction, but a successful redesign
typically involves considering processes from the customer perspective and optimizing back-office
processes accordingly to provide simple and fast claims services.

Insurers should start with an “everything is possible” mind-set to unleash truly transformative
ideas. Satisfaction surveys in claims consistently show that customers desire a fast and intuitive
process as well as transparency on where they are in the process and what happens next.
Accordingly, the digital redesign of a claims journey needs to go much deeper than superficial
process improvements. Adeslas, a Spanish company, has worked to complete an end-to-end
digitization of their claims journey, implementing features such as multichannel FNOL, automated
claims segmentation, and digital claims status tracking.

To determine how digital technologies can unlock value and improve the claims customer journey
from start to finish, managers should examine each step of the journey with the following areas in
mind and start to develop an aspirational future state for claims that is unconstrained by potential
short-term, technological barriers:

Product simplification
Customers want simple and fast digital interactions, but complex coverage details that include many
specific exceptions can create barriers. Large numbers of legacy products with different coverage

4 Ido Segev and Amy Vickers, “What the new world of insurance could look like,” August 2017, McKinsey.com.
5 Paul Sawers, “Lemonade raises $120 million from SoftBank, others to take its chatbot-based insurance service

global,” VentureBeat, December 19, 2017, venturebeat.com.

5
 Insurers have the opportunity to shift simple, routine
transactions from claims handlers to intermediaries, such
as agents and brokers, or customers themselves.

details also make it difficult to implement and maintain the technology systems necessary to improve
efficiency. A carrier should find ways to simplify products and reduce product generations to ease the
development of fully digital customer journeys.

Customer and intermediary self-service

Insurers have the opportunity to shift simple, routine transactions from claims handlers to
intermediaries, such as agents and brokers, or customers themselves. Examples include an intuitive
online tool for FNOL and an online self-scheduling tool for claims adjuster appointments. As with
any self-service tool, insurers must precisely define the necessary information, for example, where
the customer can find his or her policy number. They must also build in support in case customers
need it, such as online-chat with a claims handler or easy-to-find FAQs. Further, seamless
handoffs across channels are critical: customers who start their journey online but want to talk to
a claims handler or agent halfway through should be able to do so without having to repeat steps or
information. This functionality requires that all system interfaces follow an identical structure and
logic.

Intelligent case management

After FNOL and throughout the process, handlers typically evaluate claims cases manually to decide
on appropriate next steps, such as scheduling an adjuster appointment or providing information
about direct repair programs with local repair shops. Supporting the entire journey with automated,
intelligent case management is critical to establishing truly end-to-end digital customer journeys.
With the help of AI, a digital evaluation automatically identifies the best next step in a specific
customer journey, reduces manual touch points, and significantly speeds up the claims process. For
example, in a simple claim, this technology can allow a customer to schedule an appointment with a
repair shop as part of the FNOL. Enriching these journeys with insights from behavioral economics
can help customers to follow the most satisfying and efficient paths in their claims journeys.

Frontline and back-office process digitization

Claims handlers and adjusters manually carry out often-complex tasks, leading to significantly
divergent results. Digital tools and systems can simplify and standardize manual processes. For
example, tablet-based calculation tools for home damages can help claims adjusters estimate the
value of losses faster and more accurately and consistently – even if this means that indemnity
payments may increase for certain cases. Standardized reports and calculation methods will leave
customers with a comprehensive overview of how their claim was calculated. This results in higher
customer satisfaction and a leaner process with reduced follow-ups and recalculations or litigation.

6
 Back-office automation
Insurers can achieve the greatest efficiency gains by fully automating back-office processes.6
Customers benefit significantly from faster claims processing—for instance, through automated
verification of car repair estimates and invoices as well as automatic reimbursements as soon as the
repair invoice has been verified. In addition, digital tools can support and assist the decisions of claims
handlers, leading to better outcomes.

Communication
Providing customers with the necessary information in digital channels offers customers the sense of
control they desire. The quality of communication can raise customer awareness and usage of digital
self-service tools throughout their journey. One US insurer, for example, implemented a digital case-
tracking tool and reduced the number of status request calls by more than 50 percent.

By examining each of these areas, claims functions can start to rethink the claims customer journey
and back-office processes.7 This approach should be synthesized into an aspirational future state
outlining the digital assets needed to achieve the ideal state (Exhibit 3, on pages 8–10). Claims leaders
should prioritize these digital assets based on the value they can generate. For example, digitizing
invoice reviews and automating payment processing for clear and simple cases often significantly
reduces processing time.

Enabling truly innovative customer journeys

Offering truly innovative customer journeys requires a combination of AI and upgrades to technology
platforms as well as the digital integration of partners in the claims industry ecosystem. A greater
understanding of these elements and the digital operating model needed to bring them to life can help
claims managers make the proper investments.

AI and digital technologies

Digital customer journeys require not only the AI-enabled automation of decisions traditionally
made by claims handlers but also an IT architecture that supports real-time digital interactions
with customers (see sidebar “Defining AI,” on page 11).8 While AI should ideally support the entire
customer journey, it can generate significant value by automating claims management. Ageas UK, for
instance, is working with Tractable to integrate the latest AI and picture recognition applications
to segment claims cases in real time.9 The following three modules lay the basis for real-time
engagement:

Prediction of claims characteristics

AI can help infer as-yet-unknown characteristics of a claim, such as the likelihood of fraud, total
loss, or litigation, to speed up its downstream handling. An European insurance carrier, for example,

6 Sanjay Kaniyar, Chandresh Kothari, and Brandy Smith, “Automation at scale is driving transformative change across

insurance,” June 2017, McKinsey.com.

7 Johannes-Tobias Lorenz, Christopher Morrison, Pradip Patiath, and Ido Segev, “Capturing value from the core,”

March 2017, McKinsey.com.

8 Federico Berruti, Graeme Nixon, Giambattista Taglioni, and Rob Whiteman, “Intelligent process automation: The

engine at the core of the next-generation operating model,” March 2017, McKinsey.com.
9 “UK insurer Ageas uses artificial intelligence to manage motor claims,” Insurance Journal, May 19, 2017,

insurancejournal.com.

7
 Exhibit 3 Key digital assets along the claims customer journey (1/3)

Julia_58 years old

A rock cracked her car’s windshield.

Julia notifies her After FNOL, Julia

Julia does not have
Julia receives a insurer about the is directly offered
to worry about any
push message— glass damage via While in FNOL, to select a repair
bills. Her insurer
“how to prevent a simple, intuitive Julia’s claim is appointment with
digitally receives the
glass damage online notification analyzed and fraud a nearby repair
repair invoice, which
during winter on her phone. checked in real time shop. Julia’s car
is automatically
months.” and classified as a is picked up at her
checked and paid.
simple claim. office for repair.

Digital claims Digital first Automated Digital Automated

prevention notification of claims loss assessment settlement
loss (FNOL) management and repair

A
B

Relevant digital assets per customer journey Digital assets for customer journey above

IoT-based driving Automated FNOL, Automated, Digital, self- Digital offering of

behavior coaching eg, via telematics intelligent case service damage cash settlement
management assessment
Push notifications Intuitive, digital Digital offering of
with safety warnings FNOL for customers Automated fraud Digital, appraiser- replacement of
detection appointment damaged items
Simple, digital FNOL selection
for intermediaries Digital, real-time Automated
progress tracking Digital, repair invoice verification
shop-appointment
selection Automated
payment
processing

8
Exhibit 3 Key digital assets along the claims customer journey (2/3)

Scott_39 years old

Parking his car, Scott hit his garage wall.

Scott receives a
message from
his insurance carrier
to upload photos of
the damage via an
Scott’s car attached web
automatically app link. Now he is offered a
Scott’s claim is
notifies all relevant cash settlement via
Scott’s smartphone analyzed, fraud- Scott’s damage has
details to his insurer. a push message.
reminds him to checked, and been automatically
keep track of speed identified as only a calculated based on Scott accepts and
limits. minor damage claim. his photos. within minutes
receives the money
in his PayPal
account.

Digital claims Digital first Automated Digital Automated

prevention notification of claims loss assessment settlement
loss (FNOL) management and repair

A
B

Relevant digital assets per customer journey Digital assets for customer journey above

IoT-based driving Automated FNOL, Automated, Digital, self- Digital offering of

behavior coaching eg, via telematics intelligent case service damage cash settlement
management assessment
Push notifications Intuitive, digital Digital offering of
with safety warnings FNOL for customers Automated fraud Digital, appraiser- replacement of
detection appointment damaged items
Simple, digital FNOL selection
for intermediaries Digital, real-time Automated
progress tracking Digital, repair invoice verification
shop-appointment
selection Automated
payment
processing

9
 Exhibit 3 Key digital assets along the claims customer journey (3/3)

Betty_24 years old

A lightning strike in Betty’s neighborhood caused her WLAN router to fail.

A few days later,

Betty receives a
Betty submits new WLAN router
her claim via a Right after FNOL, via mail.
simple, intuitive Betty enters the
Betty gets a push For Betty, her
Betty’s claim is brand and type of
message warning online notification
analyzed, fraud- WLAN router she claim is resolved.
her about an on her tablet.
checked, and has by taking a She does not need
upcoming lightning to worry about
identified as a direct photo of the router’s
storm. any invoices or
replacement claim nameplate.
in real time. payments.

Digital claims Digital first Automated Digital Automated

prevention notification of claims loss assessment settlement
loss (FNOL) management and repair

A
B

Relevant digital assets per customer journey Digital assets for customer journey above

IoT-based driving Automated FNOL, Automated, Digital, self- Digital offering of

behavior coaching eg, via telematics intelligent case service damage cash settlement
management assessment
Push notifications Intuitive, digital Digital offering of
with safety warnings FNOL for customers Automated fraud Digital, appraiser- replacement of
detection appointment damaged items
Simple, digital FNOL selection
for intermediaries Digital, real-time Automated
progress tracking Digital, repair invoice verification
shop-appointment
selection Automated
payment
processing

10
 significantly improved its fraud detection accuracy implementing an AI-based fraud detection
system resulting in an 18% increase in fraud prevention as well as productivity gains in fraud
investigation. And leading players in automotive can estimate a vehicle’s damage value in real time
at FNOL based on customer pictures or a damage description, using the latest advances in AI and
picture recognition.

Claims segmentation
AI algorithms can help segment claims cases by complexity using factual and predicted claims
characteristics. Based on this segmentation, claims can be assigned to specific downstream
handling processes—either one of the fully digital self-service journeys (such as selecting a direct
repair shop in self-service) or a claims handler for more complex cases (for example, with high
litigation risk).

Supported claims handling

Going beyond the first two modules, AI can support in finding the optimal claims handling
process for a specific claim: A global insurance carrier, for example, leveraged AI to derive
business rules to identify clear and simple claims cases suitable for an automated process. An
Italian insurance carrier is even going further and developed a “best-match” routing approach to

Defining AI
Artificial Intelligence—that is, intelligence exhibited
by machines—is brought one step closer by recent
advances in algorithms (for example, machine
and deep learning).1 Still, the now-evolving AIs are
exclusively “applied AIs.” In contrast to generalized
AI, they are highly specialized on certain tasks and
can learn and operate only within this predefined
area. Applied AI is also often referred to as advanced Watch the video feature, “What’s
analytics. driving today’s progress in AI?,” on
mckinsey.com.
Possible applications for applied AI range from
uncovering hidden patterns from structured data (for This video is one in a five-part
example, the claims database) to harnessing image Ask the AI Experts series that
recognition (for example, Tractable’s picture-based answers top-of-mind questions
claims segmentation) or natural language processing about the technology.
(such as Amazon Alexa or Rasa’s enterprise AI
platform for chatbots).2

1 Gaurav Batra, Andrea Queirolo, and Nick Santhanam,

“Artificial intelligence: The time to act is now,” January 2018,
McKinsey.com.
2 Michael Chui, James Manyika, and Mehdi Miremadi,
“What AI can and can’t do (yet) for your business,” January
2018, McKinsey.com.

11
 Exhibit 4 Artificial-intelligence modules to support a digital customer journey

End-to-end digitization of the customer journey

Digital claims Digital first Automated Digital Automated

prevention notification of claims loss assessment settlement
loss (FNOL) management and repair

A
B

AI

+ + + + +
Analysis of IoT Claims event Real-time Automated Real-time
sensor data to prediction based prediction of damage-value invoice analysis
identify high-risk on IoT sensor data claims estimation based for correction
situations (eg, characteristics on picture recog- potential based
safest route or Biometric custo- nition or sensor on past invoices
parking space mer authentication Real-time data in combina- and spare-parts
prediction) segmentation tion with invoice catalogs
Chatbot-based of claims by data
FNOL and digital complexity Subrogation
point of contact Claims assessor and salvage
Supported route optimization opportunity
Processing time claims-handling identification
prediction for optimal case
management

find the best-experienced claims handler for a specific case and this way significantly improves its
claims handling accuracy. (Exhibit 4).10

Integrating real-time customer interactions and insights from AI modules into customer journeys
poses vastly different requirements for the IT architecture.11 While in the past, online interactions
with the customer were only one way (for example, saving the details of an online FNOL into the
claims database), interactive digital customer journeys require real-time, bidirectional interactions.
A new IT architecture concept—generally referred to as two-speed architecture—is required to
complement the stability of the core claims database with responsive features on the front end. A
middle layer connects the traditional, slow claims database with customer-facing interfaces and

10This was achieved by reducing both overpayments and underpayments of indemnity obligations.
11K rish Krishnakanthan, Jens Lansing, Markus Löffler, and Björn Münstermann, “Modernizing IT for a strategic role,”

12
March 2017, McKinsey.com.
 runs AI modules. This functionality connects the information a user submits with insights from AI
in real time to populate online forms and offer direct feedback to the customer.

Digital integration of the claims ecosystem

For competitive differentiation and ownership of the customer in a claims case, insurance carriers
need to proactively manage more (ideally all) processes related to a customer’s claim—also those
involving third parties. For example, the German claims solution provider Control€xpert digitally
integrates with insurance carriers and repair shops to automate its invoice-verification process. Other
providers offer appointment scheduling with repair shops and rental car companies. By providing a
fully integrated digital experience, claims functions can become the true and sole owners of customer
contact in a claims case.

To combine such offers into efficient, digital, self-service journeys, insurance carriers need to digitally
integrate with relevant players in the larger claims ecosystem (Exhibit 5). In addition, a digital
integration can vastly improve efficiency in communication between the ecosystem parties and speed
the claims processing for the customer. As this type of digital integration is currently rare, a carrier can
become the ecosystem integrator, harnessing the best of the ecosystem for its customers.

Given the complexity of this integration, carriers should prioritize pursuing digital interfaces with
the players that are involved in a high number of claims cases. In auto insurance, for example, these
players would be roadside assistance services, claims assessors, and repair-shop networks, as well as
invoice control service providers. Insurers don’t need to start from zero. In many markets, insurtechs
have started to lead the digital integration,12 for example, by digitally connecting car repair shops and
enabling digital cost-estimate and invoice transmission. Insurers should explore partnerships with
existing offerings to further digitize and integrate the claims ecosystem.

New operating model for the digital age

A successful digital transformation radically reinvents the claims customer journey with the help of
AI, digital technologies, and the claims ecosystem. To support these efforts, the claims department
needs to pursue deep, cross-functional collaboration with other functions such as marketing and IT.
Bringing the transformation to life requires new roles, including data scientists, customer journey
“owners,” and user experience designers, as well as a digital way of working, which must be instilled in
the organization. This approach involves learning by doing, which takes time to implement but can be
jump-started in the following ways:

ƒƒ The digitization of each customer journey should start with a short design phase. Ideally, design
thinking techniques are used to iteratively develop the best possible end-to-end customer journey.
This process directly integrates consumer feedback on ideas and concepts.

ƒƒ Successful players quickly move from the drawing board to prototype development. Progress
is best made with agile development methods, such as creating and improving a minimal viable
product in ten-day intervals and then quickly evolving the prototype. Early customer testing and
the resulting feedback are continually incorporated into the development of digital channels and
solutions to ensure the customer’s experience of the evolving digital claims journey continually
surpasses expectation.

12Tanguy Catlin, Johannes-Tobias Lorenz, Björn Münstermann, Braad Olesen, and Valentino Ricciardi, “Insurtech—

the threat that inspires,” March 2017, McKinsey.com. 13

 Exhibit 5 Digital integration of key players within claims ecosystem—
example auto claims

Digitally integrate via common ecosystem platform

Connect to ecosystem platform
Institutionalize dialogue and adapt existing technologies

Claims

Invoice-verification service provider(s)

Claims assessors
Direct repair-shop network
Roadside assistance service providers
Rental-car companies
Third-party and OEM repair shops
Law firms
Police and courts
Weather-information providers
Insurtech claims solution providers
Internet of Things solution providers and aggregators
Artificial-intelligence solution providers

14
 As this new approach can represent a substantial change, success depends on deeply integrating a
digital way of working into the entire organization.13 For example, Allianz’s Global Digital Factory
launched a digital delivery hub to achieve change through digital projects, such as developing claims
solutions, across its international operations. Successful organizations tap joint cross-functional
management teams to lead the effort, develop experts in all digital methods, and provide intensive
coaching for all relevant employees.

Purely digital industry attackers have raised the bar for performance by showcasing simple and
intuitive customer interfaces, making it imperative for incumbent carriers to radically redesign
their claims customer journeys. Those insurers that move swiftly and decisively to transform the
claims function can equip themselves to deliver against the new, higher customer expectations –
while increasing efficiency and improving claims handling accuracy in the process.

13Tanguy Catlin and Julie Goran, “Building momentum for cultural change,” March 2017, McKinsey.com.

Pia Brüggemann is an associate partner in McKinsey’s Düsseldorf office, where Johannes-

Tobias Lorenz is a senior partner; Tanguy Catlin is a senior partner in the Boston office; Jonas
Chinczewski is a consultant in the Hamburg office; and Samantha Prymaka is an associate
principal in the Vienna office.

15
Contact:
For information about this article and McKinsey’s Insurance Practice, please contact:

João Bueno, Partner, Sao Paulo

Joao_Bueno@mckinsey.com

Tanguy Catlin, Senior Partner, Boston

Tanguy_Catlin@mckinsey.com

Omar Costa, Senior Partner, Warsaw

Omar_Costa@mckinsey.com

Johannes-Tobias Lorenz, Senior Partner, Düsseldorf

Johannes-Tobias_Lorenz@mckinsey.com

Brad Mendelson, Senior Partner, Hong Kong

Brad_Mendelson@mckinsey.com

Further insights:
McKinsey’s Insurance Practice publishes on issues of interest to industry executives. Our recent articles include:

A roadmap for a digital Modernizing IT for a Capturing value from Intelligent process
transformation strategic role the core automation: The engine
at the core of the next
generation operating model

Additional insights can be discovered on digitalinsurance.mckinsey.com

April 2018
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