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'It's All About The Claimant Experience'

  • How well does your life insurer manage the claimant experience?
  • How well do they manage the claim process?‚Äč
  • How well are declines as well as acceptances managed?
  • We know life insurers pay, but it is how they manage the process that should count.
  • How do you know? With C-MAP you now know!
  • Not an industry audit - a reinsurer and regulator does that. It's a business analysis tool
  • It's the only true measurement of how insurers are managing claims in the industry.


EXECUTIVE SUMMARY
The Risk Store’s unique Claims Management Analysis Programme – C-MAP for short – is an independently conducted assessment of life risk insurers’ or super funds’ claims departments: the systems and standards governing their service to life insured claimants. All the elements that feed into a great client claims experience should be so much more than just “was the claim paid or not?” And if claimants are telling you that something’s not working, C-MAP will tell you what and why.



THE C-MAP CONCEPT
The aim was to design and deliver a structured and transparent analysis of the claims management operations of participating insurers and super funds, such that a valuable measurement can be made of the true client claims ‘experience’.

The immediate benefits from the programme for insurer or fund participants are: 

Internal benefits

 

  • C-MAP identifies for management, how their current claims management operation is performing against their own internally established benchmarks, policies and procedures (to a greater depth and breadth than the common peer review process can achieve). No industry audit - reinsurer or regulator - does that.
  • It provides management with a proven, robust diagnostic tool to assist in critically and objectively evaluating how well the current claims management process is providing the desired quality of service to claimants.
  • Confirms whether change management, training and resource allocation initiatives are being met or achieving the desired outcomes.
  • Subsequent ‘follow-up’ C-MAP analysis (optional) allows management to accurately track how improvements are being implemented consistently across the claims department.
  • It enhances staff’s ‘best of breed’ mentality and their pride in what they do day-to-day.

External benefits

  • C-MAP and the accompanying score rating are a perfect spring-board to promote claims performance via PR, marketing and sales channels. For example, when an Insurer sales team is pitching to a dealer group to be accepted on an APL, showing that C-MAP has been undertaken with positive results could provide a decisive edge over competitors. 
  • For a Super-Fund it provides a tangible benefit to its members as part of the insurance value proposition.
  • C-MAP sends a clear message to advisers and the IFA market in general that an insurer places the highest level of importance around claims service, offering comfort to those looking to place new business.
  • It provides a solid point of differentiation in a market that generally delivers parity across product and price.

The Risk Store’s long-term goals for the C-MAP programme are: 

  • To facilitate for the life industry a future benchmarking protocol for doing the job it is in business to do – pay claims. 
  • To eventually provide the advising fraternity with as objective a measurement of the client claim experience as possible; this supplements and enhances the traditional product-based selection process with a relevant insurer- based selection process.
  • To generate a common concern for the sustainability of premium, supporting the long- term value of the industry to the economic well-being of the population.

All insurers and funds are invited to participate in C-MAP, for the short-term business improvement benefits as well as the long-term goals. The findings and rating scores are provided confidentially only to the participating insurer or super fund. They may then choose to publish their rating, or not.


THE INDUSTRY UNIQUE C-MAP METHODOLOGY
C-MAP typically takes 150 hours to complete. Some 145 elements of claims management are assessed under the 5 key areas of:

  • Procedures and Operations
  • Internal Controls and Measurement
  • External Relationships and Complaints
  • Communications
  • Knowledge

The information is gained using, variously: 

  • Claimant files
  • Internal documentation and reports
  • Dispute records
  • Documentation supporting human capacity and other sources of information within the claims department
  • Staff interviews will test the application of some processes; the results of those ‘tests’ will be anonymous

Answers & Scoring
Information is sought to enable a series of Yes/No questions to be answered. These answers are then weighted and an overall score applied to the 5 areas. Thus it is more significant to the outcome to have

a procedure or system that is adhered to, than to measure that procedure itself (i.e. what it actually dictates). This is designed to remove judgment on any insurer’s methodologies and to rather emphasise that methodologies do in fact exist and are followed.
In order to measure actual, real claimant experience emanating out of these various existing systems and procedures, assessments are conducted on ‘spot- chosen’ files as well as a range of internal data and some staff interviews. The onsite analysis work occurs over a total of several weeks.

PARTICIPANT REPORT FORMAT
The resulting C-MAP findings and rating scores are compiled into three comprehensive, detailed and objective reports covering all claimant-impacting claims management elements of the business.

  • Scores are converted into ratings for the five key areas i.e. five A, B or C scores and the underlying percentage scores are provided.
  • Then the overall insurer rating of A, B or C, with the underlying percentage score completes the report. (see Mark Of Excellence below)
  • The client insurer or fund is the only party that will receive all the results. Once a ‘core’ number of insurers or funds has been analysed then industry benchmarks will be developed. From that point all analysis results and published ratings will be set against the benchmarks which will themselves be reviewed each time all participating insurers have gone through a C-MAP ‘cycle’.

 
THE MARK OF EXCELLENCE
We appreciate our C-MAP clients will want to promote they participated in this rigorous analysis of their claims management process and especially celebrate if they received an 'A' rating as well as an additional 'Star' rating for innovation in claims. So we created the C-MAP 'MARK OF EXCELLENCE' symbol so the participating company can clearly be identified as having successfully completed and rated - this provides confidence for intermediaries such as advisers, their dealer groups and consumers (clients, fund members) alike. The Mark Of Excellence is only awarded if an 'A rating is achieved. The 'Star' symbol can be incorporated if a meaningful innovation is related to improving the claimant experience. As part of the package, we provide you with the symbol in all major graphic file formats and a graphic style guide that your marketing team would understand and appreciate. The Mark Of Excellence has a 2 year shelf life. This indicates a fresh C-MAP analysis two years on should be conducted to ensure standards are maintained.

  

Mark of Excellence graphicGuidelines Image

 

WE GUARANTEE
No information is provided to any party other than the client insurer or client fund and if appropriate and agreed, participating research houses at a later date. 

WHO CONDUCTS IT?
The analysis will be conducted by Sue Laing and a selection of trained, accredited C-MAP consultants, we can call upon, all supervised by Sue throughout the process. Sue will present the results personally. Sue has extensive experience over 40 years across most areas of the life insurance industry from underwriting and claims, to product development, sales & distribution, dealer group management and product research, as well as founding the risk store and designing C-MAP. 

CONFIDENTIALITY
Participants enter into a basic written agreement with the risk store reflecting the terms and conditions of C-MAP including all issues of client confidentiality and protection of IP. The Risk Store including all employees and contractors will not publish results without the written consent of the participant. No ongoing commitment is required unless indicated by the client as being desirable.

TIMING
The programme can be expected to take a total of approximately 150 hours, consisting of:

  • 15 hours preparatory work with the business, including a full team briefing
  • 120 hours of analysis and
  • 15 hours of report and delivery work.

Contracted dates are set and agreed on payment of the deposit fee.

NEXT STEPS
To enquire further about this unique methodology and the outcomes you can expect for your business, please contact either Pete Wincott or Sue Laing at The Risk Store on the number below or by email. We would conduct an initial telephone conversation then progress to either a face-to-face meeting or online virtual meeting. You would be under no obligation to proceed until you are comfortable with the process and a confidentiality agreement is signed. This initial contact would also be strictly held in confidence.

 

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CONTACT US TO DISCUSS YOUR NEEDS - NO OBLIGATION
Email us a note using this contact form link

or

Call Pete Wincott on 02 4998 6977 | 0416 009 403 or Sue Laing on 02 4998 6977 | 0412 265 822

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