FE: What are the most difficult aspects of dealing with insurance claims?
Mr. Ayik: Insurance claims handling requires a specific level of technical knowledge about the nature of claims. It also involves a strong understanding of client perspective and empathy. And finally, one must have the ability to perform the necessary organization to effectively manage the entire process. Critical success factors for dealing with insurance claims are: open and effective communication; transparency and information services; and effective operational processes and speed. Maintaining an optimal balance between customer satisfaction and cost effectiveness is a key area that insurers should handle competently.
FE: What is the most ridiculous fraud attempt you have encountered while working in the claims environment?
Mr. Ayik: There are several categories of fraud attempts that are encountered on a daily basis. They vary from simple individual cases of fraud to large attempts by organized crime in which many actors constituting a large group of people are involved. The Turkish market is characterized by high fraud rates, especially in the non-life branch (especially in motor). To some extent, there is an interesting rationalization tendency of many people not to see insurance fraud as a crime. There are tens of fraud types in motor claims which I could choose from, but I’d rather talk about a funny health insurance fraud attempt.
Once, one health insurance policyholder went to a hospital with his girlfriend in order to get an abortion under his wife’s policy coverage. Then, as it turned out that there was no coverage for abortion, the operation was denied. After a while, his wife contacted the hospital for an operation and was informed about the previous incident during the provisional phone conversation. This must be the best lesson on how love affairs should not be mixed with fraud attempts.
FE: Can you share some interesting case study you have come across or a case you have struggled with personally in your professional environment?
Mr. Ayik: The Insurance Association of Turkey provides data for all accidents, including the parties involved in the accident. The data set includes identity information about the parties involved in the accident – both the insured and the driver. We have used the data in various analyses. One of the goals of the analyses is to find which insured cars are driven by multiple drivers, which is a strong indicator for the probability of insured cars being used commercially. Commercial use can be in the form of operational or daily base rental - rental policies are three times more expensive than usual single use policies on average. We found out that thousands of insured cars driven by multiple drivers (more than 10) had not been properly amended. This information and a full list of improperly amended policies were sent to underwriting units to be surcharged with additional premiums. This is a very good example of collaboration between claims and underwriting units.
FE: What are the latest innovations you have implemented in your business and how have they worked for your company?
Mr. Ayik: We have implemented an iPad application by which claim adjusters can go through the evaluation process for a damaged vehicle and provide instant approval for payment at the repair site. This method has accelerated the delivery of repaired vehicles and total claim settlement periods. We have formed a wide database of claims both from internal and external resources. This has allowed us to form a sound base for statistical analysis and modeling. Using the appropriate models, we are planning to score every claim notification received and achieve better fraud scoring.
FE: What do you enjoy most about your job?Mr. Ayik: As insurers and especially as claims managers, we are working in a very dynamic environment. Every day there are new challenges waiting for us and it is definitely not a place to get bored. With the responsibility for fraud and claims data analytics, there is the constant opportunity to directly influence branch profitability both by increasing operational efficiency and fighting fraud. Maybe the most favorable part of working on claims is having the feeling of being part of a process that helps people ease their emotional and financial burdens right at the times in their lives when it is needed the most.
FE: On a scale of 1 to 10, how important is customer experience and feedback for you? What measures is your company taking to meet customer expectations?
Mr. Ayik: Customer feedback is a definite 10 in terms of significance to long-term success. Customer experience – both positive and negative – plays a key role in consumer buying behavior. It is crucial for insurance companies to understand these buying decisions and factors affecting this process. Customer feedback can be obtained through two different approaches. The first one involves responding to the client requests and complaints received. The other one entails actively seeking feedback about the quality and level of services provided by the company. The first approach is essential, but not complete; it will probably not cover all the customer reactions and perceptions in the market. In our company (Anadolu Sigorta, Turkey), client complaints or requests received from various sources (web, telephone, social media) are collected in one single platform under the supervision of the CRM department. Then each specific request or complaint is promptly resolved by the responsible unit in a customer satisfaction-based manner. There are two goals here: One is to understand whether a complaint has originated from an internal source or process which has not been adequately managed or interpreted and to take immediate corrective measures to decrease customer churn rate. The second goal is to derive lessons out of complaints and re-organize in areas that have high complaint levels and negative feedback. Customer complaints are seen as a free consultancy service offered to us by our clients. In addition to complaint management, customer feedback is gathered through surveys conducted by independent research companies. The surveys are focused on two major objectives. One of them is to assess the quality of the claims process from the notification to the claim settlement stage. As this long process involves multiple sub-services (notification, towing, substitute car, claim adjusting, repair, payment) involving many parties, including third party suppliers, the survey should be comprehensive enough to address the possible failures in service quality for all critical functions. These satisfaction levels for various services should be compared with SLAs and the previous historical results and improvement should be monitored and ensured.