TAI REINSURANCE SOFTWARE BLOG
Stay connected to the people and software at TAI

5 Phases of Moving Claims Through to Completion

April 5, 2017 / Reinsurance, Claims

pay claims under 90 days banner.png

The first part of this series explained the importance of moving a claim through to completion within a 90-day period. To help you strive for this, I shared barriers that could prevent it from happening and key components to aid the process. To recap, the three components are:

  1. Streamline your process for submitting claims
  2. Identify & address any retention/ceding issues as soon as possible
  3. Initiate dialogue between the ceding assumed entities on any discrepancies or concerns early in the process

The first component, streamlining your process for claims submission, can be accomplished by using electronic reinsurance claims. The second and third components can be accomplished by developing a consistent stream of communication with your business partners. Throughout my experience, I've found the following five phases can contribute to strong communication, resulting in timely payments under 90 days. 

1.When the insured dies

  • Notify reinsurer of pending death (you can do this via TAIB300 Claims Program). 
  • Review the retention on the policy and confirm policy was ceded correctly- this is quick for most but if there is a potential problem it can take a while to sort out

2. When the direct side pays out the claim

  • Send the bill to the reinsurer for their contractual portion (again, if you are using TAI, this can be done within the software)
  • Send copies of applicable claims proofs (as required)

pay claims under 90 days image.png


3. Claim review period

  • Give the reinsurer about 40 – 45 days to review and pay the claim - most claims are paid in this window

4. Initial Follow Up

  • If no dialogue or payment is received within 40-45 days, send an initial follow-up asking when funds can be expected or what additional information is required to move the status of the claim along
  • At this point the reinsurer has the opportunity to review and respond with questions or requests for additional information.  This can be as simple as a notification or claim proofs being misplaced/misfiled or as in-depth as questions on retention/ceded amounts or premium discrepancies. 

5. Second Follow Up

  • Give the reinsurer about 10 days from this initial follow-up for a response or payment before sending a 2nd follow-up. 

PRO TIP: Make sure to indicate this as a 2 nd follow-up. This will catch the attention of the reinsurer, they'll know that its something that needs immediate attention.

If you have reached the 60-day mark and have had no response to follow-ups, it is time for a phone call and follow up email to escalate accordingly.  At this point the outstanding claim will take on a life of its own as both parties work to resolve the issues.

Foundation for success

Using these phases as a foundation should help you build a consistent communication stream with your business partners. Keep in mind that the way you work with various parties will differ. Over time, you'll learn what to expect from various reinsurers and the style of communication that will drive action. At the end of the day, strong communication is the key ingredient to making this happen. Combine this with electronic claims submission and you should be able to successfully get claims paid in under 90 days. 

Need a refresher on setting up electronic reinsurance claims? Find it here:

 

Written by
Robert Bouchard