Pet Insurance Claims Management for Insurers (OLD)

The numbers are in, and like a dog’s tail, they don’t lie: Pet insurance is booming

The North American Pet Health Insurance Association (NAPHIA) announced that North America’s pet insurance sector exceeded $2.83 billion at year end 2021, and industry growth more than doubled over the past four years.

Currently there are over 4.41 million insured pets across North America. This is an increase of 27.7% from over 3.45 million pets insured in 2020. With over 89 million pet dogs in the U.S. alone, this growth in premium and number of pets insured is an indication of continued, aggressive growth in the industry.

Key Challenges for Pet Insurers

Self-Reporting a Claim

Pet insurance is a first party, reimbursement-only product, meaning that your policyholders want to be able to take their pets to the vet and then come home, file the claim online, attach the invoice, and get paid. For this to happen, you need the capability for simple and accurate self-reporting of a claim by the insured, directly into your claims system.

Balancing Multiple Programs

Policyholders often choose an Accident & Illness and/or Wellness program without intimately understanding the coverages and/or limitations of each. Then when it comes time to report a claim, they may feel frustrated or misconstrued. Your claims system should be able to provide your adjuster with all the contextual information they need to quickly communicate the coverage and/or limitations to the policyholder and provide the best service.

Efficient Bill Adjudication and Payments

At this point in time, veterinarians do not differentiate care by program and bills being submitted for reimbursement will not be itemized as such. This can make bill adjudication and paying your policyholders take longer than expected.

Omnichannel Communications

Your policyholders expect real-time communication across multiple channels (text, email, chat, phone, video) – corresponding just by snail mail or even email is no longer an option.  Unfortunately, most claims insurance technology is outdated and does not support omnichannel communications,  leading to frustrated customers and unhappy adjusters.

The Benefits of Five Sigma's CMS for Pet Insurers

Our cloud-native data-driven claims management solution makes your claims processing simple and smart.

Automated Claims Submission

Our digital claims management solutions (CMS) provide:

  • All FNOL data received from the insurers/digital channels are embedded automatically into our workflows and ready for the next step in the process
  • Rapid system identification of claim types
  • Automated triage and adjuster assignment

Embedded Omnichannel Communications

Our CMS includes an API-level communication module that support all types of communications including: SMS, mail, voice video calls, and even WhatsApp. All claims-related communication is documented, stored and analyzed automatically.

Just-in-time Recommendations

Our systems flags coverage and liability issues and presents the adjuster with relevant information and investigative steps within the claims system.

Damage Assessment and Negotiation

The key to effectively negotiating a claim begins with accurate damage assessment. Our CMS includes a digital bodily injury evaluation module to itemize, assess and aggregate damages.

Monitoring and Management

Based on our advanced data modeling, we enable insurers to monitor your operations and receive actionable insights that will help you make strategic management decisions.

Building an In-House Pet Claims Management Operation

A Pet Insurtech company had grown exponentially over the last twelve months and was looking to build an in-house claims resolution process.

They were looking for a modern claims system that was:

  • Compatible and could be integrated with their policy admin system
  • Customized for pet insurance

Learn how Five Sigma provided an open, cloud based out-of-the-box pet solution that was integrated and in production within weeks.

Go live in weeks with the state-of-the-art claims management platform.