Claims Focus 2017, No. 1
Issue: July 2017 |
L/H General Industry
By Irene Ng, Life/Health Branch Manager, Singapore
Dr. Marianne Kutzner, Training Manager, Cologne
Clio Lawrence, Claims Specialist, London
Thomas Merten, Vivantes Klinikum im Friedrichshain, Berlin
Kate Swanson, Associate Claims Specialist, Cape Town
Health insurance is an important insurance product, and one of the major markets for health insurance is Asia. Irene Ng gives an insight to Asia-specific challenges of managing health insurance portfolios. Among other aspects, she describes control measures that could help insurers improve their health portfolio management.
Data analytics is essential for health insurance portfolios as well as for the detection and prevention of fraud in any kind of insurance. Kate Swanson summarises a case of life insurance fraud in South Africa. The “Pacemaker Scam” shows the importance of recognising red flags to identify potentially suspicious claims and the usefulness of data analysis to pinpoint the fraud more effectively.
Behavioural Economics (BE) is a rising insurance topic. Clio Lawrence introduces BE principles (anchoring, framing, loss aversion and reciprocation) and analyses their relevance for the claims management process. In particular she discusses BE’s role in the clients’ engagement in return-to-work and rehabilitation programs, as well as the impact on customer satisfaction.
Cognitive functioning (e.g. memory, attention) plays a crucial role in many claims cases. Neuropsychological tests that measure cognitive impairment largely depend on the individual’s willingness to cooperate. Thomas Merten emphasises the importance of symptom validity tests in neuropsychological testing to assess uncooperativeness.