Potential reasons for leakage in an insurance claims process.
Claims settlement solely depends on the efficiency of claims management. Claims leakage is the loss that an insurance company suffers over an unoptimized finalization of a claim. It is the excess amount the insurer paid to the claimer, which the client was not entitled to. Leakage poses a serious threat for insurers. Claims leakage imposes a hindrance to productivity, revenue and customer experience. Preventing leakage in a claim settlement is quite a difficult task for the insurers. There are many causes for claims leakage. Retrieving lost money is not very easy. The causes can be procedural, such as from inefficient claim processing or improper/ errant payments. It can be human error, such as poor decision-making, customer service, or even fraud. CL is often discovered through an audit of closed claim files.
Claims Leakage
Technology
Environment
Process
People
Others
Fraud
This fishbone is a methodical root cause analysis that shares ideas about steps and conventions of cause analysis for other or similar problems. We have adopted some protocols while organizing the different parent and child causes.
Curated from community experience and public sources:
