Who is Hector?
Hector is an innovative insurer in the field of motor vehicle insurance solutions and sees itself as an innovation leader. As a digital pioneer, the focus is on efficient processes through their own scalable and adaptable platform ZEUSS®, which leads to lower premiums.
Where were the blind spots?
High rates of reopened claims without clear reasons being apparent. Delays in claims processing due to unforeseen bottlenecks. The impact of subsequent adjustments to reserve provisions in claims settlement on the process was unclear.
What did we find?
High Number of Claim Reopenings
We identified recurring communication patterns between cooperating insurance companies and Hector (as underwriter) as well as document flows between these entities that cause problems. We found that a large portion of documents only arrived after the claim was closed and which document types are typically responsible for reopening.
Bottleneck Due to Delayed Invoices
We found that the main factor for massive delays (up to several months) is related to repair invoices, because appointment scheduling in maintenance workshops takes too long. As long as these invoices have not been received and reviewed, claims cannot be processed, leading to a backlog that causes delays.
Subsequent Correction of Reserve Values
We found that frequent adjustments to reserve values led to backward jumps in the process and required an additional manual step to enter the updates into the system. This extended the time required to close claims. This is an important part of risk management and financial planning that needs to be carefully reviewed.
Damage Event After Claim Reporting
Some applications were submitted with reporting dates that preceded the actual damage occurrence, leading to complications in processing the applications. These discrepancies required additional investigations, further delaying resolution and making the processing of such claims even more complicated. This can also indicate fraud.
In Detail
Claims are reopened after their actual completion. This requires additional manual processing steps, which lead to high costs.
Claims are closed after being reported by the injured party, without a documented intermediate step. This can lead to steps being forgotten or not sufficiently documented.
Claims are created or imported into IT systems before the reporting date is registered. This means that the data is likely delivered late. This increases the risk that it will have to be manually reprocessed later.
Claims are marked as closed even before they are created. This means that in some cases, data is subsequently entered into the systems, leading to poorer data quality.
Claims have a reporting date that precedes the damage event. This constitutes a causal violation and can indicate either a manual input error or fraudulent behavior.
Next Steps
Hector continues to leverage Process Mining insights to further optimize their operations.
Still unsure?
Read the full report in a downloadable PDF!