Case Study

Improving Efficiency in Claims Assessment Processes in the Insurance Sector

Goals: optimize the claims assessment process to allocate more time for negotiation and reduce the average claims cost

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The company and its commitment to efficiency and customer satisfaction

This project was carried out at one of the largest insurance companies in Portugal, a company with a strong reputation built over several decades. The organization offers a broad range of insurance solutions and is known for its service excellence and continuous commitment to process improvement. The project focused on the claims department, a critical area for customer satisfaction and the company’s operational efficiency. The primary goal was to optimize the claims assessment process, increasing the time available for negotiation and, in turn, reducing the average cost of claims.

The operational challenge in the claims assessment process

The company’s claims assessment and verification team sought to review how their teams performed their tasks to identify opportunities for improvement in both the quality and efficiency of their work.

However, the daily management of claims presented significant challenges, including variability in the number of claims and difficulties in coordinating the availability of the claimant, the repair shop, and the assessor. These issues not only hindered the efficiency of field teams—limiting the time available for negotiations with automobile repair shops—but also burdened management teams with excessive administrative tasks, leaving little time for supervising field operations or monitoring technician performance.

Recognizing these challenges, the company identified an opportunity to enhance the value-added activities of management teams while eliminating inefficiencies in field operations. This approach would enable technicians to spend more time on negotiations, ultimately contributing to lower claim costs.

The strategic approach to operational efficiency

The improvement approach involved implementing various solutions, ranging from route optimization and operational efficiency measures to strengthening the monitoring of operational performance indicators for assessors, combined with an incentive model featuring frequent payments directly actionable by the assessors.

An algorithm for distributing assessments was developed to optimize assessors’ routes, ensuring greater efficiency in field operations. Administrative tasks for both supervisory and assessment teams were eliminated, allowing professionals to focus their time on higher-value activities.

Also, standardized performance monitoring routines were implemented, enabling more rigorous oversight and facilitating corrective actions whenever deviations from defined goals were identified. An effective incentive model was created, based on the assessors’ performance, to motivate and reward those who showed the best results.

Finally, negotiation processes with automobile repair shops and large groups were standardized, using specific data to make decisions and achieve superior outcomes.

Results achieved and impact on efficiency and cost reduction

The project positively impacted various key metrics and fostered a culture of continuous improvement within the teams:

• A sustained 2% reduction in the average cost of auto claims, resulting in savings of over €2 million during the second half of the project year.
• Increased fraud detection resulting in an impact of over €7 million compared to the same period in the previous year.
• More than 200 service providers integrated into the dynamics of performance improvement and monitoring.
• Training and capability building for approximately 20 leaders in daily management skills.

This case study highlights how applying Kaizen methodologies can make processes more efficient, benefiting both the company and its customers.

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