Disprove allegations within Insurance

With £1.9 billion paid in compensations during the 2nd half of 2016, and pension annuities about to become the new PPI, artificial intelligence and analytics may be one of the best investments an insurance company can make. Business Systems’ Will Davenport explains why.

Why is the issue of annuities such a major concern for Insurance companies?

On May 26th 2017 the FCA published a policy statement on information prompts in the annuity market to address the continuing concerns around the mis-selling of annuities. The FCA estimates around 90,000 pensioners were sold the wrong pension, however other sources talk about double this number. If we refer back to the PPI scandal, CT Capital were fined shy of £2 million for failings in PPI complaint handling procedures. This is something that no one in the financial sector would like to see repeat itself.

Currently insurance companies need to put in place the systems that will help them a) ensure compliance from March 1, 2018, b) prevent similar issues from becoming the next PPI or the next annuity scandal, c) have grounds to disprove false allegations, and finally d) cope with the massive influx of claims and calls that are going to be coming in every day.

What tools can Insurance companies use to discover and prevent such instances?

Interaction analytics enables companies to mine information from all the interactions between the insurance company and their customers and prospects. This kind of insight can help shed light to many aspects relating to the way the firm conducts its business, as well as customer complaints, customer satisfaction and overall customer experience. But for the purposes of this article, a key benefit of Interaction Analytics is that it enables the insurance company to prove or disprove allegations when they happen, and essentially resolve disputes quickly and efficiently. Typically, as we have seen with our customers in the Insurance sector, there can be hundreds of thousands, if not millions of calls coming in annually, which are being recorded for FCA compliance purposes.

At the moment when a claim or dispute arises, most of the time the insurance company will find all the calls related to the claimant and painstakingly listen to each of these calls to prove or disprove the claim. For example, a claimant may say that they did mention they had a certain health issue, but have been sold a standard annuity pay out. In such a case, the insurance company will have to listen to all the calls to verify what the claimant actually said. Needless to say that this process, repeated for all similar claims coming in, can be very resource-intensive and time consuming.

Now, if there is a speech or interaction analytics solution in place, we can search for the relevant key words and phrases to pinpoint if something was actually said and when it was said. So in our example, the solution would find the relevant calls based on the mandatory identification provided at the beginning of each call, and then search within those calls for any mention of keywords related to the said health issue. If any of these keywords were indeed mentioned in any of those calls, it will retrieve the specific recordings, indicating the precise time the keywords were mentioned. This way, an officer can easily go through the specific calls for further analysis and at the end prove or disprove the allegation.

Many discussions occur during face to face meetings –how can insurance companies prevent the ‘he said-she said’ scenarios?

Face to face recording, i.e. the audio and potentially also video recording of meetings with clients and prospects, is another solution that could help Insurance companies monitor for compliance. Not many companies are implementing such solutions, and this is where the problem lies. If meetings are not recorded how will you disprove an allegation? Unfortunately if a company does not already have a recording system in place for face to face meetings, there is not much it can do in retrospect, but rely on employee notes which lives room for dispute. Going forth however, there is no excuse. Solutions today for face to face meetings are very easy to implement, simple to use and non-disruptive to the conversation, especially when compared to note taking.

Being proactive is usually safer than responding to allegations –how can analytics assist prevention?

Whether it is a recording of a phone call are from a face-to-face meeting, another key benefit of Interaction Analytics is that it can run in real-time. This means you can place alerts when words like, for example “smoking” or “diabetes” are mentioned in the same call or meeting with the term “standard annuity”, and ensure that the customer is not offered the wrong annuity. By monitoring these cases in real time we can be more proactive in addressing and rectifying such issues before they become a ‘mis-sold contract’, and ultimately protect the business from disputes, fines and reputational damage.

Sometimes a simple data entry mistake can cause many complications –how can Robotic Process Automation help?

Last but not least, robotic process automation is a key enabler to de-risking information processing. Take for example a new claim that comes in with all the contact information of the claimant. This information will be put into your CRM system and then perhaps a Claims Management System. At the moment, this tends to be a manual process performed by humans. This is not only inefficient in terms of time and resource, but is also risky in terms of accuracy. Robotic process automation uses virtual workers to operate the existing systems you have in place and automate these mundane, repetitive tasks (in our example, moving information among systems) with 100% accuracy and 24/7 availability.

If you want to find out more about Interaction Analytics and Robotic Process Automation, feel free to contact us.