When looking at the claims process of an insurance company, what would you say the core capabilities are? Examples include Claim Lodgement, Claim Management, etc
Director of Information Security in Energy and Utilities3 years ago
I'm not really engaged in the insurance business (I worked more in financial services). Having said that, the core capability for insurance companies is to take a claim through all the steps from initial filing, to processing, to investigations, to decision making, to paying out claim, to processing potential denial, to processing feedback and back/forth. Those would be critical steps that it needs to execute in order to process client claims and in case there's a BCP/DR event that's what it needs to be able to keep running and processing. If you only do some of the steps in the chain of claim processing you run the risk of a bottleneck if one of the steps of the process is negatively affected (for example servers processing details of claims (evidence upload) are not operating properly. This affects your SLA to your clients and they lose trust in your company and end result is that you end up going out of business at some point down the line.
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I'm not really engaged in the insurance business (I worked more in financial services). Having said that, the core capability for insurance companies is to take a claim through all the steps from initial filing, to processing, to investigations, to decision making, to paying out claim, to processing potential denial, to processing feedback and back/forth. Those would be critical steps that it needs to execute in order to process client claims and in case there's a BCP/DR event that's what it needs to be able to keep running and processing. If you only do some of the steps in the chain of claim processing you run the risk of a bottleneck if one of the steps of the process is negatively affected (for example servers processing details of claims (evidence upload) are not operating properly. This affects your SLA to your clients and they lose trust in your company and end result is that you end up going out of business at some point down the line.