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Pain points

Paying claims in the open market

Manual intervention, re-keying, and lack of automation 

OMC Paper for transmission

Notification of loss, policy matching and verification

  • Customer making a claim on a laptop
    Customer makes a claim
    Pain point not applicable to this step
  • A man holding a document while sat a desk with a computer
    Broker submits the claim with supporting documents

    Broker manually collates the claim file and submits this through CLASS (a claims workflow system) or LIMCLM (an EDI claims message) from their own systems, and must manually upload documents into their own systems

  • A man on a computer with a claim and policy document above
    Claim is matched against the relevant policy

    Broker manually identifies the lead underwriter who will validate the policy against the claim

  • A woman checking things on a computer
    Policy and premium verification checks are performed

    Verification checks performed by the broker and DXC require manual reconciliation against multiple data sources

Triaging, routing and assignment

  • A man receiving a notification on an iPad
    Lead underwriter and claim agreement party(ies) are notified of the claim (if required)
    Pain point not applicable to this step
  • Two people on computers with a checklist above them
    Lead underwriter and claim agreement party(ies) are assigned claims tasks

    Lead underwriter manually triages and allocates claims tasks to the claim agreement party (if required)

Agreement

  • Two people shaking hands at a desk
    Query management and requests for additional information is undertaken (if required)
    Pain point not applicable to this step
  • Two people shaking hands at a desk
    Lead underwriter and broker negotiate, and agree or deny the claim

    The agreement is submitted retrospectively on the Electronic
Claim File (ECF) after it has been agreed off system

Digital processing

Settlement and claims payment

  • A woman doing technical checks on three computers
    Technical processing checks conducted to review and finalise the claim

    Manual data entry by market participants earlier in the process can result in errors and increased query rates at this point of the journey

  • Funds being sent from one person to a computer to another person
    Funds or fees are moved

    If the customer is being paid directly, there will be a manual reconciliation of the fee and claims payment against the claim, causing delays in the claim being settled and paid

Pain points

View the pain points that our new digital solutions are addressing for paying claims in the open market.

Woman and Man blindfolded holding puzzle pieces

Lack of visibility, transparency, and collaboration

Data sheets

Unstructured and inconsistent data

Man going through step by step flow

Claim tasks must be completed sequentially

A man checking his watch in front of a clock

Delays in claims processing, payments, and movements of money to customers

Solutions

We’re delivering several solutions which are transforming how we’re paying claims in the open market. Learn more about these solutions, including our progress, benefits and where to find out more.  

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ACORD Data Standards

ACORD technical data standards will be used to populate the Core Data Record (CDR) and other key data. 
A database

Core Data Record (CDR)

A set of standardised, quality transactional data, that powers downstream processing. 
A computer with a document, a badge and a settings icon on it

Digital Processing Platform for claims (ICOS)

A digital claims processing service which can automate processes.

Related steps

Journey overview

A high-level overview of the journey including associated pain points and solutions. 

Detailed steps

A detailed view of the journey, showcasing the technology that’s involved in each step. 
Next Lack of visibility, transparency, and collaboration
Get adoption ready

Blueprint Two will be delivered in two phases. At phase one cutover, all market firms must adopt the new digital services.