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Claims 2021 Planning: Are You Placing the Right Bets?

New SMA Blog by Karen Pauli, Principal, Strategy Meets Action

It’s planning season – at least in most insurance companies. It is time to take out the 2020 budget and see where line items need to move for next year. Did the claims organization meet objectives? If not, what adjustments need to be made to ensure those objectives are fulfilled? What technology partners were aligned with the organization at the beginning of the year? And how do those initiatives need to be moved forward? It sounds like a reasonable place to kick off from, right? Actually, the answer is probably “no.” If 2020 claims plans are the baseline for 2021, I conjecture that this is the wrong place to start.

SMA’s recently released report, Claims Transformation Reset: The Impact of COVID-19, lays out the case for why claims transformation and claims operations have a new performance baseline because of COVID-19. In most cases, many things changed, such as WFH practices and interactions with customers that are no longer being done face-to-face. The pandemic’s impact is generally part of everyone’s view, but it is still evolving daily.

It is vital for claims executives to reassess other external forces impacting claims operations to effectively plan for 2021, not the least of which are workforce evolution trends and the rapidly changing digital connected world. Much has happened in these two areas, as well as three others outlined in the report. The environment that existed when 2020 plans were developed has dramatically changed.

In particular, an area with both a ring of familiarity as well as notes of a new operating world is the claims ecosystem. Even at the most basic policy level, claims organizations have extensive ecosystems: repair shops, contractors, health care providers, attorneys, law enforcement, agents/brokers, and the list goes on. Most claims organizations have traditional ways of interacting with the various segments of their ecosystem. Many of the traditional methodologies may be appropriate, but totally relying on tradition can have pitfalls. Instead, a new lens needs to be applied to the claims ecosystem.

  • How has the pandemic impacted traditional players? Are organizations such as repair shops, independent adjusters, contractors, and health care providers also working on a new COVID-driven playing field with related transformation initiatives? It is important that claims management reconnect with their traditional ecosystem partners and understand how innovation can improve outcomes on both sides of the transaction.
  • Are there new claims ecosystem players that should become prominent components of 2021 plans? Digital payment providers became mission-critical during the pandemic, but what should the next steps be in the continuing evolution of payments? Given the pace of change, are there new data providers that can surface business insights that should figure significantly in 2021 plans? A host of new claims ecosystem opportunities are identified in the report, and claims executives need to assure that each area is assessed for potential for their organization.

Having had many years of planning experience, I recognize that this time of the year can be challenging, to say the least. However, claims organizations have experienced business-altering change more than most others within corporate insurance operations due to the pandemic. Baselines of customer and employee expectations have been reset. It is not reasonably possible to go back to the comfort of 2020 and do what has been done in years past. Being a risk-averse industry, no one is fond of betting, at least from a business perspective. However, given the right set of lenses and a thorough review process, there’s a good chance that bets placed by claims management will have outcomes that “beat the house” and prove valuable.

About The Author

Karen Pauli, Principal at SMA, has comprehensive knowledge about how technology can drive improved results, innovation, and transformation within insurance operations. Karen has worked extensively with insurers and technology providers to reimagine processes and procedures to change business outcomes and support evolving business models. Her areas of focus include underwriting, claims, business intelligence and analytics, data sources, agency distribution, and customer management. Karen’s real-world experience with digital transformation projects has given her unique insight into the changing customer and distributor experience in the digital age. In her more than 30 years at insurance companies, and in the technology research and advisory space, Karen has developed her talent for aligning business goals and perspectives with technology roadmaps to create competitive advantage.

About SMA

Exclusively serving the insurance industry, Strategy Meets Action (SMA) is an advisory services firm offering retainers, research, consulting, events, and innovation offerings to both insurance companies and solution providers. Learn more about SMA at

SOURCE: Strategy Meets Action (SMA)