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Author
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Matemera, Brett M.
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Title
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Investigating the time frame for insurance claim resolution: factors influencing the duration of insurance claim settlement
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Abstract
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The study is guided by a robust theoretical framework that integrates perspectives from operations management theory, organizational behaviour theory, and information economics theory. This provides a multidimensional lens to examine the complex phenomenon. A conceptual framework is developed that depicts the hypothesized relationships between the key independent variables (claim characteristics, investigative approaches, organizational factors) and the dependent variable of claim settlement duration. The research employs a mixed methods approach, combining quantitative and qualitative data collection and analysis. The quantitative phase involves a survey of 100 insurance industry professionals, while the qualitative phase includes in-depth interviews with 20 industry experts, including claim assessors, adjusters, underwriters, fraud investigators, and claims managers. The study found that claim complexity, severity, and legitimacy have a significant influence on settlement durations. Complex claims requiring extensive investigations, high-value claims warranting more scrutiny, and claims with perceived legitimacy issues can all prolong the settlement process. The depth and rigor of investigative methods, such as site visits and document reviews, as well as the thoroughness of validation processes, including expert assessments, directly impact settlement timelines. Robust fraud detection measures also contribute to longer resolution times. The complexity of claim processing workflows, resource allocation (claim assessor-to-claim ratio), claim adjuster expertise, and the level of functional integration between teams can all influence the efficiency of the claim settlement process. The study provides practical insights and recommendations for insurers, such as implementing data-driven triage systems, leveraging technology and analytics, fostering cross-functional collaboration, and maintaining an appropriate balance between thoroughness and timeliness in claim handling. These findings can help insurers optimize their claim management strategies to improve customer experience while preserving the integrity of the claims process. The study concludes by deriving practical insights and recommendations for insurers to optimize their claim processing, fraud detection mechanisms, and organizational arrangements in order to minimize settlement durations while preserving quality standards and regulatory compliance. These actionable guidance can help insurance organizations address the critical challenge of balancing thoroughness and efficiency in the claim resolution process. Overall, this research fills an important gap in the literature by providing a comprehensive, empirical, and contextually relevant analysis of the multidimensional drivers of insurance claim settlement durations. The findings and recommendations offer valuable insights for both academic researchers and industry practitioners seeking to enhance the performance and customer experience of the insurance claims function.
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Date
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July 2024
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Publisher
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BUSE
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Keywords
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Insurance Claim Resolution
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Insurance Claim Settlement
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Supervisor
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Dr. M. Magodora
Matemera, Brett M..pdf