Insights · Claims Performance

Why claims organizations struggle to deliver expected results.

The visibility, accountability, and execution challenge facing property and casualty insurance leaders - and the five interconnected drivers that determine claims performance.

01 - Executive Perspective

The largest operating expense, the hardest to see clearly.

For most property and casualty insurers, claims represent the largest operating expense and one of the most important drivers of profitability, customer satisfaction, regulatory compliance, and organizational reputation. Claims performance is a primary concern for CEOs, boards, and executive leadership teams.

Many insurers have invested heavily in claims systems, workflow tools, analytics, automation, and digital capabilities. Yet executives often continue to face rising claim costs, staffing challenges, inconsistent outcomes, and increasing pressure to improve operational performance. The question keeps coming back: why are we not achieving the business results we expected?

The issue is frequently not a lack of technology. More often, it is a lack of visibility into how work is actually being performed - and whether organizational resources are aligned to desired business outcomes.

02 - The Visibility Problem

Reports show results after problems have already developed.

By the time increasing claim inventories, rising litigation rates, deteriorating service levels, or reserve concerns become apparent, opportunities for early intervention may have already passed. Without clear visibility into how work moves across people, processes, systems, and vendors, organizations struggle to identify where performance is breaking down - and who is accountable for corrective action.

Visibility is not another report. It is a management capability.

03 - Five Performance Drivers

What actually influences claims performance.

Organizations that consistently improve claims outcomes focus on five interconnected areas.

01

People

Staffing levels, adjuster workloads, management oversight, training, and accountability all influence claim quality and productivity.

02

Process

Workflow design, claim handling procedures, escalation practices, quality controls, and operational consistency affect efficiency and customer experience.

03

Technology

Claims systems, automation tools, analytics platforms, and integration capabilities should support business processes rather than create added complexity.

04

Information

Data quality, reporting accuracy, governance, and management metrics determine whether leadership can make informed decisions with confidence.

05

Execution

Operating discipline, performance management, issue resolution, and accountability determine whether claims objectives become measurable outcomes.

04 - Executive Visibility Framework

What leadership should be able to see.

The objective is to identify emerging performance issues before they become business problems. Leadership should have clear visibility into:

Operational health

  • Claim inventory, workload distribution, and backlog accumulation
  • Aging claims and cycle times
  • Service level performance and response times
  • Quality findings and rework volumes
  • Staffing capacity, adjuster productivity, and workflow bottlenecks

Financial & risk exposure

  • Reserve adequacy and reserve changes
  • Claim severity trends by segment and their financial impact
  • Litigation rates, attorney involvement, and escalated high-risk claims
  • Fraud indicators and leakage opportunities
  • Vendor, independent adjuster, and TPA performance
05 - Building the Capability

Visibility, accountability, and execution discipline.

The most successful claims organizations do not simply manage claims. They manage visibility, accountability, and execution.

01

Define Clear Accountability

Executives should know who owns claim outcomes, service levels, quality measures, operational efficiency, and technology effectiveness.

02

Measure Earlier Warning Indicators

Supplement historical results with operational indicators - inventory growth, claim aging, litigation frequency, quality findings, exception volumes, and workload imbalances.

03

Evaluate Process Before Technology

Technology can accelerate existing processes, but it cannot correct poorly designed workflows. Understand how work is actually performed first.

04

Strengthen Operating Discipline

Trusted data, consistent definitions, root-cause analysis, issue escalation, and corrective action management turn insight into improvement.

06 - The Bottom Line

A business-first approach

Improving claims performance is rarely achieved through technology alone. Successful organizations examine how people, processes, technology, information, and execution work together to produce results. The goal is not more reporting - it is earlier visibility, clearer accountability, and better decisions. For executive leadership, the challenge is not simply improving claims operations. It is creating the visibility and accountability necessary to consistently deliver the business outcomes the organization expects.

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