Claims and insurance operations advisory

PwC provides support in key operational areas to insurers undergoing changes in structure, seeking to improve performance, looking to reduce costs, developing new areas of business, integrating and updating information and data systems, or focusing on mitigating risks within the business.

Potential issues

  • You are having difficulty controlling claims indemnity costs and expenses, or are experiencing increased levels of customer complaints, related to the management of your internal or outsourced claims handling function.
  • You require an independent assessment of your case reserving adequacy in specific portfolio segments due to recent adverse run-off.
  • You need to evaluate the quality of the claims operations and controls of a target insurer in the context of M&A due diligence.

How we can help

  • Tighter controls, enhanced processes and implementation of technology solutions to achieve reduced claims expenditure, higher productivity and lower levels of direct and indirect claims handling costs.
  • More consistent and higher quality case reserving across multiple claims offices.
  • Improved operational due diligence and transaction negotiating capabilities.

Our services

  • Claims strategy and operational reviews to identify operational effectiveness enhancements and indemnity cost and expense savings opportunities, as well as an analysis of alternative approaches (e.g. outsourcing/offshoring) to certain parts of the claims value chain.
  • Development of predictive models to identify those claims with the greatest potential for adverse development.
  • Closed file reviews to identify areas of claims leakage, allowing you to identify the resources to self-fund claims performance improvement programs.
  • Reviews of open and closed claims file samples to assess the adequacy of case reserves and the consistency of the application of the enshrined case reserving philosophy, especially in lines such as surety, commercial property and workers compensation.
  • Implementation of third party vendor solutions such as Guidewire ClaimCenter®.
  • Benchmarking of claims handling and case reserving policies and controls against your competitors' capabilities.