Insurance Claims Process Improvement
Challenge
This leading ANZ private health insurer (PHI) had a strong track record of continuous improvement but recognised that the next wave of material benefits would not come from further optimisation within individual functions.
Claims sat at the centre of both customer experience and operating cost, yet work flowed across multiple teams and supporting functions, making bottlenecks, delays and rework difficult to identify or address from within any single area.
Members of the Cinc team were engaged to conduct an end-to-end review of claims operations and supporting customer journeys, identifying where improved cross-functional collaboration could unlock material customer, employee and cost outcomes.
Approach
Members of the Cinc team conducted an end-to-end review of claims operations and supporting customer journeys, tracing how work moved across teams, hand-offs and functions to identify the root causes of bottlenecks, delays and inefficiencies.
The review focused on:
End-to-End Visibility
Mapping claims processes and customer journeys across operational and supporting functions to establish a shared understanding of how work actually flowed.
Interface and Hand-Off Analysis
Identifying where delays, rework and failure demand were generated between teams and functions.
Cross-Functional Improvement Opportunities
Uncovering opportunities where improved collaboration and more integrated ways of working could materially improve customer and employee outcomes.
Prioritised Improvement Roadmap
Developing recommendations to improve cost, risk and service performance, prioritised according to benefit, practicality and implementation effort.
Capability Building and Implementation Planning
Working alongside operational leaders to strengthen improvement capability and develop implementation plans to support sustained delivery beyond the review.
Team members involved: Peter Campbell and Michael Love.
NB This engagement was delivered prior to the establishment of Cinc. The experience and results described reflect work personally delivered by the team members identified above.
Results
$1.6M-$3.7M
per annum in sequenced benefits identified through cross-functional opportunities agreed by the business, unlocking value that no single team could have realised independently.
Shared visibility of claims performance
A common, evidence-based view of performance was established across previously siloed teams, enabling leadership to address root causes rather than symptoms.
Clearer links between operations and outcomes
Improved visibility of how operational performance influenced cost, risk and customer outcomes, creating stronger alignment around improvement priorities.
Capability for ongoing improvement
Operational leaders were equipped with the tools, understanding and improvement capability required to sustain momentum after the engagement concluded.
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