only a 3 pages research project part following this outline written in new time romance 12 and a work cited page IV. Claims A. Explain the concept of indemnification B. What happens during the traditional claims process? 1. Investigate a) Submitted loss investigated (1) Collection of scene data? (2) Interviews/Statements of witnesses (3) Scene recreation 2. Evaluate a) Submitted loss evaluated (1) Is this a covered loss? (2) Did the loss occur in a covered manner? (3) Did it occur within the contracted term? (4) Attempt to identify potential fraud 3. Adjudicate a) Is the loss covered? (1) Covered loss (a) Indemnify according to contracted terms (b) Subrogate insured satisfaction if appropriate (2) Uncovered loss (a) Denial of satisfaction for insured’s loss (b) Investigate and prosecute potential fraud C. Effect of “Big Data” on the Claims process 1. Verification vs. Investigation a) Ability to verify information rather than discover information (1) Insurer has greater access to information regarding insured (a) Identification of changed risk factors (i) Ex. New “of age” driver(s) at an address (ii) Ex. New home addition (b) Identification of changes in insurable interest (i) Ex. Vehicle not registered with the state (ii) Ex. Property tax arrearage (2) Insurer has faster access to 3rd party/claimant data (a) Identification of claimant (i) Name verification (ii) Address verification (iii) Contact verification (iv) Claimant coverage (a) Term of coverage (b) Limits of coverage (v) Subrogation opportunities (a) What is subrogation? 2. Identification of fraud a) Identification of concurrent coverage (1) Data appended to subject from marketplace sources b) Identification of frequency and type of claims submission (Slip and Fall) (1) Data appended to subject from marketplace sources (2) Data appended to subject from police records (3) Data appended to subject from court system records c) Identification of Medical Fraud (Bodily Injury) (1) Extended treatment (a) Data appended to provider from marketplace sources (b) Data appended to subject from marketplace sources (c) Data appended to subject from police records (d) Data appended to subject from court records (2) Excessive billing (a) Data appended to provider from marketplace sources (b) Data appended to subject from marketplace sources (c) Data appended to subject from police records (d) Data appended to subject from court records 3. Expedition of Claims process a) Benefit for Insured/Claimant (1) Better customer service experience (2) Shorter time frame for indemnification b) Benefit for Insurer (1) Reduction in Time in Process (TIP) (a) Lower severity in claims settlement (b) Fewer litigated claims (2)

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