Claims Services

The Claims Process

The ValuationWhen the policyholder buys a policy, the home is valuated with 360Value. 360Value uses the same data to estimate replacement costs that most adjusters use to settle claims. Insurance companies also have the option of allowing homeowners to collaborate during the valuation process, and policyholders can complete floor plans, enter inventory lists, and so on.

Matching the front-end valuations with the back-end claims protects your policyholders and is good for your company. In the event of a total loss, consistency between underwriting and claims means no surprises for you or your policyholders.

Xactware products and services are designed to make the claims process easy, fast, and fair.

The Damaging EventA sudden windstorm snaps a large tree that smashes through the main roof of a home, causing structural damage and destroying a big-screen TV.

The policyholder calls in the claim. The policyholder’s claim is immediately assigned electronically using the XactAnalysis network, which is integrated with the insurance company’s call center system.

The policyholder’s claim

is immediately assigned

electronically using the

XactAnalysis network

These assignments can be forwarded to staff claims representatives, independent firms, and service professionals such as contractors or emergency board-up people. The initial valuation created at the time the policy was sold can also be sent with these assignments.

In this case, a staff claims representative is automatically assigned the claim, an emergency board-up company is sent to mitigate damages, and a contractor is asked to submit an estimate and perform the repair work.

Valuate As a policy is sold or reviewed, an accurate replacement-cost value is determined with the same data used to settle more claims than all other pricing data combined.

Assign When a loss is called in, assignments are sent to staff, independent adjusters, contractors, or other pros. Most of this process is automated.

Estimate Repair costs are estimated using the industry’s number-one estimating software and the number-one pricing data. Information for the original valuation can often be used to quickly compile the estimate. The estimate—along with photos, notes, and audio files—is sent back to the assigner.

Monitor Once an assignment has been sent, managers are immediately alerted if company standards are not being met. Managers see in real time exactly what work has been done and the current status of the claim.

Manage Detailed reports help managers find potential problems and solve them as they are happening. Managers can see everything from company-wide trends to individual items in individual estimates.

Settle Accurate, well-documented information leads to fair settlements and satisfied customers.

Claims Services Workflow

The Claims and Repair Professionals ArriveSeconds after the claim is assigned, the XactAnalysis network makes mobile phone calls and sends faxes, pages, and emails out to the claims and repair professionals assigned to the claim. Within, minutes they are mobilized to the job. XactAnalysis is fully customizable to allow these professionals to tell XactAnalysis the best methods and times during the week to notify them of these important assignments.

The Contractor Completes a Structural EstimateUsing the Xactimate estimating system, the contractor downloads information about the claim from the XactAnalysis network. This includes the policyholder’s address and information compiled when the policy was written and the home was valued. In this case, the valuation includes a roof plan with dimensions and information about the manufacturer of the shingles.

The contractor also downloads the latest pricing data from Xactware. Xactware’s pricing data is updated monthly and can include both structural and contents items. If the windstorm that knocked over the tree also caused widespread damage elsewhere, roofing prices may have gone up. Xactware carefully monitors disaster pricing and issues updates as needed.

Estimating the damages to the buildingtakes only minutes for the contractor, thanks to advanced tools in Xactimate and information obtained when the policy was written and the home was valued.

Managers and the adjuster could view the contractor’s complete estimate on XactAnalysis at 10:12 a.m. the day after the claim was reported.

Managers can be notified automatically if particular “response time” touch points are not updated within an acceptable amount of time. If the policyholder has not been contacted or the property has not yet been inspected within the time limit set by the company, XactAnalysis will notify the proper people to ensure the claim is handled promptly. As contacts and inspections are completed, information is immediately updated and noted in XactAnalysis. Everyone collaborating on the claim can immediately see progress in real time.

On our fallen-tree claim, managers can see the adjuster was contacted at 8:00 a.m., the policyholder was contacted at 8:10 a.m., and the contractor completed the board-up repairs at 10:15 a.m. that same morning.

Everyone collaborating on

the claim can immediately

see progress in real time.

The Structural Estimate is ReviewedThe claim adjuster reviews the claim sent by the contractor. The estimate contains photos of the damage, including detailed photos of the framing in the roof. Also attached is an audio file of the contractor explaining how he plans to repair the framing damage.

Advanced auditing algorithms in XactAnalysis call the claim rep’s attention to a possible error. The possible error was found in the living room where the contractor estimated to paint all the walls and the ceiling and also estimated to replace wallpaper on one long wall.

Using XactAnalysis to collaborate, the claim rep and the contractor discuss the possible error. The contractor submits a new estimate with the error corrected. At 2:45 p.m., the claim rep approves the estimate and authorizes the contractor to do the work.

Managers monitor trends and spot areas of concern.

The Claim Professional Completes aContents EstimateContents estimates are built either within the Xactimate estimating software or in a completely online contents estimating package. The insurance company also could have elected to have the contractor include contents items in the structural estimate.In our fallen-tree claim, both structural and contents items were damaged. Since the insured and the contractor indicated the TV was the only damaged contents item, the adjuster used the XactAnalysis network’s collaboration tools to ask the contractor for a photo of the damaged TV, along with a model number, and decided to create the contents estimate by phone.

The claim adjuster types the model number of the TV into the XactContents search. She finds the TV is no longer manufactured, but XactContents lists other TVs of like kind and quality.

The homeowner indicated she wanted to order the new TV as soon as possible. The XactContents search links the replacement TVs to major retailers who offer the TV. The homeowner selects one of the replacement TVs and requests the replacement be sent. The TV is delivered to the policyholder’s door and set up by a major national retailer. This streamlined process allows the homeowner and the insurance company to save time and money.

XactAnalysis network sends the assignment with the contact info.

Most contents estimates are more complex than the fallen-tree claim example. For more involved estimates, XactContents contains a wide variety of tools to make the process faster. Contents estimators can import Excel inventory worksheets completed and submitted by the policyholder to reduce double entry. XactContents can even search and find large quantities of content items in the background while you do other work.

The XactContents database has access to millions of contents replacement items and prices from the sources you trust.

Floor and roof plans are attached to the estimate.

The Claim is ClosedIn record time, the claim is processed, monitored, and completed. The contractor completes the work, and the homeowner is back in the home with life back as it was.

Using Xactware tools for the complete claims cycle provides an unprecedented level of documentation and accuracy. Highly documented claims reduce misunderstandings and disputes. Xactware tools also make the process faster for everyone involved. This means lower claims costs and better service for your customers.

Call today to see how Xactware tools can integrate with your existing tools to provide a complete and efficient claims-handling system.

The Claim is MonitoredManagers see the progress of the claim in real time as it proceeds. The estimate data is also included in trending reports viewed by managers. National managers can see reports and trends for the entire country or by region and can focus as closely as they want to on specific areas or even drill down to an individual claim. Local managers can be given access to see only reports for their region of responsibility. XactAnalysis helps all managers see where potential problems may be occurring and where training or additional resources may be needed.

Managers can also benchmark their data against other regions and trends from other professionals in the same industry. Any manager who sees a potential problem with our fallen-tree claim can drill down and review the information.

The Claim is ReinspectedUsing features set in the XactAnalysis Quality Review program, our fallen-tree claim is randomly selected for reinspection. The reinspector assigned to the claim conducts an online review of the claim file, sketch, photos, and audio file. The reinspector fills out a customized reinspection form for the file. All reinspection work is done without interrupting the normal workflow or slowing the claim progress. Claim data for the reinspection is copied to the completely separate Quality Review module.

In the fallen-tree claim, the reinspectors found a clean claim. On other claims, reinspectors could conduct overwrites or underwrites, monitor new adjuster work quality, and suggest training in areas where improvement is needed.

Photos are attached to the estimate.

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