Call for papers Volume-12, Issue-1, December 2022 Last date of submission : 26-12-2022

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DR. GENER N. CADAG & DR. RICHARD OLIVER F. CORTEZ

Fraud Prevention In Online Processing Of Insurance Claims: Basis For Enhanced Guidelines

ABSTRACT

Claim management is a major concern for insurance companies. Effective claim management can save your company effort and money while improving customer satisfaction and customer retention. Although manual paperwork may be required, tools and technologies such as claim management software can help businesses automate processes to increase profitability. The claim process is an important moment in  customer relationships in non-life insurance. To maintain and expand market share, insurers need to focus on improving their customers' experience through online processing

The purpose of this investigation was to improve the fraud prevention policy when processing insurance claims online. In particular, we are looking for answers to achieve the following goals:  1.) To determine the degree of effectiveness of online claims processing for motorcar insurance. 2.) To identify the different variables that help in preventing fraud.  3.) To know the recommendation offered by the respondents on insurance training.  4.) To describe the different fraud in claims processing for motorcar insurance in terms of gravity. 5.) To develop an enhanced policy on how to prevent fraud in motorcar insurance claims.

A descriptive method was used in this study. In selecting 60 car employees and customers, researchers used the purposive sampling and  structured questionnaires were used as the primary means of 60 respondents. Random interviews with owners, managers and customers were conducted as part of a meeting with a group of respondents. Statistical tools used to display, analyze, and interpret  data are percentages, weighted averages, Likert scales, and rankings.

The most important conclusions are: 1. ) Younger generations or young professionals still preferred to insure their vehicles in the event of an accident, especially in these times when traffic is increasing, with the service provider's excellent insurance concept. 2.) More and more male customers prefer insurance  services. They are more aggressive driving style. These drivers assume a high probability of an accident. 3.) Married vehicle owners are more responsible driver. It is believed that by getting insurance coverage for the utility of the vehicle, they will appreciate their vehicle more. 4.) College graduates are already employed, so it is assumed that they  already have a vehicle when their  income increases. Similarly, not all employees decide on their degree. 5.) The level of claims processing transactions is the fast-tracking transaction they used, significantly reducing the latency of both claims handlers and customers from the previous peak of weeks to just days. 6.) They will pursue strategies to further improve the process for processing claims online, adapting technologies such as service access and payment processing to claims, and providing quality service to our customers. 7.) Various training programs in the field of modern technology will greatly help employees acquire knowledge of modern technical equipment. Insurers may require video quality and fair and impartial processing if they have sufficient knowledge of claim processing and claim adjustment. 8.) If the processor and adjuster are unaware that the fraud case is involved, have no knowledge of the underwriting aspect, and can handle the fraud without using the latest technology, then the car insurance claim needs various serious fraud cases.