How to keep a challenging customer promise

In business, as in life, it can be good to set yourself a significant challenge. But sometimes, that challenge can become even more daunting than you expected – especially when it also involves keeping a promise.

One of our US clients recently found itself facing this predicament. This major insurance company has a single focus – supplemental health insurance for product lines such as critical illness, hospital indemnity, and disability. For example, upon diagnosis of a condition such as cancer or heart disease, the policy pays out a lump sum to the policyholder, to be used entirely as the policyholder wishes.

Customer service – the next level

Although organizations pay great attention to their customer service, our client prides itself on its client service, turnaround time, and best-in-class payment time. However, as claims continue to grow, they face a number of challenges around economies of scale.

In particular – and this is the significant challenge in this case – the company has made a name for itself not merely by promising to respond to claims within 24 hours, but by allowing those claims to be made in a number of ways. Yes, there were claims forms, but claimants were not required to use them. As business was growing, so was the pressure. With literally tens of millions of documents passing through the system every year, how was our client going to maintain simplicity for its customers, make the process more manageable, scalable, and streamlined for itself – and still react quickly to new documents, templates, or changes in volume to honor its commitment to a one-day response?

In addition, our client wanted to harness the buzz around intelligent automation, but didn’t know where to start. Ultimately, they needed to digitize the entire function, as a precursor towards implementing automation. Our ESOAR methodology proved to be just the ticket.

ESOAR in action

We started by absorbing as much information as we could about claims value chain. We observed the process from end to end, examined the claims forms that were integral to it, and made sure we also understood the variety and content of the many different unofficial applications people were submitting.

One of the first things we established was that our client was capturing more information on the forms than it needed. This made claims processing cumbersome for the claims processors, and even discouraged some claimants from using the form in the first place. The key information was there, but it was buried.

Our understanding of the supplemental health insurance industry and claims processing proved both relevant and useful. It enabled us to partner with the client and then leverage our own cognitive data processing techniques to extract the key information we’d identified on each claim.

The application of this technology, backed by the insights we brought to the process, enabled us to create what was effectively a “data-extraction-as-a-service” operation, providing relevant, digitized data from our client’s pages annually, and identify up to 45 key fields from each claims packet. Armed with this information, adjudications could be made and obligations to customers could be met.


  • Remove unnecessary fields from the claims process, and the redundant tasks associated with them

  • Produce a single, standardized claims form featuring relevant client-specific data extracted from the 45 data fields…

  • … to simplify, streamline, and optimize processing, while continuing to deliver flexibility for claimants.

  • Extract and process claims data automatically…

  • … with human intervention only for exceptions

The journey ahead

What is emerging from our application of ESOAR principles in this case is effectively a holistic approach to digital transformation. It’s a project that constitutes work in progress. The journey – and benefits that will come form it – are still evolving and growing. Now we have digitized the client’s information and created a set of defined fields, the next step is to build an intelligent bot to automate the process, to a point where the claims team will only need to handle exceptions.

Importantly, we’re demonstrating that it’s possible to continue to meet an expectation, even when it becomes more of a challenge – as long as you assess and plan carefully, and you act in accordance with what you learn.

And that, too, is a lesson for life, as well as for business.

Despite being a transformation journey, the results our solution and the application of ESOAR methodology continue to deliver include:

  • Enhanced operational efficiency
  • Improved customer experience
  • Increased quality and compliance
  • Enhanced agility.

Aashish Jain is responsible for driving go-to-market strategies, strategic solutions, and alliance ecosystem to facilitate growth of Capgemini’s Insurance Services unit.