Strengthening Claims Performance with a Claims Health Check
Claims operations sit at the center of insurance performance, directly influencing loss ratios, customer satisfaction, and overall profitability. At a time when carriers face rising claim severity, reserve pressure, talent constraints, and accelerating technology change, maintaining healthy claims operations is more critical than ever. Small breakdowns in claims handling, workflow design, or governance can quickly cascade into higher costs and poor customer outcomes.
ReSource Pro’s Claims Health Check provides a comprehensive, data-driven assessment of claims practices—helping carriers identify inefficiencies, reduce operational risk, and strengthen bottom-line results through practical, execution-ready insight.
Why Claims Operations Require a Health Check
Claims departments are not traditionally viewed as profit centers, yet they directly influence an estimated 55%–60% of gross written premium. Even modest inefficiencies in reserving accuracy, claim cycle times, vendor usage, or adjuster productivity can have an outsized financial impact.
Many carriers struggle to gain a clear, objective view of claims performance. Data is often siloed across systems, legacy processes vary by line of business, and internal benchmarks may lack external context. As a result, leaders may know something isn’t working—but not where the root causes lie or how best to prioritize improvement.
The Claims Health Check is designed to deliver an unbiased, end-to-end evaluation that goes beyond a traditional audit. Rather than focusing solely on compliance, it examines how claims operations actually function day to day—where work flows smoothly, where it breaks down, and how decisions impact cost and customer experience.
A Collaborative, Insight-Driven Approach
ReSource Pro takes a collaborative approach to claims assessment, working closely with claims leadership, supervisors, and frontline staff throughout the engagement. This ensures findings reflect operational reality rather than theoretical best practices.
By engaging the people closest to the work, the Health Check builds shared understanding and encourages ownership of outcomes. Recommendations are shaped by how claims teams operate in practice—not how processes look on paper.
The assessment integrates process analysis with organizational and technology alignment, confirming that people, workflows, data, and systems are working together effectively. Where misalignment exists, it becomes visible and actionable.
Proprietary Views into Claims Performance
A defining element of the Claims Health Check is ReSource Pro’s proprietary Views—targeted analyses that examine the core components of a healthy claims operation. Each View provides focused insight while contributing to a comprehensive, enterprise-level perspective.
Core Views include:
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Resource Management: Evaluates workload distribution, staffing models, productivity, and skill alignment.
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Workflow Process: Reviews end-to-end claim handling processes to identify bottlenecks, rework, and unnecessary handoffs.
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Financial Analysis: Assesses reserving practices, leakage, expense drivers, and cost containment opportunities.
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Best Practices: Compares current operations to proven industry practices across lines and claim types.
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Vendor Management: Examines how external vendors are selected, managed, and measured for performance and cost control.
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Customer Service: Evaluates communication, responsiveness, and consistency across the claim lifecycle.
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Technology: Assesses system utilization, automation, and alignment between tools and workflows.
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Analytics: Reviews how data is used to monitor performance, detect risk, and support decision-making.
Together, these Views surface insights that are often difficult to see internally—revealing both strengths and hidden gaps.
Actionable Deliverables and Clear Outcomes
The Claims Health Check can be delivered as a comprehensive review or as a targeted assessment focused on specific operational areas. Regardless of scope, engagements produce clear, actionable deliverables designed to drive execution.
Key outputs include detailed analysis of risk and opportunity areas, predictive analytics and modeling to support early identification of potential fraud, and prioritized recommendations tied directly to measurable outcomes. Importantly, the engagement also includes a practical implementation plan outlining how to operationalize improvements—not just what to change.
This ensures insights translate into action rather than remaining static reports.
Measurable Benefits for Carriers
Carriers that complete a Claims Health Check gain clarity and control over claims operations. Typical outcomes include estimated savings of 2%–4% on combined ratios, improved claim cycle times, higher adjuster productivity, and more consistent customer experiences.
By reducing inefficiencies and strengthening governance, carriers can better manage loss costs, control expenses, and improve service quality—without sacrificing compliance or oversight. These improvements are especially valuable in a claims environment defined by rising complexity and heightened customer expectations.
Why ReSource Pro
ReSource Pro’s consultants bring deep insurance, claims, and risk management expertise to every engagement. With firsthand industry experience and proprietary analytical frameworks, the team delivers informed, objective insight into the people, processes, and technologies shaping claims performance.
Rather than prescribing generic solutions, ReSource Pro helps carriers understand what is working, what isn’t, and where to focus next. The Claims Health Check strengthens claims operations today while laying the groundwork for future efficiency, resilience, and sustained performance in an increasingly demanding insurance landscape.
