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🔧 '''Claim management''' is the end-to-end discipline of receiving, investigating, evaluating, and resolving [[Definition:Claim | claims]] filed against an [[Definition:Insurance policy | insurance policy]], encompassing every operational, financial, and customer-facing activity from [[Definition:First notice of loss (FNOL) | first notice of loss]] to final payment or [[Definition:Claim denial | denial]]. In the insurance industry, claims represent the moment when the promise embedded in the policy is tested — making claim management arguably the most consequential function an [[Definition:Insurance carrier | insurer]] performs. Effective claim management directly controls [[Definition:Loss ratio | loss ratios]], shapes [[Definition:Policyholder | policyholder]] satisfaction, and influences regulatory standing.

⚙️ A mature claim management operation begins with efficient intake and [[Definition:Triage | triage]], where incoming claims are categorized by complexity, [[Definition:Line of business | line of business]], and suspected [[Definition:Fraud | fraud]] indicators, then routed to the appropriate [[Definition:Adjuster | adjuster]] or automated workflow. Investigation follows — which may involve field inspections, third-party vendor coordination, medical record review, or forensic analysis — before the examiner sets an initial [[Definition:Loss reserve | reserve]] and negotiates the [[Definition:Claim settlement | settlement]]. Throughout this lifecycle, the [[Definition:Claim file | claim file]] documents every action. Modern [[Definition:Claims management system | claims management systems]] embed rules engines, [[Definition:Artificial intelligence (AI) | AI]]-powered damage estimation, and [[Definition:Straight-through processing (STP) | straight-through processing]] for low-complexity claims, allowing human expertise to focus on the files that genuinely require it. [[Definition:Key performance indicator (KPI) | KPIs]] such as [[Definition:Cycle time | cycle time]], [[Definition:Claim frequency | frequency]], [[Definition:Claim severity | severity]], and [[Definition:Customer satisfaction | customer satisfaction]] scores are tracked to drive continuous improvement.

💡 Well-run claim management does more than control costs — it generates strategic intelligence. Patterns uncovered through claims data feed back into [[Definition:Underwriting | underwriting]] and [[Definition:Product development | product design]], helping insurers refine coverage terms, adjust [[Definition:Pricing model | pricing]], and identify emerging [[Definition:Loss trend | loss trends]] before they materialize in financial statements. For [[Definition:Managing general agent (MGA) | MGAs]] and [[Definition:Insurtech | insurtechs]] that rely on delegated [[Definition:Claims authority | claims authority]], demonstrating disciplined claim management is essential for retaining [[Definition:Capacity | capacity]] from carrier partners. Poor claims practices, by contrast, invite regulatory action under [[Definition:Unfair claims settlement practices | unfair claims settlement practice]] laws, erode brand trust, and inflate [[Definition:Loss adjustment expense (LAE) | loss adjustment expenses]] that weigh on profitability.

'''Related concepts'''
{{Div col|colwidth=20em}}
* [[Definition:Claims management system]]
* [[Definition:Loss adjustment expense (LAE)]]
* [[Definition:Straight-through processing (STP)]]
* [[Definition:Adjuster]]
* [[Definition:First notice of loss (FNOL)]]
* [[Definition:Claim settlement]]
{{Div col end}}

Definition:Claim management - Revision history

PlumBot: Bot: Creating new article from JSON