Spotlight on Complex Claims

Coming from a law background, Alex joined Pro Global in the Summer of 2022 as part of the Complex Claims team, which was relatively new. She previously worked at an insurer and subsequently a claims solicitor on asbestos-related claims for claimants. 

We were lucky enough to catch up with Alex and shine the spotlight on her role – including her journey at Pro Global, her perspective on the evolving claims landscape, and the rewarding – and sometimes challenging – nature of handling complex claims.   

Key challenges 

Alex highlights that complex claims often present consistent challenges, particularly due to intricate policies with lengthy exclusions and confusing excess terms. Additionally, meeting Service Level Agreements (SLAs) – contracts that outline the required service standards for insurance providers – is essential for securing client agreements. 

But now “everything is becoming more streamlined” with technology and data analytics playing a major role in improving claims processes.  

Alex says: “We have end-to-end claims processing, everything is within the same system – from intimation, policy record searching, payments, to closure. 

“Pro Global Claims is also developing an updated claims processing system, which will speed things up even further, as well as provide transparency to clients as they can access the system – our team for Prudential’s claims are already using it, and it will be ready to use by leading insurers within the next few months. Data capture – this is easily extracted so we can see trends in our handling and SLA efficiency.” 

In addition, with fraudulent claims, data capture is pivotal in triaging suspect claims and identifying fraudulent patterns through comparison with other evidence. 

Human in the loop  

Despite this digitalisation, Pro Global advocates a balanced approach between technology and the human in the loop. As trusted advisors to the global re/insurance sector, the experts at Pro Global have an unmatched perspective of the trends, opportunities and challenges impacting the sector operationally and financially around the world.  

“When I started my very first job in the legal sector, it was pretty much all paper files. At Pro Global it’s all electronic, you can answer any query, and I can do more in less time,” Alex adds.  

She pinpointed 2014 to 2015 as the “pivotal years” for the changeover from manual to digital systems.  

Alex says: “Before joining Pro Global, I had never worked with such a diverse group of professionals. There’s always someone to turn to for questions, each bringing valuable experience and insights. The most rewarding part of her job is successfully navigating intricate legal challenges that arise as well as working with her team.” 

The business has an open forum where case or trial legalities as well as unusual or groundbreaking evidence can be shared. 

Alex says: “We have a mixture of experience – many people who worked for years directly for insurers, now work on their book of business within Pro Global. This brings such a depth of understanding of policies and procedures. We then also have a vast range of experience from other insurers, law firms, and industries, it is the most cohesive and knowledgeable workforce I have ever been part of.” 

Describing the claims team in one word – ‘strategic’ – she concludes: “Every claim is different, and from the outset and needs its unique strategy”.