The Challenge of Managing Claims in Today’s Environment
Claims in the insurance sector can arise for multiple reasons: discrepancies in coverage, delays in compensation, errors in documentation, among others.
Each claim requires personalized, agile, and transparent attention, allowing the client to feel heard and supported.
However, many insurers still manage these processes in a fragmented manner, with disconnected channels, long response times, and little traceability. This not only affects customer satisfaction but also exposes the company to legal and reputational risks.
Service Cloud as an Intelligent Care Platform
Salesforce Service Cloud allows insurers to centralize claims management on a single platform, connecting all care channels (phone, email, chat, social networks, web forms) and activating automated flows that guide the agent in each step of the process.
From the opening of the claim to its resolution, Service Cloud offers functionalities such as:
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Automatic case assignment according to priority criteria, specialization or workload.
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Complete visibility of the customer’s history, including policies, claims, previous communications, and documentation.
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Activation of workflows to request additional information, validate documents, or escalate the case.
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Integration with internal systems such as ERP, document manager, or compensation platforms.
However, for this process to be legally robust, it is necessary to incorporate a layer of digital certification that guarantees the authenticity, integrity, and traceability of communications.
CertySign: Certified Communications with Probative Value
The integration of the Salesforce connector product with CertySign with the Salesforce Service Cloud solution allows automating omnichannel communications with legal value to ensure that each interaction with the client is recorded with electronic evidence valid before third parties.
In the context of claims management, CertySign allows compliance with regulations such as GDPR, eIDAS, NIS 2, and DORA, ensuring the auditability of the process for:
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Request documentation from the client (invoices, medical reports, photographs, etc.) through channels such as email, SMS, or WhatsApp, with certified acknowledgment of receipt.
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Send legal notifications about the status of the claim, case resolution, or rights of the insured, with complete traceability.
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Record electronic evidence of each communication, including date, time, content, IP, device, and geolocation.
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Archive documents in a legally valid format, with time stamping and electronic signature if required.
Benefits for the Insurer
✅ Improvement of Operational Efficiency
By automating the reception of documentation, data validation, and sending of notifications, the resolution time of each case is reduced. Agents can focus on value-added tasks, while the system manages routine interactions.
✅ Legal Security
Each step of the process is supported by certified electronic evidence, which protects the insurer against possible litigation, claims before regulatory bodies, or internal audits.
✅ Superior Customer Experience
The client receives clear, timely, and reliable communications through their preferred channels. The transparency and traceability of the process generate trust and reduce frustration.
✅ Cost Reduction
The digitalization and automation of communications allow reducing the use of paper, physical messaging, and telephone calls, optimizing the resources of the customer service area.
✅ Regulatory Compliance
The solution guarantees compliance with European and national regulations on data protection, electronic contracting, and evidence management, avoiding sanctions and strengthening the company’s reputation.
An Inspiring Case
Let’s imagine an insurer that receives a claim for damage to the home.
From Service Cloud, a case is automatically opened, and a request for documentation is sent to the client via certified email. The client responds with photographs and invoices, which are archived with probative value.
The agent reviews the documentation, validates the coverage, and sends a resolution to the client by certified SMS, indicating the amount of compensation and the payment term. The entire process is recorded, with complete traceability and electronic evidence that supports each decision.
In conclusion, this approach not only streamlines the resolution of the case but also protects the insurer against possible disputes and improves the client’s perception of the service.
