ACT’s Claims Process
Framework

Deliver Clarity, Consistency, and Confidence When Your Customers Need It Most

When customers experience a claim, our industry has the opportunity to demonstrate its true value. A claim often follows an unexpected, stressful, and sometimes life-changing event. During these moments, customers rely on their insurance agency and carrier for guidance, support, and expertise.

Helping clients navigate the claims process is one of the most important promises we make. It is an opportunity to reinforce trust and deliver on the value of insurance when it matters most.

Because claims situations can be emotional and complex, agencies should establish well-defined, documented processes for both agency staff and customers. Clear expectations and consistent execution help ensure a positive experience while supporting efficient claim handling. (Downloadable templates are available at the bottom of this page.)

ACT has developed high-level process frameworks to help agencies create a differentiated and customer-focused claims experience. As you review these frameworks and adapt them to your agency’s specific needs, consider the following factors that can significantly influence your approach.

Evaluate Your Current Processes

Before implementing significant procedural changes, take time to review your existing claims processes with your team.

Consider:

• What is working well today?
• Where are customers or employees experiencing friction?
• What feedback has your team received from customers?
• Are expectations and responsibilities clearly defined?

Engaging employees in the review process helps identify opportunities for improvement while creating alignment around any future changes. It also provides an opportunity to reinforce why delivering an exceptional claims experience is important to your agency and your customers.

Consider Your Agency’s Mix of Business

While all customers expect support and advocacy during a claim, the way that experience is delivered may vary based on your agency’s customer base, lines of business, and service model.

Although excessive segmentation can create unnecessary complexity, thoughtful differentiation can help align service delivery with customer expectations and agency goals. If your agency adopts different claims-service approaches for various customer segments, ensure those differences are clearly documented, communicated, and consistently applied.

Examples of Customer Segmentation

Personal Lines vs. Commercial Lines

Commercial and personal lines customers often have different expectations regarding communication and support.

For example:

• Personal lines customers may be more likely to use carrier-direct reporting options.
• Commercial clients may require more consultative support and coordination.
• Communication preferences may differ, with some customers preferring phone conversations while others favor email, text messaging, or digital portals.

High-Net-Worth, Standard, and Non-Standard Personal Lines

Agencies may choose to provide varying levels of outreach, monitoring, or personalized service based on customer needs, expectations, and relationship value.

Small Commercial vs. Middle Market and Large Commercial Accounts

Commercial claims service models may differ based on:

• Premium size
• Revenue contribution
• Complexity of operations
• Length and depth of the customer relationship
• Risk management requirements

Other Lines of Business

Specialized products such as Surety, Life, and other niche coverages may require unique claims workflows and additional planning.

Leverage Existing Technology

When evaluating opportunities to improve efficiency and consistency, many agencies immediately begin looking for new technology solutions.

Before investing in additional tools, take a close look at the capabilities already available within your existing technology ecosystem. Agency management systems, customer communication platforms, CRM solutions, and carrier integrations may already offer functionality that supports automation, workflow management, task reminders, reporting, and customer communication.

If gaps remain, explore solutions that align with your agency’s strategy and customer experience goals. Many claims-related processes can be automated and customized to improve both operational efficiency and customer satisfaction.

Understand Carrier Capabilities

Carriers play an important role in the overall claims experience. Because capabilities vary among carriers, agencies should maintain a current understanding of the tools, services, and support options available to policyholders.

Make it a regular practice to review carrier offerings and stay informed about enhancements, new technologies, and service improvements.

Key capabilities to evaluate include:

• First Notice of Loss (FNOL)
• Direct claim reporting
• Claims status tracking
• Preferred provider or contractor programs
• Auto glass repair programs
• Claims download and integration capabilities
• Digital communication and customer self-service options

Understanding these capabilities can help agencies design service models that maximize both efficiency and customer value.

Consider Related Business Processes

The primary goal of any claims process is to support customers with accuracy, efficiency, and empathy. However, claims interactions can also create opportunities to strengthen relationships and improve other areas of agency operations.

Examples include:

Referrals

Following a satisfactory claim resolution, customers may be more willing to refer family members, friends, or colleagues to your agency.

Customer Feedback and Experience Measurement

If your agency tracks customer satisfaction, Net Promoter Score (NPS), or other customer experience metrics, the post-claim period can provide valuable feedback and insights.

Coverage Reviews and Cross-Selling

Claims often reveal coverage gaps or changes in customer circumstances. A post-claim review may uncover opportunities to strengthen risk management strategies or discuss additional coverage needs.

Customer Information Updates

Claims interactions can provide an opportunity to verify and update:

• Contact information
• Communication preferences
• Household or business changes
• Other customer data that supports future service and marketing efforts

Communicate Internally and Externally

Successful process improvement requires effective communication.

Internally, ensure employees understand:

• What is expected
• Why the process matters
• How responsibilities should be carried out
• How performance will be measured

Externally, make claims guidance readily available through:

• Your agency website
• Mobile applications
• Customer portals
• Social media channels
• Email communications
• New customer onboarding materials

Customers do not always expect immediate answers, but they do value clear expectations, consistent communication, and reliable follow-through. Agencies that establish and meet those expectations can create meaningful differentiation and strengthen customer trust during some of life’s most challenging moments.