The Insurer's Guide to a Better Claims Customer Experience

Guide policyholders through claim submission

Imagine a policyholder gets stuck uploading a document and calls your support team. The agent asks them to try again, but the same error appears. The conversation ends with the claim still unfinished. We know you've been there.

To address these kinds of problems, look at the questions and obstacles your support team handles during submission. Then use those conversations to find where agents need clearer guidance, a more practical way to help, or a route to someone who can resolve the issue.

Focus on these practical improvements:

• Create a checklist for each claim type showing which documents are needed at submission and which can follow later
• Prepare approved wording and examples for questions policyholders regularly misunderstand, like the incident date, the circumstances of a loss, or the documents being requested
• Document troubleshooting steps for your digital self-service tools, covering failed uploads, file requirements, and common error messages
• Use cobrowsing to enable your agents to securely scroll, click, or annotate on the claim page alongside your policyholder and guide them through confusing fields, upload steps, or error messages

When submissions come in right the first time, no one has to chase missing details, because nobody enjoys chasing down loose ends.

Keep policyholders informed while their claim is reviewed

"Your claim is under review" is one of the more frustrating messages your policyholder can get. It leaves them with more questions than answers. "When will they be done?" "Have I forgotten any documents?" "I hope my claim comes through soon."

We know your agents aren't making claims decisions, but they do need enough detail to ease the anxiety of your policyholders. Agree in advance with your claims department which information agents receive, how to keep the information current, and what they can and cannot share with policyholders.

Build your update process around the questions that come up while policyholders are waiting:

• Make the date and source of the latest claim update visible to agents so they know how current the information is
• Choose which events can automatically trigger an update, like a completed assessment or a request for more evidence
• Make every request for more information specific: what's missing, why it's needed, and where to send it
• Set reminders for promised updates, and contact policyholders when an expected date changes, with the reason and the new timeframe

Improve handoffs between agents and channels

Transitions are always challenging for support teams. Your policyholder usually starts with live chat or chatbot support, then calls because their problem is still unresolved. When an agent answers the phone they have no record of previous conversations and your policyholder has to start all over again.

To smooth this friction, filter your customer service escalation workflows using conversations that involve a transfer or channel change. Follow what happened in similar conversations with policyholders, including the information provided, who was responsible for solving it, the number of transfers, and the ultimate resolution, to determine where your workflows fall short.

Here are some tips to help make your search for call transfer friction more successful:

• Define which questions require technical support, a claims handler, or a supervisor, based on the skills and authority needed to resolve them
• Use a short handoff note containing the claim reference, the unresolved question, actions already tried, and any promises made
• Test a conversation that moves from chatbot to live chat to phone, and check that the receiving agent can retrieve the earlier messages
• Keep responsibility with the referring agent until the receiving person or department accepts the handoff

Explain claim decisions and next steps clearly

A policyholder expecting a payout learns that only part of their claim has been approved. They're annoyed and trying to understand what happened while simultaneously working out how they're going to cover the remaining costs.

Help your agents manage expectations by preparing them for both parts of the conversation. Agents need an accurate explanation from the claims department and the skill to talk through what those outcomes mean for your policyholder.

Use real conversations from your claims customer service team to practice how agents should:

• Walk through the reasons and relevant policy terms in plain language, including how the payment amount was determined
• Give policyholders room to explain their concerns, acknowledge what they've said, and check which questions remain unanswered
• Cover any next steps, the payment arrangements, and how to request a further explanation or review
• Know when to involve a claims specialist or supervisor, particularly when questions go beyond their knowledge or authority

Remember to keep personal support available and compassionate when policyholders are grieving, facing financial hardship, or disputing a decision. Make it obvious how they can reach someone to talk through their situation, and give agents enough time to handle these calls with care.

Find and address recurring problems in your claims customer service

A complaint is easy to treat as something to smooth over and move past. But when you take it seriously, it does two jobs at once: the policyholder feels heard, and you learn exactly where your process is letting people down.

"I had to call three times" gives you something specific to investigate. Was the policyholder waiting for an update, receiving conflicting answers, or being passed between departments? Reading the comment alongside the conversation history helps you find what needs to change.

To turn feedback into fixes:

• After each claim closes, send a short survey that asks separately about the outcome and the support received, including how easy it was to get an answer they understood.
• Group feedback by the point where the problem occurred, whether during submission, progress updates, transfers, or the decision conversation.
• Choose a recurring problem, assign an owner, and record the change being made, like revising an upload guide or adjusting callback reminders.
• Compare feedback and repeat contacts before and after the change to see whether it improved customer satisfaction.
• Thank policyholders for their feedback and tell them what you changed because of it, even if it's a small fix.

For a broader view, use Net Promoter Score (NPS) surveys to ask how likely policyholders are to recommend you. Follow the rating with a question about why they gave that score, and read those comments to understand customer sentiment.

Share findings that need action from claims, product, or IT, with real examples from the feedback. If you have renewal data, compare customer retention with claims feedback over time, keeping in mind that price and coverage changes also play a part.

1. Customer relationship management (CRM) platforms for profile tracking

A CRM platform gives your insurance agents one place to see who the policyholder is: their policies, past claims, recent conversations, and open requests.

Agents spend less time searching across systems and more time answering the question in front of them. It also makes it easier to notice when someone needs extra care, like after a second claim within a few months. Compare more options in our guide to the best CRM for insurance agents.

Recommended platform: Salesforce Financial Services Cloud, which pairs Salesforce's service tools with an insurance data model and an optional claims management add-on.

2. Omnichannel help desk tools for ticket communication

An omnichannel help desk brings email, live chat, messaging, and phone into one workspace, with one conversation history for each policyholder. This tool helps with the handoff problem we covered earlier: when a chat turns into a phone call, the next agent sees everything that's already been said.

Look for routing rules, saved replies, and reporting on resolution times so you can see where claim questions slow down.

Recommended platform: Zendesk, which combines ticketing, messaging, voice, and AI tools in one agent workspace.

3. Cobrowsing integration for high-friction guidance

Some claim problems don't fit into workflows, no matter how much we want them to. A failed upload, an error message, or a confusing question is far easier to fix when your agent can securely see and navigate through your customer's same screen.

Cobrowsing lets your agent join the policyholder's browser tab in seconds, point to the right field, and guide them through each step, with no downloads and sensitive fields masked from view.

Recommended platform: UserView cobrowsing is designed for high-friction support. It connects in under three seconds with a four-digit code and embeds directly into Salesforce, Zendesk, and Intercom.

4. Knowledge base software for self-service answers

Many claim questions repeat: which documents a beneficiary needs, what an explanation of benefits means, how long a review usually takes. A knowledge base answers them in plain language before anyone picks up the phone, and gives your agents the same approved answers to share during calls.

If Zendesk is already your help desk, its built-in help center covers the basics. For more control over structure, languages, and search, a dedicated tool is worth a look.

Recommended platform: Document360, which publishes public and internal articles from one place, supports more than 40 languages, and shows which searches don't return an answer.

5. Feedback and survey platforms for sentiment gathering

Survey platforms turn "I had to call three times" into something you can measure. Send a survey right after the claim decision, and link each response to the conversation history so you can see what went wrong.

Recommended platform: SurveyMonkey Enterprise, which offers HIPAA-compliant surveys for teams handling health information.