Claims Transformation Qorus-NTT DATA Innovation in Insurance Awards 2026

Prudential’s Claims Transformation Initiative reimagined the claims journey to be faster, simpler, and more empathetic—delivering a digital-first, omnichannel experience that supports customers when they need it most. The objective was to replace paper-heavy, manual workflows with self-service intake, touchless adjudication, and seamless electronic payment, improving both customer and employee experience while lowering cost-to-serve.

The transformation was driven by clear pain points: traditional claims processing relied heavily on paper and manual steps, customers encountered complex forms and limited digital options, and turnaround times did not match evolving expectations for convenience and speed. In a market where many competitors provide only basic digital notification and payment options, Prudential saw an opportunity to lead with deeper automation, greater transparency, and faster time-to-pay—setting a higher standard for the overall beneficiary and customer experience.

Delivered through phased rollouts, the initiative built a modern claims ecosystem anchored by a mobile-friendly First Notice of Loss (FNOL) portal and IVR call deflection that routes customers to SMS self-service. Prudential enabled touchless digital claim processing with automated adjudication and electronic funds transfer (EFT) payments. GenAI capabilities—intelligent document processing and LLM-based call summarization—reduced administrative burden and improved consistency, while eSignature and email notifications accelerated communications and reduced reliance on mail, helping customers stay informed throughout the process.

Execution excellence came from tight cross-functional collaboration: Agile Technology and product leadership partnered with data science, claims examiners, telephony experts, customer service teams, and control partners in risk, legal, and compliance. The team overcame the central challenge of moving to fully digital workflows in a highly regulated environment by designing human-in-the-loop controls, updating intake tools and call-center scripts, and sequencing pilots and staged releases to protect service continuity.

Results to date demonstrate clear, sustainable impact. Manual intervention has been reduced by 80%, enabling a 35% productivity gain and $3M in operating cost savings. Payment speed improved dramatically—99% of payments are completed within four days, and 93% are processed within one day for straight-through claims. Customer experience improved, including a 24-point increase in Ease of Doing Business. Transparency gains reduced claim-status calls by 60%, while proactive notification emails increased by 114%. Digital adoption strengthened materially, with eSignature usage rising from 22% to 49% and email notifications from 26% to 63% (Jan–Apr 2025); U.S. Mail decreased by 10% while email delivery increased by 49% and eSignature delivery increased by 16%.

With a scalable foundation in place, Prudential will continue expanding digital experiences and automation to additional business units, broaden intelligent document reading to more document types, and enhance AI-driven next best actions—extending the benefits of speed, clarity, and empathy across the enterprise.