Gamify Claim Handling

Engage, Explore, Solve, Deliver & Need, Feature, Benefit

 • “Gamification is effective in
increasing engagement in online
programs” (Looyestyn et al,
2017)
Does gamifying • “Interaction with game elements
work increase facilitates basic psychological need
satisfaction” (Bitrián, Buil, Catalán,
user 2021)
engagement? • “Gamification can boost employee
morale and increase retention”
(Fallon, 2023)
 Proposed Gamification model

  Engage Explore Solve Deliver

Calls
• Greet • Ask appropriate questions 1. Need - Based on explore, what does 1. Offer/Provide solutions to the member
• Confirm member is • Allow member to speak in relation to the the member need? 2. Set expectations regarding how the
speaking to the claim 2. Feature - What resources/capabilities solutions address member's needs and
right person • Follow the Thread (Vulnerability cues i.e., do we have to address needs?(i.e., the expected timeframes for the
determine presence and extent of service suppliers, HyperCare, solutions to have desired effect
vulnerability, Complaints i.e., what is the Complaint process)
root cause and desired resolution) 3. Benefit - How will addressing needs
in this way benefit the member?
Claims
• Identify claim for • Ascertain loss cause? 1. Need - Based on explore, what does 1. Offer/Provide solutions to the member
action • Do we know if coverage is applicable? the claim need? 2. Set expectations regarding how the
• Is this claim a • What has been done so far? 2. Feature - What resources/capabilities solutions address member's needs and
workflow priority? • What is likely required to progress do we have to address needs? (i.e., the expected timeframes for the
• Am I equipped to further? service suppliers, HyperCare, solutions to have desired effect
manage this Complaint process)
claim? 3. Benefit - How will addressing needs
in this way benefit the member?
References
Looyestyn J, Kernot J, Boshoff K, Ryan J, Edney S, Maher C (2017) Does
gamification increase engagement with online programs? A systematic
review. PLoS ONE 12(3): e0173403.
https://doi.org/10.1371/journal.pone.0173403

Bitrián P, Buil I, Catalán S, Enhancing user engagement: The role of

gamification in mobile apps, Journal of Business Research, Volume 132,
2021, Pages 170-185, ISSN 0148-2963,
https://doi.org/10.1016/j.jbusres.2021.04.028. (
https://www.sciencedirect.com/science/article/pii/S0148296321002666)

Fallon, N. (2023, February 22). Gamifying Your Workforce: How to Make

Employee Engagement Fun. Www.businessnewsdaily.com. Retrieved
February 22, 2023, from https://www.businessnewsdaily.com/8258-
gamification-employee-engagement.html.