Waterdrop Insurance's "Help Compensation" has assisted in claims exceeding 1 billion over three years, addressing users' claims pain points

Recently, Waterdrop Insurance held an online live broadcast for the third anniversary of its "Help Compensation" service, titled "From Micro Light to Torch: Walking Together with Love," to answer users' questions about insurance purchases and services, and to introduce the growth journey and service achievements of "Help Compensation" over the past three years. Data shows that the "Help Compensation" service has handled over 200,000 claims cases, assisting in claim amounts exceeding 1 billion yuan, with 88% of Waterdrop Insurance users choosing the "Help Compensation" service when facing claim issues.

Figure: "Help Compensation" Third Anniversary Live Event

Building a "Four Helps" Service System to Address Users' Claim Pain Points

In 2022, Waterdrop Insurance launched the "Help Compensation" claims service, innovatively establishing a full-process service system of "Help Application, Help Review, Help Interpretation, Help Mediation." When facing users' claims inquiries, "Help Compensation" consultants proactively understand the users' overall policy situation, help users determine which policies can be claimed, the order of claims, and provide comprehensive claims consulting and agency services. In 2024, Waterdrop Insurance will further upgrade the user service experience by launching a "Three Good Services" model centered on good service, good products, and good claims, covering the entire process of insurance services including insurance planning, product customization, and claims services, continuously pushing insurance services towards higher standards.

A relevant person in charge at Waterdrop Insurance stated that insurance products have a high professional barrier, and users need professional full-process services. Research shows that 80% of users hope for more efficient and convenient claims, and 73% of users require clear explanations of claim results. Providing a full-process companion service that can answer users' questions at any time and assist in applying for claims when risks arise is very necessary.

Over the past three years, "Help Compensation" has continuously practiced the service concept of "one-on-one full-process assistance," providing users with professional and warm claims services. A user from Sichuan, Brother Cai, was hospitalized due to acute myocardial infarction and previously claimed 400 yuan from his medical insurance on his own. Later, when applying for critical illness insurance through Waterdrop Insurance, the "Help Compensation" team discovered that Brother Cai had failed to meet the critical illness standards due to a missing key laboratory report when applying for medical insurance, resulting in a deduction of 10,000 yuan from his deductible. With the assistance of "Help Compensation," Brother Cai ultimately successfully received 150,000 yuan in critical illness insurance claims and recovered 10,000 yuan in medical insurance claims. Brother Cai's case is a microcosm of Waterdrop Insurance's "Help Compensation" service. So far, the "Help Compensation" service has handled over 200,000 claims cases, assisting in claim amounts exceeding 1 billion yuan.

AI Empowering the Claims Service Process, Intelligent Upgrades Achieving Efficient Service

With the empowerment of AI, "Help Compensation" has also welcomed a service upgrade. Data from "Help Compensation" shows that each year, claims for medical insurance due to malignant tumors account for about one-third of the total claims for million medical insurance, with one in two malignant tumor patients continuing to apply for subsequent treatment claims; in outpatient and emergency insurance, 31% of users will make multiple claims under the same policy This group of users typically makes periodic or relatively frequent claims, and they require higher efficiency in claims services. Therefore, in the "assistance with application and review" service, for high-frequency claim users such as cancer patients, "Help Claim" automatically completes material identification, classification, and integrity review through an intelligent system, allowing for quick claims processing within 1-2 hours, truly achieving timely fund turnover for major illness users and rapid feedback for small claim users.

In the "assistance with interpretation and mediation" service, the platform will introduce AI big data capabilities to assist in determining claims conclusions based on professional data such as insurance terms, medical materials, and medical diagnostic standards, reducing manual review bias. For example, whether the disease in a medical insurance claim meets the major illness standard; whether the judgment of mild, moderate, and severe conditions in critical illness insurance is accurate and if there are any omissions; and in the claims practice of products without health declarations, whether the determination of "pre-existing conditions" and "complications arising from pre-existing conditions" is reasonable, etc.

The long-term goal of the "Help Claim" service is not only to focus on individual case handling but also to improve the fundamental issues reflected in the claims process. To this end, Help Claim will launch a claims service video account in 2025, having already released over 100 popular science videos covering insurance category introductions, medical insurance knowledge, claims processes, etc., to help users understand the claims process in advance.

A Glimmer Becomes a Torch, Building a Comprehensive User Rights Protection System

In terms of enhancing user experience, Waterdrop Insurance will fully upgrade its membership system in 2024, providing a wealth of member benefits. It has selected three major service resources, accumulating over 30 benefit items, covering health management services, green channel medical services, and high-end customized services to meet various customer needs.

In addition, Waterdrop Insurance continues to improve its safety protection system. In response to the "agent policy cancellation" and other black market issues in the insurance market, Waterdrop Insurance relies on AI technology to build an anti-black market supervision model and has established a special governance team to effectively combat black market behaviors such as "agent policy cancellation."

Over the past three years, Waterdrop Insurance's "Help Claim" service has evolved from creating processes and enhancing experiences to comprehensive coverage. In the future, the platform will continue to practice the three good principles of "good service, good products, good claims" to create more value for users