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Fundamentals of IRIS Model for Claims Management

Fundamentals Of IRIS Model For Claims Management

IRIS Model for Claims Management is a new concept in the field of Insurance Management. 

The successful implementation of IRIS model is the core for any Insurance department of any Organization.

Once implemented, it will serve as backbone for Insurance department of any Professionally Managed Organization.

What is Risk

The term “Risk” has many meanings. In Insurance parlance it refers to the exposure to any possible danger.

As per Investopedia

Risk is defined in financial terms as the chance that an outcome or investment’s actual gains will differ from an expected outcome or return.

Risk includes the possibility of losing some or all of an original investment.

As per Corporate Finance Institute

In finance, risk is the probability that actual results will differ from expected results. In the Capital Asset Pricing Model (CAPM), risk is defined as the volatility of returns.

The concept of “risk and return” is that riskier assets should have higher expected returns to compensate investors for the higher volatility and increased risk.

IRIS Model of Claims Management

Claims Management is the integral part of any Organization’s Insurance and Risk Management programme.

Claim Control and Management is the KPI (Key Performance Indicator) of any Insurance or Risk Manager.

There are many tools and IT enabled services available for Claims management.

But here we are discussing about the very interesting tool which is known as IRIS Model of Claims Management.

IRIS Definition

IRIS Model refers to the systematic approach of Organization’s Incident Reporting and Information Management System(IRIS Model).  It can be managed either electronically or manually.


IRIS Model serves as a base for

  • MIS preparation
  • Claim Control
  • Claim Analysis
  • Decision making
  • In IRIS framework, each and every Incident or near miss accidents recorded and reported with all vital facts and available information.

Under IRIS framework, the reporting and recording of each and every Incident is the base of IRIS.

It creates the next step in this process by generating MIS report.

This MIS will further use in inter related departmental use.

The systematic recording of data provide base for  Claim analysis, which further lead to help to take concise decision for Claims control

  • IRIS Model is an Organized way to register incident online with all vital information in tailor made format and it further links to interested parties in this information.
  • It facilitate use of less Email exchanges for each information
  • It presents a bird eye view of all vital information, which is required for lodging any claim to insurers
  • Digitally record of Information
  • The retrieval of information is easy and data can be fetched anytime anywhere whenever required
  • The respondent will also get a copy of responses submitted by him
  • The information recorded through this can be analyzed in various formats

Advantages of IRIS?

  • Faster Claim reporting
  • Minimum information dilution
  • Interactive way of Claim reporting
  • Ease in Information retrieval Digitally recorded data
  • Data Analysis & Reporting
  • Centrally information reporting
  • Increased Productivity and Efficiency

How to Proceed for IRIS?

For adoption of IRIS the Central Insurance team or concern department, should take initiative in designing and implementation of IRIS.

While designing IRIS, following points should keep in mind:-

  • Past Claims details like nature, frequency, area etc. (if available)
  • Challenges for Claims Management
  • Key department related to Claim information
  • End user of IRIS generated Information
  • Once all above information available then the designing of IRIS could be initiate by designing Flow charts of processes and information.