Mr. Koonce is the Chief Claims Officer, for Sedgwick. In this role, Koonce is responsible for product development and innovation, industry analysis and thought leadership, best practices and compliance standards, legislative and regulatory relationships, and continued involvement in client programs for Sedgwick’s lines of business.
Prior to his current role, Koonce was the Managing Director responsible for Sedgwick’s casualty retail business unit in which he oversaw program results and service execution across the company’s retail customer base. This included use of innovation and technology to improve client outcomes and customer experience.
Prior to joining Sedgwick, Koonce was senior director of risk management for Walmart Stores, Inc., the nation’s largest private sector employer. In this role, he managed the retailer’s domestic property and casualty claims program. He simultaneously served as president of Claims Management, Inc., Walmart’s wholly owned third party administrator. An attorney by trade, Koonce was previously an administrative law judge for the Arkansas Workers’ Compensation Commission and an appellate court justice for the Arkansas Court of Appeals.
Koonce has served on various state self-insured association boards, as well as the National Council of Self Insurers (NCSI), and National Unemployment and Workers’ Compensation (UWC). He continues to serve as a member of several local non-profit boards and industry risk management advisory boards.
Koonce earned his BBA degree in economics from Harding University and his JD degree from the University of Arkansas in Little Rock. He is licensed to practice law in the State of Arkansas and is a member of the American and Arkansas Bar Associations.
Following is the conversation we had with Koonce.
As the Chief Claims Officer at Sedgwick, could you provide an overview of your role and responsibilities within the company?
In my role as Chief Claims Officer at Sedgwick, I focus on a myriad of different areas within the company to support achievement of Sedgwick’s overall objectives with its clients, colleagues, and regulatory agencies. This includes supporting product development through evolvement of best practices, innovation, and collaboration with various partners within the industry; engagement with legislative and regulatory bodies regarding industry changes; ensuring compliance standards are being met within our property and casualty operations; industry analysis; and thought leadership.
What are some of the biggest challenges that you face in managing claims processes, particularly in the context of evolving regulatory environments and emerging risks?
I see three primary areas of focus in the current environment:
First, the industry is facing a talent crisis. According to the U.S Bureau of Labor Statistics, almost 500,000 insurance employees will retire soon. Additionally, a recent survey by The Institutes found that eight in ten millennials have limited knowledge of insurance career opportunities. The industry has a twofold challenge: a loss and a lack of experience and knowledge. Hiring, talent development and retention must remain a focus.
“Technology is a factor in simplifying processes, supporting various communication venues, and prompting proactive claims management.”
Second, we live in an environment where the expectations of individuals involved in the claims process are wide and divergent. Yes, each individual wants their claim addressed in an expeditious, efficient and fair manner. Yet the expectation of how to create a consistent and meaningful experience varies significantly. For most claims, people don’t know what to expect. They don’t understand the rules for claim determinations and get lost reviewing the documentation that is provided to them. By clearly explaining benefits, timelines, rules and the approval process, you provide support for a positive outcome in a challenging situation. Technology is a factor in simplifying processes, supporting various communication venues, and prompting proactive claims management. Companies must be prepared to accommodate the varying expectations of those in the claims process. If they do not, they risk greater exposure to unnecessary litigation, customer dissatisfaction, and ultimately higher costs that can be avoided.
Lastly, the healthcare environment plays a pivotal role within the claims process, particularly in workers’ compensation. The American Hospital Association estimates that the physician shortage will be at 124,000 by the year 2033 and that over 200,000 nurses are needed on an annual basis to meet the rising need in the healthcare industry. This challenge has the high potential to impact the manner and timeliness of medical treatment for injured employees who have filed workers’ compensation claims, which in turn would have numerous downstream effects. For those in the industry, ensuring that workers’ compensation medical networks counter these potential headwinds is critical to achieving the best possible outcomes for injured workers.
The insurance industry is evolving rapidly, with advancements in artificial intelligence, automation, and other emerging technologies. How do you see these technologies transforming claims management, and what benefits do they offer?
There is great promise for no-touch programs and automation across the claims spectrum. Certain segments like the low-severity, high-frequency claims space are finding immediate benefit—better outcomes, more fulfilling customer experience—from balancing new technology and automation with human intervention.
Technology will continue to transform the claims process and specific tools will emerge that improve performance and outcomes at points in the cycle. However, the broader goal is full end-to-end integration—bringing the right tools, data and people together to support the claims holistically for clients and claimants. Utilizing a combination of skilled and empathetic professionals, cutting-edge technology platforms and tech-enabled solutions, the needs of those within the claims administration process will be met in a more effective and efficient manner.
Additionally, the data used in benchmarking has evolved and become more sophisticated. This will provide organizations added direction to identify new ways to proactively optimize performance and promote improved outcomes within the industry.
As the Chief Claims Officer, what key trends or developments do you anticipate in the claims management landscape in the next few years?
The greatest development for the claims management landscape of the next several years will likely arise out of utilization of technology and data in three primary areas:
Communication: Claims management is a people experience business—user experience matters. Communication will continue to transform customer service, build more meaningful experiences, and influence how people engage throughout the claims process. Individuals within the process expect full service, instantaneous options and flexible communication options (such as voice-to-voice, text and chat).
Automation: Claims process automation and digitization of tools is occurring in large and small ways as we continue to push tech forward. Automating segments of the process and integrating rules-based decisioning can take a burden off of the claims professionals and spur the resolution process, which will improve the experience of those within the system.
Innovation: Forward-thinking organizations are data driven, leveraging the latest advances in technology strategically as well as securely. Utilizing both structured and unstructured data in new ways, decisions become optimized, supporting improved value and outcomes. Further, data and next-generation artificial intelligence combine to simplify complex processes, supporting real-time action to drive outcome improvement.
What advice would you give to young professionals who are interested in pursuing a career in insurance, and what qualities do you think are essential for success in this field?
There are many rewarding aspects of the insurance profession, specifically claims management, which offers the opportunity to contribute to helping people in the moment when support is needed. That desire in and of itself is a unique skill set. Other skills that are necessary are communication, math, analytical, and investigative. Even if those skills are not someone’s strongest traits, the opportunities exist to develop and nurture them within an environment such as with Sedgwick, where resources abound to sharpen one’s skills and grow their career.
In the past, the insurance industry has not been seen as a glamorous profession. The industry has evolved, however, and now offers many areas of focus that provide vast opportunities for career growth. Consider the increased use of data and technology, which offer opportunities for development alongside data scientists and programmers. Consider the opportunities for then utilizing these tools as part of your everyday responsibilities in claims administration. Compared to the past, there are so many different aspects of the profession that offer a wide array of careers for professionals who want to make a difference. Insurance can be as professionally and personally rewarding an industry as any.
