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      Navigate claims complexity with confidence

      In today’s complex and highly regulated claims environment, organisations face mounting challenges – from inefficient systems and rising claim volumes to increased scrutiny from regulators. Poor performance can lead to reputational damage, financial penalties and loss of licence. 

      KPMG’s Claims Management service helps clients overcome these challenges with scalable, high-impact solutions across six strategic pillars: claims remediation, claims managed services, claims transformation, claims risk and compliance, grants management and complaints handling. 

      By combining deep technical know-how, digital innovation and operational excellence, we deliver measurable outcomes that enhance operational efficiency, strengthen compliance and improve financial performance – driving long-term sustainability and value.

      Service offerings

      KPMG provides the following services to businesses:

      Smiling, happy work colleagues at a work meeting

      Driving value through claims support

      Our end-to-end Claims Management services are designed to support insurers, employers and government schemes, improve accuracy, streamline operations, strengthen compliance and drive cost efficiency. 

      Managed services and grants management

      Our offering includes delivering outsourced claims and injured management services aligned with global best practices. We also work with clients to improve the integrity, transparency and efficiency of grant disbursement and oversight.

      Claims remediation and complaints handling

      We help clients address systemic underpayments and legislative misapplications and enhance customer trust and regulatory compliance through robust, responsive complaints resolution frameworks.

      Claims transformation, risk and compliance

      We work with clients to strengthen governance through audits and uplift programs, and redesign operations using predictive analytics and digital tools. We bring deep knowledge in defining digital functional requirements and operationalising both digital and business transformations.

      Tech enablers streamlining claims and operations

      • Workers’ compensation calculators

        Automated tools for pre-injury earnings and weekly benefit calculations.

      • Life insurance benefit calculators

        Streamline and standardise benefit assessments.

      • Predictive analytics

        Leverage data-driven insights to anticipate trends and improve decision-making.

      • Cognitive intelligent automation

        Enhance processing speed and accuracy through AI-powered automation.

      • Digital claims platforms

        Modern, scalable platforms that support end-to-end claims lifecycle management.

      How we help you improve claims management

      • Ensure scalable, accurate remediation

        Resolve systemic issues such as incorrect benefit payments using robust methodologies and advanced tools, helping restore trust and confidence among stakeholders.

      • Bring trust to outsourced services

        Benefit from high-quality claims, grants and complaints management for insurers, self-insurers, employers and government schemes.

      • Transform operations

        Redesign operations with digital tools and predictive analytics to reduce cost-to-serve and improve return-to-work and service outcomes.

      • Gain regulatory confidence

        Strengthen compliance through targeted audits, uplift programs, and robust governance frameworks.

      • Access specialist knowledge

        Leverage a team with deep technical knowledge and a strong track record across Australia and globally in claims, grants, and complaints environments.

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      Frequently asked questions

      Our services span workers compensation (self-insured and scheme-based), life and general insurance, grants and complaints processing, across both public and private sectors. We also help employers meet their workers compensation obligations with confidence, accuracy and efficiency.

      We support clients through targeted audits, internal assurance and uplift programs to meet legislative obligations and close compliance gaps – often helping retain licences, resolve penalties and build stronger stakeholder confidence.

      Yes. We assess your current environment and design solutions that integrate seamlessly with your operations and technology stack, including payroll and leave systems – maximising efficiency and minimising disruption.

      Clients typically see reduced processing times, improved data accuracy, enhanced compliance and better return-to-work outcomes. These improvements not only contribute to financial sustainability and long-term value creation but also lead to better customer outcomes through faster, fairer and more transparent claims experiences.

      Yes. We provide hands-on training, change management, and communications support to embed new systems and processes effectively, ensuring sustainable adoption and improved performance across the organisation. We have also co-designed three state-based workers compensation professional standards frameworks.

      Yes. We have deep expertise in systemic remediation, including pre-injury and weekly benefit calculations, often triggered by payroll and leave issues. Importantly, any payroll-related remediation directly affects workers compensation entitlements. To remain compliant with regulatory requirements, this typically necessitates a follow-on workers compensation benefit remediation. Our scalable tools and well-founded methodologies ensure accurate recalculations that support both compliance and financial recovery.

      We provide flexible delivery models, including fully outsourced claims management and surge support during peak periods. Our services are aligned to global best practices and tailored to improve scheme performance, reduce cost-to-serve and enhance return-to-work outcomes.