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6 Priorities for Claim Organizations to Improve Efficiency and Outcomes

Claim organizations face significant challenges in today’s environment. The escalating cost of claims continues to be a major concern, along with increasing administrative burden. From timely incident reporting to accurate claim resolution, organizations need to adopt strategies to improve efficiency and focus on costs, outcomes, and service.

Advances in technology can help claims managers handle claims with speed and precision. With workflow automation, compliance support, streamlined document management, and enhanced analytics and reporting, claim organizations can ensure an efficient operation that delivers optimal outcomes.

Modern technology can transform these six elements of the claims administration process:

1. Improve productivity, even with higher caseloads and less-experienced adjusters.

One of the biggest concerns that claim organizations face is managing a changing workforce. With constant pressure to improve profits and reduce costs, many claim organizations are looking for savings by hiring less-experienced adjusters. This trend results in adjusters with less industry knowledge and limited experience in the use of existing tools. Claim organizations need to ensure new hires are capable of handling claims with as little disruption as possible. If not properly mitigated, employee changes can hinder the efficiency of claims operations.

Experienced adjusters have had to adapt to new challenges as well, especially when it comes to the sheer volume of claims they must manage. Not too long ago, the typical caseload for an adjuster was around 65 to 80 open claims. Now, it’s common for an adjuster to have 125 to 150 open claims in their caseload.

Technology can help claim organizations overcome the challenges of a changing workforce and rising caseloads. For new adjusters, a modern claims administration system can dramatically reduce the time needed to learn new procedures, improve consistency in internal processes, ensure regulatory compliance, and facilitate a smooth transition from one claims handler to the next. For adjusters who are more experienced, specialized software is essential to managing an increased caseload and more complex claims.

 

2. Achieve better job satisfaction and outcomes with workflow automation and a modern user experience.

Insurance claims are costly, complex transactions involving multiple parties, systems, and regulatory concerns. The administrative process is highly labor intensive and often requires tedious manual tasks. To streamline these workflows, claim administrators need software that is easy to learn, intuitive to use, and effective in driving optimal outcomes.

New adjusters are entering the workforce, and while lacking industry experience, they tend to be tech savvy and eager to adopt modern software. Experienced adjusters can use their expertise to design customized workflows in software solutions based on their organization’s unique requirements.

Automation allows claim organizations to achieve a higher level of output with less manual interaction throughout the life of a claim. Adjusters can minimize routine tasks and focus on higher-value initiatives.

With claims administration software, adjusters can send and schedule emails, create diaries, trigger alerts and notifications, set reserves, and more – all while ensuring strict criteria and deadlines are met. Intuitive dashboards allow for each user to see, upon login, any outstanding tasks that need to be completed or high-priority action items that must be addressed. With custom business rules, dashboards, and approval thresholds, claim organizations can improve job satisfaction while ensuring consistency and accuracy.

 

3. Stay current with compliance changes and satisfy all local, state, and federal reporting requirements.


Claim organizations must always be up to date with ongoing compliance changes at all levels, and they need to ensure appropriate interactions with claimants and governing entities at every stage of the claim process. These regulations require a thorough understanding of industry standards and emerging trends.

Modern claims administration systems can provide compliance support to help adjustors stay current with new requirements. When evaluating potential claims systems, claim organizations should look for a solution that maintains compliance standards for these key areas:  

  • IAIABC reporting for mandatory jurisdictions
  • Compensation benefit rates for U.S. jurisdictions
  • Forms for U.S. jurisdictions
  • CMS reporting
  • OSHA reporting
  • 1099 reporting with TIN matching
  • W-2 for disability

By choosing a claims system provider that maintains these compliance standards, claim organizations can focus more on improving claim outcomes.

 

4. Save time by streamlining document management and automating content distribution.


While many claim organizations have embraced the digital age, the world of claims administration still has a deeply ingrained reliance on paper. However, paper-based processes can result in a weakened claims infrastructure with limited transparency and efficiency.

A typical claim generates a large volume of content: correspondence received and sent (both email and physical), task assignments, document images, and more. For claim adjusters, selecting and distributing claim-related content is a frequent, time-consuming task.

With modern document management tools, it’s possible to package claim files with the click of a button, upload hundreds of documents at different stages along the workflow, easily locate files, and share documents effortlessly. For simple content distribution, adjusters can streamline the process of reviewing, selecting, compiling, and distributing content to authorized third parties with a central distribution printer, stuffer, and mailer for the physical delivery of content.

 

5. Respond to events promptly with enhanced intake of incident data directly from the field.


To improve efficiency even more, claim organizations can focus on capturing incidents and events quickly and accurately from the field. The longer it takes to respond to an incident, the more expensive it can become. One of the keys to closing claims with optimal outcomes is shortening the lag time between when an incident is reported and when the adjuster begins administering the claim.

With a mobile intake solution, authorized users can submit incident data directly from the field with intuitive surveys, resulting in faster incident reporting and improved data integrity. Claim organizations can ensure accuracy with mandatory questions, variance thresholds, and dynamic branching logic. Data collected from the field is immediately available for reporting, analytics, and action.

 

6. Identify potentially high-cost claims early with predictive analytics.


Each and every claim must have adequate reserves to cover the costs throughout the life of the claim, and claim managers need to identify opportunities to mitigate some of the costs and settle the claim as efficiently as possible. One type of claim can be particularly difficult to manage. Although appearing relatively standard at FNOL, these claims can suddenly “jump” after 90 days or so, becoming high-cost claims that require close management, an increased reserve, and more resources.

Predictive analytics is a method of forecasting that employs multiple sources of both internal and third-party data to predict the way a claim is likely to unfold. This allows claims managers to get an earlier indication of those claims that have the potential to “jump” and take proactive steps to mitigate the costs earlier by allocating the appropriate resources and identifying possible preventative measures.

By embracing modern technology, claim organizations can make impactful changes to enhance efficiency and optimize claim outcomes. With a specialized claim system, skilled staff can spend less time on administrative tasks and more time on claim resolution and customer service.

 

Next Steps

To learn more about how a claims administration system can transform your claims operations, contact Stephen Thomas, VP of Product Management.

Feb 4, 2021

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