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Hit or Miss for Improved Claim Management?
There has been a lot of
hype about how the Internet can transform the claim
management process. Today, with many signals pointing to
a prolonged hard market, it is a good time to outline
the true value and savings that Internet technology can
deliver. Claim managers want to distinguish among the
latest capabilities, including application service
providers, browser-based applications, and web services.
Internet claim systems promise real-time access to
information anytime, anywhere. But just how can this be
delivered, and what are the barriers to implementation?
By analyzing today's Internet capabilities, we can
better determine just how close we are to a truly
Internet-based claim process, and how it will improve
claim management.
Today, the property and casualty
insurance industry continues to be challenged on several
fronts: the difficult economy, rising health care and
indemnity costs, an increased severity and frequency of
claims, heightened pressure to improve performance, and
a reluctance to adopt leading-edge systems that can
alleviate certain costs and inefficiencies. Because of
these problems, claim managers need cost-effective
technology that can help achieve their specific
objectives.
To show how new Internet technology can be
useful, let's take a look at how it applies in the
workers' compensation claim process. In this line, the
main goal always has been to obtain the best, most
appropriate medical care for injured workers, and return
those individuals back to work as soon as possible. Here
are some key ways that Internet technology can
facilitate these objectives through improved
communication and collaboration:
- Collaboration with
case management. By far, managing return-to-work
outcomes affects the greatest areas of cost, both
indemnity payments and medical expenses. Remote nurse
case managers using a PC with an Internet browser now
can facilitate medical treatment and share claim
information with adjusters. Browser-based technology
provides the support infrastructure for improved
collaboration.
- Increased participation from front-line
managers. Front-line managers enable prompt reporting of
claims, immediate response to injuries, and improved
returnto- work outcomes. As a result, there are many
benefits to having these managers be part of the claim
management process via browser-based software. In
addition, the outcome of a claim can be affected
positively by concern expressed by these direct
managers. Managers also can ensure that employees
carefully follow medical instructions and adhere to work
restrictions, helping to avoid re-injury and additional
claim activity.
- Working with medical providers.
Communication with the provider is, inarguably, a key
factor in the successful outcome of a claim. If a
provider relies solely upon the employee to provide a
description of his work duties, it may result in a
mistaken determination that the employee is unfit to go
back to work. As such, employers now are providing
detailed job descriptions and lists of responsibilities,
along with modified duty options through browser-base
technology. This information is used by providers to
make more objective determinations as to the capacity in
which an employee can return to work. The job
descriptions also can be used by medical providers to
create a treatment program designed to move the employee
back to normal duty, consistent with physical
limitations that exist.
- Information validation. When a
claim is first reported, accurate information is
critical to effective claim handling. Using web
services, tasks such as checking coverage, employment
verification, and other validations can be done in
real-time and remain transparent to the users.
Browser-based technology allows this validation to occur
easily, whether policy and employee information is
internal or external to the claimhandling organization.
- Third-party partnerships. Today, claim managers want
to get the most out of their TPAs and other vendors to
ensure that their claim dollars are being spent wisely.
Browser-based software can be shared with a TPA, and
provides a means to observe claim-handling procedures,
oversee the efficiency of operations, and audit
performance measures carefully. Claim managers then can
closely work with the TPA to achieve the best results.
Today's claim operations are challenged by many factors,
such as high claim volumes, processing inefficiencies,
disjointed communication among various parties, and lack
of useful information. Using Internet technology, claim
managers reap the value of improved work flow and
collaboration, increased cost containment, renewed
managed care capabilities, and a continual feedback loop
to improve their prevention and safety programs.
Constant change is afoot on the Internet front to
further streamline the claim process. Although the
insurance industry traditionally has taken a
wait-and-see approach, early adopters already have
gained competitive advantages in claim cost-savings and
best practices via browser-based software. As Internet
technology continues to evolve and change the claim
management paradigm, we must continue to leverage the
maximum possible benefits from these capabilities.
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Kevin Confetti