TPAs continue to face increasing pressure to find more innovative ways to drive efficiency and do more with less. An article in Lexology states, “Automated claim processing is the future for insurance carriers, third-party administrators (TPA’s) and large employers, to improve efficiency and reduce the resources required to process claims.” Determining a strategy for automating claims handling can be challenging.
A recent post examined the ways top performers approached automation. One key benchmark study of differentiators recommended: “Employ claims decision support tools – such as workflow automation, advanced analytics, and predictive modeling – and use them more frequently throughout the claim lifecycle.” In fact, top performers are 4X more likely to use automation throughout the cycle than all others.
To achieve the results similar to those of top producers, a comprehensive approach to improvements through technology must be employed.
Mobile applications and online portals accessible via a browser on any device allow for claims data to be collected while in the field. Claimants can also attach photos, maps, and files to the claim, providing the adjuster with much more information when processing.
One workload study estimated that the typical adjuster has 130 open cases, with an average of 20 attachments per case, many of which are sent via email. Origami Risk allows emails, with attachments, to be forwarded to a specific address and automatically attached to the claim record.
ODG Benchmarking Integration
Origami Risk is integrated with the Official Disability Guidelines (ODG) benchmarking data from the Work Loss Data Institute. Origami Risk’s ODG integration provides direct access to evidence-based medicine (EBM) data aggregated from over 10 million cases and decades of research. Rising Medical Solution’s 2016 Workers’ Compensation Benchmarking Study found that users of evidence EBM data were more than 4X more likely to be top performers than those who did not.
Claims and Task Assignment
The Lexology article also addresses the need to use event-based triggers to set tasks and initiate other actions. “Depending on the type of claim, different activity tasks should automatically generate based on specific details.” With Origami Risk, claims events can automatically generate tasks, send emails, or create alerts.
In addition to triggering automated task triggers, claim assignment can be based on complexity tied to benchmarking severity workflow balancing, or other criteria such as geography and line of business. This way claims automatically get routed to the resources best suited to handle them. Senior resources remain focused on the more complex claims, while the workload is evenly spread across other claims.
Set the rules for payment approvals based on your organization’s established procedures, client requirements, or the experience level of adjusters. Whenever thresholds are reached, the automated approval process ensures that oversight is applied and controls are enforced.
Origami Compliance automates FROI/SROI reporting with direct access to 5,000 state and federal forms. This allows your adjusters to eliminate the wasted time searching for forms while ensuring that the correct version of each form is submitted in a timely manner.
An efficient claims handling operation is critical to a TPA’s success. By focusing on a comprehensive view to automating claims management, your organization can create a differentiator in service and performance that helps you attract and retain clients.
Use of a customizable claim portal has improved data quality and reduced the amount of time claim specialists spend tracking down incomplete claim details.