Category: TPAs

TPAs and automation, part 2: Attracting and retaining talent

In TPAs and automation, part 1: Humanizing customer service, we looked at ways in which the use of features available in integrated claims management software—automation tools, push-reporting, and online portals—can help improve the level of service provided to clients and claimants. The automation and self-service features of a claims management software solution also have roles to play in another business-critical area for TPAs and organizations self-administering claims: recruiting, hiring, and retaining top talent.

Challenges to hiring and keeping qualified claims professionals

As is the case across most industries, a combination of baby boomers reaching retirement age and a strong economy continues to make it difficult for businesses in the property/casualty insurance industry to find qualified candidates. According to the Insurance Journal article Insurance Industry Facing Competitive Labor Market, the industry’s unemployment rate of 1.7% is even lower than the reported national average of 3.9%. Even so, the article points to the fact that, as of its April 2019 publication date, the “need for technology, claims and sales/marketing staff is expected to grow the greatest in the next 12 months.”

Beyond the challenge of finding qualified candidates to fill open claims department positions is the issue of employee retention. A 2018 CompData Survey shows that total turnover among organizations in the insurance industry stood at 12.8%. Although lower than the average for all industries (19.3%), this rate has trended upward in recent years.

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How TPAs can tame the onboarding process

The onboarding process can be challenging for both TPAs and their clients. Migrating data from one claims management system to another is often a difficult, resource-draining part of that process. Wesley White’s article 10 Data Migration Best Practices For Any Organization summarizes the extent of the challenge:

Migrating data to a new information management system from multiple sources is a complex and often headache-inducing undertaking. Data migration is often necessary to keep up with technological advancements and industry standards, but it requires great effort. Data from various storage areas—both onsite and in the cloud—must be evaluated, analyzed, cleaned up and organized before it can be combined and reconciled.

The right technology can help to reduce the tremendous burden that data migration places on new clients. It can also transform the onboarding process and showcase the unique insights, savings, and benefits your organization delivers. As White notes, “It doesn’t have to be as hard as you may think to get past these challenges and successfully migrate your data.”

Assisting with the pre-migration phase

Research from the independent research firm Bloor paints an ominous picture of data migration projects. Of these projects, 37% exceed budgets, 67% take longer than expected, and 84% fail to meet expectations. In Why do so many data migration projects end in disaster?, Colin Rickard, a data management director with Experian, is asked to explain the high failure rate. “Often there has just not been enough analysis done at the start, so you end up with a lot of data problems at the end,” he responds.

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Eliminate the burden (and costs) of maintaining a workers’ comp state forms library

When does maintaining an up-to-date library of workers’ compensation state forms become too great of a bureaucratic burden for your claims adjusters or administrative staff? The most straightforward response is this: The more states in which your organization handles workers’ comp claims, the greater the challenge of staying on top of form revisions and additions.

Time and resources could certainly be allocated to more important activities. In the International Risk Management Institute, Inc. (IRMI) article Workers Compensation Bureaucracy Drives Costs, Mark Walls and Kimberly George cite training and education as two such examples:

One of the goals of workers compensation regulations is to ensure that injured workers are paid benefits in a timely manner at the correct rate and that they have access to appropriate medical treatment,” write Walls and George. “There was a time when payers had offices located in most states with adjusters handling only that state. Now, with most payers utilizing multistate adjusters, payers must be constantly training and educating their adjusters to ensure that they understand all of the nuisances of the different states that they handle.

For organizations looking to reduce the bureaucratic burdens their adjusters face, Origami Compliance offers a secure, API-based solution that integrates with any claims management system to provide immediate access to a single-source, up-to-date library of state and federal workers’ comp claim forms. Without leaving the claims system, an adjuster can quickly find the right form based on state or category. And when that form is selected, form fields automatically populate with claim data and a PDF version is generated.

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TPAs and automation, part 1: Humanizing customer service

Automation is great, except when it isn’t. Examples of the dark side include endless button pressing in automated phone trees that often conclude by yelling the word “operator” into the phone, and receiving form letters or emails containing incorrect, basic information. It’s no wonder the Aspect Customer Experience Index states that “nearly a third of consumers would rather clean a toilet than talk to customer service.”

Yet automation, when done well, remains a central tactic TPAs can deploy to gain competitive advantages in efficiency, accuracy, and resource allocation. When mismanaged, however, it can lead to impersonal service and damaged client relationships. The key to successful automation is to take advantage of technology’s benefits without losing the “human-centric” element. Kristin Smaby explores this concept in Being human is good business.

“In an era when companies see online support as a way to shield themselves from ‘costly’ interactions with their customers, it’s time to consider an entirely different approach: building human-centric customer service through great people and clever technology. So, get to know your customers. Humanize them. Humanize yourself. It’s worth it.”

In this three-part series we’ll examine how strategically balancing the human/automation mix can deliver a competitive advantage through:

  1. Improving customer service
  2. Enhancing employee retention/recruitment
  3. Boosting performance KPIs

Addressing these three initiatives from a human-centric perspective allows your organization to meet the personalized service expectations your clients demand, while gaining the productivity boosts smart automation delivers.

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Make automation matter

It’s not exactly a secret: Regardless of size or industry, every organization stands to benefit from using automation technology to cut down on repetitive, time-consuming administrative tasks. More than simply speeding up a process or getting people to work faster, automating administrative tasks yields value by freeing up employees to focus on the aspects of their job that really matter and provide value.

Automation is wonderful. Except when it isn’t.

As covered in Behind the Hype of Robotic Process Automation (RPA), businesses can run into issues by rushing to reduce costs and improve productivity through automating processes without first evaluating their effectiveness and necessity. The benefits of automating repeatable, administrative tasks can also be lost if automation technology is too difficult to use. The result? Time that could be used performing more high-value activities winds up spent managing software.

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How to prepare for 2019 data breach trends

Data Breach Today offers predictions in What’s Ahead for Health Data Privacy, Security in 2019? While the article focuses primarily on health data, a few key trends apply more broadly and are likely to resonate with all types of organizations.

Prediction: Disruption from regulatory changes is likely

Rebecca Herold, author of 19 books on information security and CEO of The Privacy Professor consultancy, begins the list of predictions by examining the potential for agency updates to HIPAA. “Based on continued pressure from local, state and federal government agencies, law enforcement, researchers and others to ease the sharing of patient and mental health data by removing the need to obtain patient consent, I expect to see OCR issue proposed HIPAA updates,” she notes.

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Build a culture of safety — go beyond audits and get employees involved

For risk and safety professionals, the new calendar year brings with it a renewed focus on improving their organization’s culture of safety. Whether looking to put a new safety program in place, make wholesale changes to an existing program, or build upon previous successes, many organizations face the challenge of ensuring that their employees are fully participating in safety efforts.

A recent EHS Today article takes a look at a potential solution for involving people across an organization in this process: safety assessments.

How safety assessments differ from safety audits

To Build Safety Culture, You Must Get People Talking provides an overview of a 2018 Safety Leadership Conference session — “Distracted Drivers R US — Assessment RX for Success” — led by Walter Fluharty, vice president of EHS and organizational development at Ohio-based Simon Roofing.

Where static surveys may be seen as yet another safety-related requirement, focus group-based assessments followed by the completion of self-assessments are more likely to drive engagement and add value.
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How to Use ODG Data to Improve Workers Comp Case Management

This post was originally published on Risk Management Monitor.

Regardless of whether or not their organizations operate in states where the use of Official Disability Guidelines (ODG) has been adopted/mandated, risk managers can often leverage ODG data and the claim data from their risk management information systems (RMIS) to benchmark the medical and lost-time components of their workers compensation costs against national averages.

With its origins dating to 1995, ODG (www.mcg.com/odg) provides “unbiased, evidence-based guidelines” and analytical tools designed to “improve and benchmark return-to-work performance, facilitate quality care while limiting inappropriate utilization, assess claim risk for interventional triage, and set reserves based on industry data.”

The following are some ways risk managers can use ODG data in conjunction with their existing risk information tools to drive improvements in their workers compensation case management and achieve greater precision in loss reserve practices.

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Five trends at the 2018 Origami Risk User Conference

Origami Risk’s 2018 User Conference, held last week, utilized a new format that not only placed a premium on client presentation of use cases, but also focused on digging into “how” presenters managed to implement their specific solutions. Listening to a diverse set of cases, several common trends emerged.

1. Transparency is key

Many of those presenting echoed the need to establish transparency and accountability in their processes. You can’t measure what you can’t see, and you can’t improve what you don’t measure. The most obvious culprits were paper-based procedures—everything from workplace safety “coaching cards,” to incident intake reports. Spreadsheet-centric workflows, such as data-heavy values collection efforts, also failed to identify the “who, what, when, and where” type of information required to make any process fully transparent.

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How to create a successful and sustainable near miss culture

The importance of establishing a near miss culture is clear. The OSHA and National Safety Council Alliance, a cooperative program, puts it this way: “History has shown repeatedly that most loss producing events (incidents), both serious and catastrophic, were preceded by warnings or near miss incidents. Recognizing and reporting near miss incidents can significantly improve worker safety and enhance an organization’s safety culture.” Effective near miss programs can prevent more serious incidents from occurring.

A previous post highlights some of the challenges surrounding this issue. Fear of reprisal or embarrassment, difficulty in the reporting process, and a sense of futility if reports don’t result in tangible changes. Each challenge presents obstacles when trying to establish a near miss culture.

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