If you have been asking yourself “how can Origami Risk help me better use data to make key decisions within my organization?”, today is your lucky day!
Over the past couple of months, Origami has been working to advance our capabilities around predictive analytics, machine learning, and artificial intelligence. While Origami takes an agnostic approach to our data integrations, Gradient AI is our first strategic partner in the predictive analytics space and we are excited to roll out a solution that will be repeatable and provide great value to our clients and prospects.
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Workers’ compensation claims compliance can be incredibly complex on a state-by-state basis. With variation across 50 jurisdictions, how can organizations mitigate the complexity of state forms?
Between keeping up with ever-changing laws to ensuring that internal reporting requirements are adhered to, carriers, TPAs, and self-insureds have a lot of things on their plates. If not given the proper attention, workers’ compensation state form requirements can quickly take up a huge amount of time and possibly become a liability.
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In May 2020, Origami hosted a number of virtual RIMS webinars in-place of the RIMS 2020 Annual Conference, which was cancelled due to coronavirus. One of the five sessions Origami offered, “Driving Customer Satisfaction with Digital Engagement,” was led by Tim Cuckow, Senior Sales Executive, John Carolan, Senior Sales Executive, and David Duden, Strategic Relationships Executive. The presentation highlighted how stakeholders across the insurance value chain (i.e., insurers, pools, and TPAs) can leverage new digital engagement tools and predictive analytics to make underwriting and claims administration more efficient, differentiate their offerings, and drive agent and policyholder satisfaction.
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What are the true costs of the repetitive, simple administrative tasks claims adjusters perform throughout the course of the workday? Inefficiencies stemming from manual procedures and repetitive tasks can directly impact the bottom line of claims organizations. Added to this are hidden costs that organizations may be less likely to account for: the impact those types of procedures and tasks can have on employee engagement and job satisfaction levels.
The Hidden Costs of Repetitive Tasks
As shown in a study published by the Society for Human Resource Management, when employees are required to perform repetitive tasks, they quickly lose interest and a sense of purpose. These employees are both less satisfied and less engaged. With reduced rates of job satisfaction comes the increased likelihood of turnover and the costs associated with hiring and training new adjusters.
There are also missed opportunities associated with high levels of engagement and wellness. Laid out in the Forbes article, 10 Timely Statistics About The Connection Between Employee Engagement And Wellness, these benefits can include reduced employee burnout, more empowered employees, and increased rates of profitability.
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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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Greater efficiency in handling workers’ compensation claims can contribute to a reduction in claim costs and improved claim outcomes. These gains are quickly undone when errors result in penalties for the violation of state-specific workers’ compensation laws.
According to the article Avoid Workers’ Comp Penalties and Other Pitfalls, two of the five most common errors that result in penalties occur when filing First Report of Injury (FROI) and making mandated benefits payments to claimants. The use of workers’ compensation technology solutions can reduce the likelihood of making these errors, in addition to streamlining the claims process.
1. Simplify the process of completing First Report of Injury (FROI) forms
As mentioned in Improving adjuster efficiency and accuracy with an integrated forms solution, the process of locating a workers’ comp form and then keying claim details into form fields for every claim can be tremendously inefficient. This administrative burden reduces the time available for staff to engage in other activities that can have a positive effect on claim outcomes. This approach to populating forms also has the potential to add costs, including fines for late filing, errors, or the need to correct and resubmit forms.
The article states: “A reliance on manual data entry increases the likelihood of error and exposes the organization to the costs of bad data. In most cases, the work is also duplicative, with claimant and accident details having already been keyed into the claim system.”
The submission of inaccurate or incomplete claim details in the FROI can have consequences beyond the potential for incurring penalties. In the article First Report of Injury Accuracy Critical for Workers Comp Success, Rebecca Shafer, an expert in the field of workers’ compensation, points out that multiple parties typically use the information in the FROI when setting up their workers’ compensation files. As a result, even minor errors on the reports can be copied, creating complications down the road. And while these errors can be fixed by re-submitting a corrected form, Shafer writes that doing so “is a waste of time for all the parties involved. Plus, when the First Report of Injury is inaccurate or incomplete, it can often be exploited by the employee’s attorney.”
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Workers’ compensation programs consist of a complex web of claims, numbers, analyses, and communications that require an inordinate amount of time and focus from claims adjusters and claimants alike. And with 2.8 million nonfatal workplace injuries and illnesses reported by private industry employers in 2017 alone, according to the U.S. Bureau of Labor Statistics, this complicated process is widespread.
Furthermore, claims themselves are growing more complex. A survey conducted at the 2018 NWCDC & Expo by Risk & Insurance revealed an increase in complex claims as among the top 10 workers’ comp challenges for 2019. Dr. Robert Goldberg, chief medical officer for Healthesystems, told Risk & Insurance, “Many complex claims develop due to the psychological aspects of the injured worker that either pre-date the injury or are caused directly or indirectly by the injury. Early identification and intervention are required to short-circuit the development of such claims.”
With the right technology in place, companies and their employees can simplify and streamline the workers’ comp process. This reduces claim complexity, protects injured workers, and returns business to usual more quickly.
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“A workers’ compensation adjuster is not a paper pusher.” That’s one of “60 Tips for Superior Claims Handling” issued as part of a panel discussion held at a past National Workers’ Compensation & Disability Conference. “Work comp claims are more difficult than general liability claims. If you think of them as a paper pusher, that’s the output you’ll receive.”
Numerous articles make clear the impact of adjusters’ experience, skills, and judgment on claims outcomes (For example, see “Good Adjusters Know When to Settle Your Workers Comp Claims.”) Nonetheless, as indicated by the fact that panelists felt it necessary to make the point that adjusters are far more than back-office clerks, the misperception persists.
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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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A good workers’ comp claim adjuster is a master of coordination. Managing 100-125 open claims certainly stands as proof. Yet, caseloads alone hardly tell the complete story.
For newly assigned claims, information must be collected from the employee, employer, and medical provider. Reserves must be established and reviewed for accuracy. There’s regular follow up with claimants, nurse case managers, attorneys, and other stakeholders. Compensability reviews. Evaluation of settlement opportunities. Mediations to attend. And that only begins to scratch the surface.
Yet according to the Accenture white paper “Claims at a Crossroads,” claims professionals can “spend nearly half their day on activities that do not impact the outcome of the claim.” While those administrative activities may be necessary components of the process, that time is better spent engaged in activities—such as those cited above—that fully leverage the adjuster’s talent and experience, keep claims moving on the path toward successful resolution, and increase the likelihood of outcomes that benefit both employee and employer.
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