Is Your Claims Administration Software Ready?

A look at how the COVID-19 pandemic may impact workers’ compensation claims administration.

There is no shortage of questions when it comes to the effects of the COVID-19 pandemic on workers’ compensation claims, for instance:

  • How will workers’ comp regulations evolve on a state-by-state basis as researchers and medical professionals continue to learn more about the virus’s behavior and options for treatment?
  • What will the economic downtown mean for the volume of COVID-19-related workers’ comp claims?
  • How will courts rule when it comes to claims compensability?
  • How can businesses and other organizations that administer claims reduce potential claims losses, especially as states begin to reopen?

The impact of the COVID-19 pandemic on workers’ compensation claims administration will, of course, be determined by the answers to these questions and others like them. As states and businesses begin to open up, what is clear is that we’re only at the beginning of what will be a lengthy process of ongoing developments that will require insurers and organizations that administer claims to be prepared to adapt.

In many cases, organizations have shown the ability to do so. For example, the pandemic has already had a part in where adjusters perform their jobs—from home. According to those interviewed for the Risk & Insurance article, COVID-19 Forced Claims Adjusters to Work from Home. Here’s How It Turned Out, those outcomes have been generally positive. But the challenge extends well beyond the ability for adjusters to work from home.

The potential for the pandemic to result in new reporting and documentation requirements, increases in caseloads, and additional litigation may also necessitate changes in how adjusters perform their jobs. While it is hard to predict what the implications of these new regulations and evolving business challenges will be, the right claims administration technology can contribute to positive outcomes by helping to balance these and other needs with the ever-present need of insurers to streamline workflows, contain costs, and quickly adapt to latest economic, regulatory, and epidemiological developments. In this evolving claims landscape, a highly-flexible system that combines digital technology and workflow automation tools with all of the functionality needed for the end-to-end handling of claims is essential.

Make it Easier to Report COVID-19-Related Claims

Providing policyholders and their employees with the ability to report workers’ compensation claims as quickly and easily as possible is, as it has always been, a critical first step in ensuring claimants receive the treatment they need and outcomes are optimized. Given the threat posed by COVID-19 exposure and infection, as well as the reporting requirements mandated by states, digital technology, such as a self-service claims portal, can help facilitate the entry of a diagnosis or a positive COVID-19 test result. Origami’s strong analytics and reporting capabilities enable both policyholders and insurers to see, in real-time, the potential impacts to their bottom line—enabling them to be proactive in taking additional steps to prevent losses.

Automate to Drive More Efficient, Smarter Actions

As discussed in a recent Origami webinar, Transforming Your Workers’ Compensation Claims Organization with Digital Engagement, workflow automation can help the right claim go to the right adjuster or stakeholder at the right time. For example, upon submission, a claim might be auto-assigned to an adjuster based on workload or specific details. Furthermore, rules can be put in place to trigger workflows for a more efficient and cost-effective claims administration process—while driving loss prevention. Reporting a positive result to a COVID-19 test could be configured to trigger alerts to specific claims specialists based on expertise or other parties (medical directors, attorneys, etc.) who need to access and review details and associated documentation.

Use Digital Technology to Facilitate Communication and Maintain Compliance

Origami’s digital technology can be leveraged to streamline communication and compliance efforts. For example, texts and emails with notifications of updated details or requests for additional information can be sent directly from the system to workers or supervisors. Healthcare workers can be given a link that allows them to provide additional information or the results of follow-up tests via a web-based portal. If required, the system can also be configured to ensure reports are generated for filing with workers’ compensation boards or other designated state agencies. This is especially important as regulations evolve during the pandemic.

Be Ready to Respond to Ongoing Developments

The evolving nature of the COVID-19 pandemic requires that claims organizations are able to make adjustments based on ongoing developments and subsequent regulatory changes. A claims solution such as Origami risk allows for configuration changes—rather than the need for expensive and time-consuming custom coding—to meet such challenges. Access to administrative tools means users with the appropriate permissions no longer have to wait for a service request to add fields, adjust workflows, update business rules, or schedule secure file transfers. They can, instead, make adjustments themselves, as demonstrated in recent responses to the coronavirus pandemic on the part of Origami clients. Of course, members of the Origami service team also stand ready to collaborate with clients to ensure the system is configured to help meet their specific business needs.

The Right Technology Solutions for Your Claims Administration Processes

Exactly what the impacts of the still-developing COVID-19 pandemic will be on workers’ compensation claims is far from certain. What is certain–and in your control–is the technology used in the claims administration process. The right tools can help you improve access, streamline workflows, promote collaboration, and be ready for the changes that are sure to come. Origami stands ready to help you implement the right solution for your claims administration processes.

Origami Risk is a scalable, cloud-based platform that has all of the functionality required for the end-to-end handling of workers’ compensation claims, as well as claims across all lines of coverage. The SaaS platform combines workflow automation and digital engagement tools that help insurers and claims organizations keep clients, claimants, brokers, and agents informed, while also streamlining the claims handling processes and helping adjusters work more efficiently. To learn more or request a demo, contact us.