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Technology can play a pivotal role in improving claims management by providing adjusters, claims managers, and other stakeholders with direct, centralized access to the pertinent claims information that they need to do their jobs.

As Improving Claims Administration with an Integrated Solution points out, centralizing claims data in an integrated system “that combines workflow automation tools with all of the functionality needed for end-to-end claims adjusting can be transformative.” This is especially true when the system is used to streamline claims handling processes, increase adjuster productivity, and inform decisions that contribute to swift, cost-effective claim closure.

Improving incident reporting, controlling costs, and closing claims more quickly certainly count as claim management “wins.” Yet, as Christopher Mandel points out in Next-Level Claim Strategies, there is the potential to take claims management to an even higher level.

“Just when you thought risk managers understood and had explored all the opportunities around optimizing the claims management function, next-level opportunities emerge,” he writes at the outset of the article, which examines the shared goals, motivations, and hurdles that make up the “long minimized and largely untapped synergy between casualty claims (risk management) and the benefits world.”

This approach, as well as other next-level claims strategies outlined in the article, go beyond what Mandel describes as the “traditional casualty claims handling process” that is typically “focused on timely reporting, cost control, and closure time.” The approach is more all-encompassing, extending across teams and departments to support the strategic goals of the organization as a whole and emphasize optimal care for injured employees.

Next-level claims management: an integrated approach

“On its face, the value of collaboration seems obvious,” writes Mandel about the potential for employee benefits and risk management functions to work together to reduce the medical expenses related to claims, as well as the costs associated with lost productivity when an injured or ill employee is unable to perform his or her job.

While acknowledging that distinctions between the two functions exist and, in some cases, may be significant, Mandel points to a number of key goals that employee benefits and risk management share in common. These commonalities include “caring for people under medically related distress (regardless of source), minimizing disruptions to workforce productivity, and closing claims efficiently and effectively with mutual fairness to all parties and their respective goals and objectives.”

Along with shared goals, Mandel points out both functions share mutual components of process effectiveness such as:

  • rapid, accurate reporting; timely, complete investigations;
  • compassionate and equitable treatment of claimants;
  • verification of facts;
  • compliance with laws and statutes;
  • efficient and effective resolutions; and
  • robust cost-control tactics.

Given fundamental similarities in motivation, goals, and processes, an integrated approach to managing claims will likely make sense for many organizations. So what stands in the way? The answer to that question, of course, varies by organization.

According to Mandel, the “biggest hurdle may, in fact, be the necessary extent of collaboration among and between these typically distinct functional areas and their leaders to secure the best outcomes for injured employees.”

Having a strategy for overcoming these hurdles is essential. A technology solution like Origami Risk can help.

Breaking down silos of data

Access to data from across the organization is at the heart of any efforts to transform claims management. Without shared data, a collaborative process fails.

Yet, as Lay the foundation for a strategic approach to claims management points out, centralizing claims data, alone, can be complicated: “When it comes to the ability to manage risk and losses, risk managers often face the challenges that come with claims data that is spread across multiple systems and spreadsheets.”

The challenge is exponentially more complicated when it comes to sharing and working with data from one or more teams or departments. “Whether it’s from years of mergers and acquisitions, or due to the sprawling nature of some large organizations, highly decentralized environments led to units asserting their own independence and making enterprise-wide changes daunting,” explains Five trends at the 2018 Origami Risk User Conference.

How Origami Risk helps

Origami Risk simplifies the collection of claims, transactions, and supplemental claims-related information by providing update tools and services that allow for the import of data from carriers and TPAs. Additionally, the platform provides on-screen tools for importing data from spreadsheets. Origami Risk also integrates seamlessly with almost any third-party software. This allows for the secure exchange of data among HR, accounting, and payroll applications, as well as among systems used by medical billing and nurse case management providers.

Facilitating collaboration

“Obtaining the data is not the end goal. Making better decisions is what really matters,” states the author of The data-driven risk manager. “If data does not directly influence the decisions, either because it is not timely enough or it fails to add insight to the process, then it holds no value to the organization.”

Outdated legacy software or disparate systems can severely limit the ability to report on data in a way that adds insight and informs decisions. Mandel points out that organizations pursuing a more collaborative approach will benefit from a number of key elements, including:

  • integrated reporting across departments,
  • integrated measurement across departments,
  • robust analytics that drive prescriptive actions with impact,
  • a more holistic focus on the care of affected employees, and
  • the overarching goal of a healthy, productive workforce.

How Origami Risk helps

In Origami Risk, integrated analytics and benchmarking help make analysis straightforward and fast. Dashboards and reports help to visualize claims data and provide key insights to decision makers. Origami Risk provides access to more than 100 standard reports, graphs, and dashboard templates that can be adjusted based on user roles and the specific needs of any team or department in the organization.

Promoting buy-in

Another potential roadblock that Mandel points to is getting “key functional leaders to care more about the truly significant leverage possible in managing employee injury and health exposures more collaboratively.” Deciding what specific information needs to flow to the executive team or out to operational managers can be a challenge.

As The data-driven risk manager, points out, “passing along data that offers no actionable intelligence or doesn’t connect with the organization’s strategic goals holds no value for those already bombarded with competing messages.” Executive teams need relevant, actionable data to inform strategic decisions, as well as clear feedback that a more collaborative approach is both effective and truly supports organizational initiatives.

How Origami Risk helps

Highly configurable reports and dashboards in Origami Risk measure and demonstrate success to leaders of the organization. Reports can be scheduled for automatic distribution to key stakeholders. Dashboards can also be tailored and shared to provide useful views of claims management metrics and outcomes.

Origami Risk is an integrated solution for next-level claims management

Christopher Mandel makes a strong case for a next-level claims strategy that focuses on collaboration between risk management and employee benefits functions. As with any new approach to claims management, challenges exist. An integrated RMIS and ERM solution that includes full claims administration functionality can help risk managers overcome data silos, drive collaboration, and promote buy-in on the part of the C-suite. Origami Risk is a scalable, cloud-based platform that includes all of the functionality required for the end-to-end handling of claims across all lines of coverage, combined with virtually limitless integration, workflow automation options, and ERM/GRC program management features.

To learn more or schedule a demo.