Tag: Best Practice Tips for TPAs

Supercharging your claims handling

gears and light bulb

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.

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TPA Best Practices #3: Selecting Technology Partners

The Importance of Technology Partners

Choosing a technology partner is increasingly becoming a more critical strategic decision for TPAs. In Accenture’s Technology Vision for Insurance 2017, 76% of respondents agreethat “competitive advantage will not be determined by their organization alone, but by the strength of the partners and ecosystems they choose.” Identifying technology solutions that support the company mission and differentiate your organization from the competition is an important part of developing an effective business strategy.

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TPA Best Practices #2: Success with Evidence Based Medicine and Comorbidities

A major 2016 Workers’ Compensation benchmark study found that one of the largest differentiators of high-performers versus all other groups was the use of Evidence Based Medicine (EBM) guidelines. Users of EBM data were more than 4X more likely to be top performers than those who did not. The same study included a survey asking “What are the greatest obstacles to achieving desired claim outcomes?” Respondents ranked “Psychosocial/comorbidities” as the number one issue.

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TPA Best Practices #1: The Power of Automation

A 2016 workers’ compensation benchmark study found that half of all high performers employed automation at specific intervals in the claim cycle. Additionally, high performers were almost 4X more likely to rely on automation throughout the cycle than all other groups. Given that another workload study, which conducted over 4,500 interviews with claims professionals, found that adjusters spend up to half of their hours on non-core tasks, it is clear that removing administrative burdens on adjusters is critical to becoming a high performer in the industry.

Employing Workforce Automation with Origami Risk

The workload study estimates that the average adjuster has 130 open cases, with an average of 20 attachments per case, many of which are sent via email. If it takes an adjuster 1 minute to open the email, download the attachment, and then upload it into the case file, it would take one full week simply to manage those documents. With Origami Risk, this process takes seconds. When a case-related email with attachments is forwarded to a dedicated Origami address, the system verifies access rights to the proper claim based on the sender’s mail address. It then uploads the email message, along with all attachments, directly to the claim record.

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