The Role of Technology Advancements in Disability Claim Operations
BACKGROUND
Accurate and timely disability claim decisions, long the exclusive responsibility of human management, are being augmented in powerful and exciting ways. Driven principally by both expense pressures and the challenge of attracting and retaining the talent necessary to manage claim complexity, many claim organizations are seeking technology and outsourcing solutions to support the claim decision-making process. Numerous offerings are available, most of which are organized around a handful of themes, including:
- Data Mining: Aggregation of data from publicly available sources to obtain a broader view of the claimant’s level of capacity beyond what’s provided in medical records.
- Predictive Analytics/Segmentation: Leveraging of historical data to direct claims to certain unique management segments by predicting claim complexity and duration.
- Machine Learning: Combining historical data to direct claim management with providing updated duration estimates based on new structured, unstructured, and external data.
- Workflow Automation: Outsourcing administrative functions and routine claim decisions to achieve expense efficiencies.
Carrier motivations for choosing technology support differ depending on a variety of issues, including the tenure and diversity of their workforce, what each organization considers to be gaps in performance, and cultural considerations. Irrespective of the type of technology utilized, each claim operation will seek to maximize its investment by optimizing effectiveness, productivity, and customer service.
With almost 70 years of combined experience working closely with the leading disability claim organizations, Brown & Brown Absence Services Group’s Consulting Practice has significant expertise in implementing large-scale change within disability claim organizations. As a result, we have a unique perspective on the opportunities and risks associated with the effective and efficient integration of technology solutions. What follows is a summary of those risks and opportunities for your consideration.
OPPORTUNITIES
The thoughtful integration of technology to enhance the claim decision-making process is essential to the future of successful disability claim management. Done right, a claim organization will benefit from a variety of key outcomes that will create a competitive advantage, including:
- Sustainability: Technology is inevitable for the long-term viability of the industry, especially given the growing challenges associated with hiring, training, and retaining skilled employees.
- Efficiency: Appropriate technological support will allow skilled and expensive resources to focus on high-exposure claims.
- Consistency: There will be a reduction in inconsistent decision-making resulting from the variability of experience and skills.
- Claimant Experience: The claimant’s experience will be enhanced by quicker, more accurate decisions with less administrative burden.
- Expense Reduction: The cost per claim will be reduced by shifting much of the variable cost of employees to a fixed cost of technology on a high volume of routine claims.
RISKS
A comprehensive strategy must be developed and implemented to achieve success and maximize an organization’s return on its investment of capital, time, and effort. Careful consideration must be given to how the use of the technology will impact other key functions of the organization, like training, quality, measurements, and accountability. Successful implementation can be at risk from a variety of issues, including:
- Integration: No single technology partner has the expertise to fully integrate its offering with the key elements of a high-performing claim model.
- Strategy: The technology may focus on addressing acute tactical issues yet not be aligned with the organization’s strategic vision and goals.
- Ownership: There can be a tendency to allow the technology partner to drive the implementation of a technology solution with the expectation that the carrier will adapt its claim model to it, not unlike what the industry has experienced with claim system implementations. The technology and/or claim process should be adjusted as necessary to reflect a best-practice model, and the carrier should drive these adjustments.
- Focus: To ensure the organization is maximizing its large investment and is not distracted from day-to-day responsibilities, consideration should be given to a dedicated team responsible for the development of a robust plan to mitigate the associated risks to success.
- Skills/Knowledge: The level of skills and knowledge of claim managers and claim leaders may atrophy over time. While many claims can benefit from various technology solutions, there will always be claims requiring customized judgment. The industry will remain highly regulated, and the legal environment is unlikely to become less litigious.
- Measurements: Claim leadership may not be equipped to manage performance within a blended technology/people model. The carrier’s measurement infrastructure may not be appropriate or robust enough to thoroughly evaluate the efficiency and efficacy of any new claim process.
- Culture: While the younger generation new to claims management will expect the support of technology, more tenured claim managers may perceive these changes as a threat. Creating a unified approach that serves both groups will be critical to the complete and successful adoption of this new approach.
The leveraging of data mining, predictive analytics/segmentation, machine learning, workflow automation, and many more enhancements yet undiscovered are here to stay. Their value proposition is far too compelling to ignore, and the future of the disability claims management industry would languish without it.