Predictive analytic tools allow insurance companies to utilize historical claims data to proactively mitigate exposures and claim outcomes. Models can identify potential severity early in the life of a claim, ensuring appropriate assignment, collaboration with managed care, and execution of key claim management activities. Additionally, predictive analytic models afford the opportunity to identify potential claim exposure on traditionally no-touch claims, ensuring they are reviewed and the appropriate action is taken early in the claim management process.

Key Activities to Optimize Predictive Analytics Implementation:

• Develop strong partnership and joint effort with claims and IT
• Include Claims Field Operations early in the model development process. Their key responsibilities are as follows:
  • Develop and tweak the model for efficiency
  • Act as advocates - utilizing field operations in a pilot prior to rolling out to the rest of the organization. Employ Claims Field Operations in targeted training programs.
  • Ensure that Managed Care is brought into the process and integrated with Claims Field Operations where appropriate

Measuring the Impact of the Predictive Analytics Program:

• Set up measurements to track model progress
  • What happens to claims that are being assigned?
    • Long-term measurements: Compare duration and average paid prior to and after model implementation
    • Short-term measurements: Compare claims volume and average time to reassign or convert medical-only to lost-time claims prior to and after model implementation
• Additional Benefits
  • On average, clients see earlier reserving and involvement of managed care
• Ongoing management of the program
  • Continually re-evaluate and measure as time progresses

Ensuring you have a proper plan in place for implementation of a predictive analytics model, and have communicated the implementation process and expectations to all parties who will be involved in the rollout, is essential to the model’s success. As a mature organization, PMA ensured that there was appropriate collaboration amongst Claims Field Operations, Information Services staff, and Managed Care personnel for a smooth transition and cohesive process. This was achieved by conducting a pilot program with claims supervisors who later assisted with the program rollout to ensure a smooth implementation. Additionally, PMA identified core metrics that would assist in tracking the model’s success. For more information on predictive analytics, please contact your PMA Claims Representative.