Matching Predictive Analytics with Human Intelligence

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.