Claims costs are rising with the increasing complexity of the workers’ compensation landscape.  Comorbidity, our aging workforce, and generally higher medical costs are among many factors driving this trend. Claims professionals are confronted with the challenges presented by this complexity and strive to manage their claims portfolios to achieve positive outcomes for injured workers and employers alike. 

Incorporating innovative data collection and data analysis into the claims management process affords claims professionals critical added insight. Insurers can use data to their advantage and here we outline the key points to consider.

1. Data and data analytics complement professional expertise and judgement, which remain critically important. The adjuster’s working knowledge of traumatic medicine, jurisdiction, and the law is enhanced, not replaced.
2. “Right claim, right professional.” The ability of data analytics to predict a claim’s potential problem areas and potential exposure speeds assignment to the claims team and professional best suited to manage it by bringing the right knowledge and skills to bear.
3. Data helps to ensure consistent execution of critical internal and external processes and procedures, particularly those that are jurisdictionally sensitive.
4. Enhanced integration of managed care data with the claims management process helps to drive the best outcomes. Best practice insurers re-evaluate the data on a regular basis to ensure that the most relevant information is being identified, analyzed, and shared at critical points early on and throughout the claim, and to avoid false positives.
5. Measure outcomes and behaviors. The adage “what gets measured gets done” rings true. Using data to track results respecting critical key performance areas is essential to gauging compliance and progress, and provides important feedback to teams.

Data and analytics can be very effective in helping to achieve positive claims outcomes when managed correctly. And insurers need to monitor the effectiveness of claims professionals in their use of data analytics. Implementing early intervention is key to ensuring that claims are handled appropriately and have the best chance for success. For information on PMA’s claims services, visit our website at https://www.pmacompanies.com/claims.