Claims Management Software

Purchasing new claims management software is by no means your only option. You also can upgrade your existing system.

Here’s a look at how those options compare:

Even the best software is virtually useless if it’s too difficult to use. Make sure your software is quick to learn, intuitive to use, and enjoyable to work with. In addition, it should be accessible from a variety of devices – phone, tablet, laptop, and desktop – so claim data can be captured quickly and accurately by anyone.

Claims administration software can cover a range of related activities. Some systems are a “one-and-done” type, while others allow you to start small and bolt on other capabilities as needed. Some of the most popular uses include:

Claims generate an abundance of data. The key is figuring out how to put it all to good use.

Artificial intelligence combined with big data can identify subtle but important patterns to guide decision making. You’ll be able to respond faster, allocate resources better – and even prevent similar claims altogether.

Claims data can be used to identify:

Performance Levels

Use important indicators such as lag time, litigation rates, average claim duration, severity, closing ratio, aged-claim counts, to determine how well your claims program is performing.

Fraud

Calculate the degree of fraud potential, and identify early warning signs so those claims can be quickly referred to an investigator and/or medical evaluator.

Litigation Potential.

Use location, attorney involvement, and other criteria to determine which claims are likely to litigate so defense attorneys can immediately start building a case.

There is no shortage of vendors that say their software can administer claims efficiently. But sorting through these assertions to find the vendor that truly understands your needs, processes, issues, and pain points can be tricky. It takes plenty of research to uncover the truth about how well each vendor matches up.

Here are some considerations to help you narrow down the field:

Ease of use.

Is the software easy and intuitive to use? Is it designed around the way you work? The easier the software is to navigate, the more efficient users can be. Claims professionals manage heavy workloads, so it should be as easy and enjoyable as possible to review claims, enter notes, set reserves, approve payments, and do all of the other tasks that consume their day.

Convenience.

How convenient is it to report claims? Is the software easily accessible from any device? Easy and accurate claim entry is one of the most critical functions of claims administration software. Intuitive, mobile-friendly, and standardized forms not only make it easy to report claims, they also ensure that the data captured is accurate and complete.

Automation.

How many tasks does the software automate? Software that automates routine tasks – e.g., generating correspondence, assigning follow-up tasks, and scheduling payments – gives adjusters and supervisors more time to focus on higher-value activities that improve claim outcomes.

Functionality.

What systems can be integrated into your claims management software? Many adjusters rely on data from internal departments like HR, finance, and accounting, as well as from other third-party sources like Official Disability Guidelines (ODG), ISO, Office of Foreign Assets Control (OFAC), CMS, medical bill review, pharmacy management, document management, vendors, and regulatory compliance. Automatically integrating this data with your claims administration system can significantly reduce the time spent gathering, prepping, rekeying, and submitting data. A direct interface also means the data is more accurate, which makes for better decisions.

Flexibility.

Will you be able to make adjustments to accommodate changing market conditions without enlisting the help of the vendor – or your IT department? Highly configurable systems allow you to quickly and easily modify business rules, change workflows, and add data.

Intelligence.

Does the software have advanced reporting and analytic capabilities? Analytics are critical for tracking individual claim performance and potential outcomes, which will help you discover trends, gain insights, and reduce costs.

Security.

Is the system cloud-based – and is it public or private? Is the system locally hosted? Do you have the in-house expertise to manage maintenance and updates? And do you have the budget to handle the hardware and software expenses? Make sure your data is protected behind a secure firewall with a robust disaster recovery program in place.

Experience.

Does the vendor have demonstrated expertise in risk, claims, and insurance technology, implementation, compliance, and support? Is there schedule for implementation and training? Will implementation be handled by the vendor or through a third party? Purchasing claims administration software is a big commitment. Make sure the vendor you select has the flexibility, scalability, longevity, and customer service to support you well into the future.

The claims vendor list is long – attorneys, medical professionals, auto-repair shops, contractors, medical case managers, and the all-important TPA. Not only are you spending good money for their services, these vendors represent your company. And both your reputation and your bottom line are at risk.

Strengthening these vitally important relationships can both lower costs and improve customer service. Quantitative measures – claims resolution costs, timeframes, closing rates, etc. – are certainly important. But it’s the qualitative factors that can make or break the relationship.

Strong vendor relationships can balance workloads, control costs, and drive efficiency. The key is to build a collaborative, cross-functional team that works well together.

Here are four tips to set you up for success:

1. Get to know vendors personally. Having a human connection paves the way to open communication and constructive collaboration. Meet the people who are working on your claims, and get to know them personally. A little old-fashioned rapport with who is on the other end of the line also makes it much easier to deal with any issues that do come up.

2. Establish clear expectations. Spell out realistic, clear, and concise instructions, and include all the right controls for response time, reserve increases, settlement authority, etc. And make sure the vendors’ employees are well trained in executing those instructions.

3. Hold vendors accountable. Vendors need to have skin in the game. Make sure they are hitting key metrics and are following your instructions. And know when to step in to keep things on track. It’s also important to monitor vendor performance to reduce claim leakage and expense on your bottom line.

4. Seamlessly integrate systems. The more vendors that can automatically integrate with your system, the better. Direct data feeds eliminate the need to manually input data – which reduces human error, simplifies communication, and frees up staff for more valuable tasks.

Vendor relationships can quickly deteriorate because of:

Switching vendors can be costly and disruptive, so make that a last resort. Instead, recognize early signs of trouble, and do everything you can to get a derailed relationship back on track. The best option is to avoid trouble in the first place by selecting vendors that match your company’s values, and maintain regular and direct communication to keep everything moving along smoothly.

The right technology will help you take advantage of all the claims data you’ve been collecting. Advanced analytics can transform data into insights that will help you make better decisions, root out fraud, reduce cycle time, and allocate resources more effectively. Making good use of dashboards and reporting keeps your thumb on the pulse of the claims process, while improving communication with top management, and enhancing collaboration among the entire claims operation.

Technology is also the springboard for improving other aspects of your claims process. Strengthening your relationships with vendors – including seamlessly integrating with their systems – can yield impressive results. And it’s worth taking another look at your processes with an eye toward automation where appropriate to add consistency and speed to the claims process.

Justifying a purchase when you already have a system in place, however, can be a challenge. Start by quantifying the true cost of the current system. How much time and money are you spending to patch, upgrade, or revise the software? How much time is wasted logging on to separate systems or tracking down necessary data? How much time is spent manually entering data?

Attaching numbers to those delays and inadequacies can cast that system in a whole new light.  And then there are costs that are harder to quantify. What is the added cost of claims delayed by system breakdowns? How much are your decisions unsupported by timely and accurate reports costing? What is the cost of opportunities missed because of incomplete or inaccurate data? And do you trust your current system to properly maintain records – or are you keeping back-up paper files “just in case”?

Legacy systems, budgetary constraints, and overworked employees all can make change an uphill battle. But even small improvements in the way claims are handled are worth it when you add up the potential savings – which goes right to the bottom line.

And that is sure to be welcome news to the C-suite.

For more on taking your claims management process to the next level, download our e-book, Claim Success: How to Achieve Excellence in Claims Management, and check out Riskonnect’s Claims Administration software solution.