September 2021 – Claim Volumes Are Up!
COVID, long COVID, anxiety, depression… whatever the reason, claim volumes are up.
In this situation we have to modify our procedures to increase productivity. Reliable claim segmentation is a key part of this process.
We need to work smarter!
We must have the courage to not manage certain claims. Yes, that’s right! We don’t allocate certain claims to case managers.
These should be the low-risk claims, that are probably going to return to work anyway without a case managers help! Then we can focus the case managers on the most complex claims where the risk lies.
This suggestion typically gets two reactions:1. “Oh we already segment our claims…!” Maybe, but on diagnosis alone? Sorry, that’s just not accurate enough! Or… “we do a telephone interview then decide”…. Sorry, that’s too expensive!
2. “How can we reliably segment our claims?” Ah…Read on…
Well, it’s all in the data, we have to collect a wider group of information about the claimant. We must try to understand what else is going on in their lives that will influence their return to work, beyond the medical diagnosis, such as:
- Do they have depression or anxiety (as well as the primary diagnosis)?
- Are there any workplace issues that could further delay a return to work when the time comes?
- What’s going on in their domestic life, that will cause further complications?
- What about their finances?
- What about their motivation, their will and drive to over-power obstacles?
If this information is ‘self-reported’, and provided in a structured electronic format, no extra effort is required from the case managers. This will give us a wider view of the claimant’s situation. Then the questionnaires can be scored on a consistent repeatable scale to determine the complexity or risk profile for that claim.
Low risk claims should get put on a fast path, and an expedited workflow, not touched by a case manager. This is like an advanced-pay-and-close process, but it is not done by a case manager, it’s done by the data! These claims need to be handled in a ‘no-touch’ process.
One of our clients passionately believes “If your case managers are touching every claim, then you have too many case managers!” Save your case managers for the complex claims and manage those claims carefully, not missing any follow-ups.
So to increase the productivity of our case managers, we must get the data to drive the claims process.
To do this, we need to collect better data!
For more information about The Claim Lab’s Questionnaire Platform, email us at info@claimlab.org