3 Steps to Help Close Workers’ Compensation Claims Performance Gap

August 13, 2018

According to the analysis by Rising Medical Solutions, just 24 percent of claims organizations are high performers. The white paper released by the study group sought to answer what the other 76 percent need to do to catch up.

The report —”How to Close the Claims Performance Gap: Top 3 Findings in 5 Years of the Workers’ Compensation Benchmarking Study— provides a picture of how outcome-based activities dominate top claims strategies and how high performers outpace lower performers up to 10 times more in their use of certain key practices.

Co-authored by study program director Rachel Fikes and industry journalist Peter Rousmaniere, the report finds that top claims performers:

  1. Focus on medical and return to work management and compensability investigations. Respondents indicated these were the “top three most critical” to claim outcomes.
  2. Invest more in equipping and training claims staff. According to the white paper, “higher performers are more likely to raise staff performance expectations, spend money on training, and nurture mastery throughout their adjusters’ careers.”
  3. Invest in technology. The authors wrote, “The most successful claims organizations are far more likely to have higher IT budgets, utilize predictive modeling, and invest in other metrics-gathering tools and techniques.”

Higher performers also tended to measure various core competencies, claims outcomes and utilize predictive analytics.

Better closing ratios was also found to be indicative of a well-run claims organization. “Claims experts agree that a claims ratio of 101 percent or higher is a reliable sign that the organization is managing claims outcomes effectively,” according to the report.

“With so many competencies claim departments are often asked to excel at, it can be difficult to decipher exactly which practices will actually move the needle,” said Fikes. “For those organizations that choose to close the performance gap, the data is clear on how to narrow the divide between average and superior performance.”

Source: Rising Medical Solutions

Topics Claims Workers' Compensation Talent

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