Claims professionals have long been the frontline of claims management – this has not changed. What has changed is just about everything else.
Claims continue to grow in complexity – and therefore have become more complex to manage. The claims workforce is changing, too. As we continue to try to attract talent to the industry, the bar becomes higher for what these new professionals expect. Better tools and a better experience. Humans are becoming increasingly hardwired for digital preferences and interactions. And with reason – with the right tools, there are tremendous efficiencies to be gained over historical methods. (Dozens of phone calls in a day? Let’s all pause for a reminiscent chuckle.)
And even as the tools and workflows employed to facilitate claims professionals’ jobs become increasingly more sophisticated – the tools themselves cannot appear more complex. The bar is set at nothing short of a streamlined, easy to use, one-stop experience.
It’s a big ask, but one that we’re driven to continually find new answers for. Here are five ways Healthe is leveraging technology, analytics, and insight to enhance claims professionals’ digital experience.
Part and parcel with technological design is the human element. How is the end user going to feel using the tool? What value are they going to derive from it?
When designing solutions meant to assist claims professionals, we start – and finish – by asking the prospective users what they think and what they need from these tools. These frontline users know just how many ways things can go wrong, or how often they run into the same hiccups in the claims process.
When captured effectively, claims professional insights can inform innovation in ways that improve productivity, deliver more informed interactions with injured workers, and make the process of claims management easier and more effective – while also improving claims staff satisfaction.
Here is where user research and user validation studies become valuable tools for understanding stakeholder preferences and pain points that can inform program enhancements and new services that meet the unique needs of different users – whether the day-to-day claims examiner, the nurse case manager, or claims leadership.
Having the right information at their fingertips, at the time it is needed, is crucial to helping claims examiners make timely decisions that move a claim forward.
Effective information architecture brings greater visibility to important information across the claim lifecycle, while also removing the clutter. And an informed approach to information architecture includes applying research and data, including data on user behaviors within systems.
Research data helps to identify areas where visibility is lacking, prioritize the most and least valuable data elements that examiners wish to see in their claim tools, and ultimately creates an intuitive digital experience that includes step-by-step workflows and prepopulated data elements.
This ease-of-access and self-service visibility into key information has become even more important post-pandemic, where claims organizations continue to employ a remote workforce, reducing person-to-person interaction as a resource for claims examiners to help answer questions and troubleshoot problems.
Different stakeholders in workers’ comp have different preferences regarding the technology they use for day-to-day tasks.
For instance, our research indicates that injured workers prefer text message updates, while examiners more often prefer email updates. And it’s no secret that too many notifications – especially ones containing information that stakeholders don’t prioritize – can be overwhelming.
Concurrently, more tech-savvy claims professionals may be accustomed to more advanced technology with customizable features. These employees may feel that technology used in the workers’ comp industry is outdated, especially considering current consumer technology on the market.
Development of future solutions and enhancements must find a way to balance these preferences to improve staff satisfaction and productivity, and to keep workers’ comp programs running smoothly. One approach to accommodating the different and evolving needs of different stakeholders? Built-in user preferences that allow users to choose how they display and customize applications to best fit their needs.
Claims examiners are true jacks-of-all-trades and have a wide range of different knowledge sets, but they may need more in-depth expertise to make claim decisions, especially in unique or complex cases.
Seeking out information can be time consuming, and sometimes what is being asked of them is beyond their scope. For example, claims may have clinical warning signs that are not immediately obvious. Incorporating evidence-based medicine and other advanced logic can help identify concerns within claims faster and get them in front of the right people.
Meanwhile, workflow automation can drive a low-touch solution that takes tasks off claims examiners’ plates, providing examiners with the time and clinical guidance they need to focus on these more critical tasks.
It is rare that a decision or metric is not captured in workers’ comp (albeit often in disparate systems), creating mountains of data that has the potential to drive program performance, savings opportunities, clinical intervention opportunities, productivity, staff behavior – nearly anything imaginable.
A good analytics program can highlight these trends and guide strategy, but only if data is centralized and consumable in an easy-to-use way. Analytics tools that deliver visually intuitive data make decoding the insights simple – and these insights can help claims professionals at every level.
On a day-to-day level, these insights can prioritize risk and guide claims decisions. At a higher level, analytics can arm program managers and claims leadership with the knowledge to educate and empower their claims staff – providing visibility into program adherence and other opportunities for intervention or training.
This article content originally appeared on WorkCompWire.
