Streamlining the workers’ compensation claims process through automation is essential for insurers aiming for an end-to-end digital experience. The workers’ compensation claim management process is complex with many regulatory guidelines, timeframes on determining compensability, benefit payment mandates, managing return-to-work, and litigation.

The pandemic accelerated the need for greater automation in claims technology to meet growing customer expectations for an end-to-end digital experience as we enter a truly digital age.

Workers’ compensation insurance carriers have an opportunity to demonstrate their value to policyholders (employers), including the injured worker, by streamlining and automating the claims process. An automated claims process can increase customer satisfaction and generate operational savings for insurers to allocate to more complex manual claims.

A great place to start claims automation is by adopting straight-through processing (STP) for relatively simple claims.  According to Novarica’s recent report, Straight-Through Processing in Underwriting and Claims, nearly 60% of insurers have no STP in the claims area, and on average fewer than 10% of claims are processed straight through. STP is a more common process in personal and individual life insurance.

An easy way to speed up the workers’ compensation claims process is to simplify it at its core, enabling information to be filtered through a process across multiple points. Leveraging straight-through processing (STP) is a viable way to reshape and optimize an insurer’s operations.

STP eliminates unnecessary costs, automating routine tasks and enabling claim professionals to focus on higher-value tasks found within the workers’ compensation claim lifecycle.

Areas where STP can make an impact:

  • Increase claim adjuster’s productivity
  • Increase customer satisfaction (both employer and injured worker)
  • Decrease operational costs
  • Decrease loss exposure and risk

STP also provides a path to differentiate the carrier.  Using AI methods, carriers can develop and apply insights gained from the company’s past claims history to build algorithms that produce consistent business outcomes that save time and money.

Data technology solutions enable STP to inform the claims process by combining human judgment with data-driven analytics.  Insurance carriers can predict which claims are likely to result in litigation or require nurse case management – allowing for better decision-making.  Carriers gain insights to impact claim decisions before a reported injury becomes out of control.

STP for workers’ compensation requires a technology platform that enables a fast tracking of “medical only” or minor injury claims, allowing for no-touch or low-touch claims processing experience (automating claim segmentation, reserving, notifications). These capabilities ensure straight-through processing can accelerate the end-to-end process without sacrificing business results.

Other technologies that enable straight-through processing (STP) include:

  • Optical character recognition (Smart OCR) Cognitive and deep data extraction of all incoming documents (structured, unstructured, continuous text, handwriting, etc.) is interpreted and translated into fully contextualized claims scenarios which prepares the ground for an AI-based decision framework for automation and decision support.
  • Digital signing eliminating the need for paper forms to capture approval or consent
  • Electronic funds transfer (EFT) to process payments
  • Analytics interpreting data, producing insights and feeding decision-engines

Learn more about our CoreSuite for Workers’ Compensation that supports STP and partner solutions.