Discover the Secrets Within your Data

Nothing can save money and secure customer satisfaction like superior claims service. Whether your claims organization is state-of-the-art or facing some challenges, the secret to improving the claims process lies within the information you already have.

With the help of new data analysis techniques, you can better understand how key factors such as reporting delays, vendors, independent adjusters, attorney involvement, injury type and claimant characteristics impact your claims process. Compare this to traditional approaches to claims auditing, which can point out problem areas but cannot identify complicated patterns and trends nor evaluate key factors simultaneously.

Unleashing the Power of Predictive Modeling

Predictive modeling can take many potential influences on the claims process and analyze them simultaneously to reveal their true impact. This important approach relies on company data but can also be supplemented with outside data.

While traditional claims audit processes rely on benchmarks, intuition and long-held beliefs, predictive modeling recognizes patterns in the data. Some patterns may confirm traditional thinking while others may challenge commonly-held assumptions. For example, it is commonly known that claims which remain open longer typically tend to settle for more money. Finally, you can quantify these results.

Predictive modeling will also help answer questions such as which service providers — claim adjusters, medical providers, repair shops — are adding value or detracting value in resolving the claim.

Additionally, by identifying claims that show the potential to become very expensive at an early stage, you can take proactive measures to resolve the claim effectively.

Claims predictive modeling also helps identify more potentially fraudulent claims. By applying predictive modeling to historically fraudulent claims, pattern anomalies can be identified and trigger further investigation.

Pinnacle Can Help

Whether you are satisfied with your company’s claims process or not, chances are claims predictive modeling can improve it. Below are some questions your management team should be asking. The more you answer “yes,” the more Pinnacle can help. Are claim settlement costs increasing more quickly than expected? Does your company have large areas of outside expense — such as medical, rehabilitation adjusters, attorneys or auto repair shops — in the claims handling process? Are there significant numbers of large or extraordinary value claims? Does your company’s fraud detection program need to be evaluated? Are you concerned about the impact of potential legislation of court decisions? Does your company’s claims process need tightening to reduce claim reporting or settlement lag time? Could your company benefit from a more effective absence management program (e.g. return-to-work and modified duty) that reduces claim duration while improving employee morale? Does your company have significant employee turnover in the claims department? Is customer satisfaction with the claims process less-than-desired? Is it leading to a loss of customers?