10 Factors to Consider When Investing in an RMIS

Has your organization recognized a need to shift from manual processes? Are you interested in streamlining incident reporting, risk management and claims processing?

You may be considering investing in a risk management information system (RMIS). An RMIS consolidates all data related to claims, incidents and insurance policies and stores it in a centralized location. It provides a complete picture of how well an organization handles claims and addresses risks while increasing workflow efficiency.

Investing in an RMIS or switching to a new vendor could be fruitful. However, it requires carefully considering what you need in an RMIS and whether a particular solution meets those requirements. The following are the most important things to consider when buying an RMIS.

1. Is the RMIS Secure?

As a self-insured organization, you likely handle massive amounts of valuable data, including financial information. All this data calls for strong security measures to protect your company and customers from cyber threats. Considering that the average cost of a data breach in the United States was $9.48 million in 2023, it is worth placing security high on your RMIS checklist.

To ensure an RMIS is secure and promotes compliance with data protection laws, look for a vendor that can provide a SOC 2 Type II compliance report. This report confirms that the vendor’s RMIS successfully underwent a third-party audit to evaluate the security, confidentiality and privacy of its internal controls.

2. Is the RMIS Cost-Effective?

RMIS solutions are not all the same. It is important to consider various pricing models, ongoing maintenance costs and potential customization capabilities to select the most cost-effective option for your organization.

For example, if you choose a software-as-a-service (SaaS) RMIS, the SaaS provider will likely handle software maintenance and upgrades as part of its service. By contrast, an on-premise solution requires internal IT members to maintain and update your RMIS. An on-premise RMIS adds to the workload of internal IT staff or potentially requires seeking external IT support — which may not be the most cost-effective for your organization’s needs.

Once you have identified an RMIS vendor that could be a viable partner, contact them for an ROI analysis. An ROI analysis will reveal the benefits you can expect from the RMIS compared to its cost. At APP Tech, we can provide a company-specific ROI analysis following a Demo of Cloud Claims, our RMIS solution.

3. Does the RMIS Integrate With Other Systems?

One of the greatest advantages of an RMIS is its ability to integrate with various internal and external systems. Integration capabilities simplify data collection, reduce errors related to re-keying information and enhance collaboration between all stakeholders, increasing claims and risk management efficiency overall.

To get the most value from your RMIS, look for a solution that integrates with your current human resource and accounting systems so you can easily access employee and financial data to generate accurate analytical reports. Also, consider an RMIS that will integrate with your Third Party Administrator (TPA) and insurance carrier systems through tools like application programming interfaces to enable streamlined claims processing.

4. Is the RMIS Scalable?

A scalable RMIS will easily adapt to your organization’s evolving needs and support business growth. In other words, whether you have 100 or 1,000 employees, your RMIS will accommodate your risk management requirements.

Here are features to look for in a scalable RMIS:

  • User-definable data fields
  • Configuration capabilities that do not require IT intervention
  • A pricing model that is independent of claim volume
  • Unlimited data storage

5. Does the RMIS Streamline Incident Reporting?

An RMIS should simplify capturing incident data and sharing it with the right stakeholders at the right time to enable proactive risk mitigation. By streamlining incident reporting, an RMIS also allows key stakeholders to intercede before a claim is filed, potentially saving your company incident-related costs.

The following RMIS features can facilitate efficient incident reporting:

  • The ability to upload documents, photos and videos remotely
  • Seamless integration with stakeholder systems
  • Documentation management capabilities
  • The ability to automatically notify stakeholders of incidents
  • Modifiable incident report templates

6. Is the RMIS Easily Customizable?

Choose an RMIS that you can easily customize to suit your organization’s needs, which does not require you to work with a developer. For example, an RMIS that features customizable fields and drop-downs allows you to tailor the system to your line of business and define elements like claims types, policy coverage class and loss categories.

With the ability to customize the RMIS to suit your organization and its risk managers, claims adjusters and other staff, you can foster higher productivity. Your employees may also appreciate the easy navigation and enhanced user experience of a relevant and adaptable RMIS.

7. Does the RMIS Offer Robust Reporting?

Today’s businesses can harness technology to collect, aggregate and analyze risk data, enabling them to make enhanced, financially impactful decisions. For instance, in a 2023 survey of data and analytics executives, 92 percent claimed their organizations saw measurable value as a result of investing in data and analytics.

However, simply having data does not mean it will be put to good use. Consider choosing an RMIS that will facilitate fast, data-driven decisions so your organization can improve its risk mitigation efforts. Look for features such as:

  • Visualization tools to present data in an easy-to-digest way
  • Ready-to-deploy reports for frequent applications, like loss runs
  • Integration capabilities to enable easy data transfer between systems and ensure data integrity
  • Customizable dashboards, report libraries and filters to tailor reporting to match your needs
  • Simple report generation and streamlined sharing options
  • The ability to easily export data to external business intelligence engines

8. Is the RMIS User-Friendly?

An RMIS is only valuable if employees use it. If an RMIS has a complex navigation system or a cluttered design, for example, employees might get frustrated and avoid adopting the solution. Conversely, a user-friendly RMIS engages users and has a positive effect on widespread solution adoption, enabling improved data capture and increased insight.

To ensure employees embrace your RMIS and utilize it to its potential, look for a solution that highlights user-friendliness. This includes qualities such as:

  • A simple, organized and attractive dashboard
  • Intuitive navigation
  • Global search functionality

9. Does the Vendor Provide Training and Support?

Regardless of how intuitive the system is, efficiently and effectively integrating an RMIS into your workflow can be challenging without the right support. Choose a RMIS provider that offers technical assistance and adequate implementation support to ensure your organization successfully adopts the solution. Your RMIS vendor should help you integrate the solution with your other systems and make sure you understand how to navigate and use it fully.

At APP Tech, we offer tailored onboarding and unlimited support to maintain our client’s success. Providing unlimited support to clients enables a client’s success after the custom onboarding process is completed.

10. Does the Vendor Have a Reputation of Excellence?

The vendor’s trustworthiness and quality of service are just as important as the RMIS itself. Take time to research the vendor, read reviews and evaluate the company’s reputation.

Overall, an RMIS vendor should give the sense that you can trust their team to provide a secure and reliable solution. You will also want to confirm that they will respond quickly to any concerns and are eager to form a supportive, long-term partnership.

Here are a few questions to ask a potential vendor when determining if they are the right fit for your organization:

  • What experience do you have?
  • What problems does your solution solve?
  • What methods do you use to ensure data protection and privacy?
  • Do you have a SOC 2 Type II compliance report?
  • What is your approach to updating and maintaining your RMIS?
  • Can you provide customer references?

You Can Have Confidence in Cloud Claims

An RMIS can improve your organization’s risk management approach, increase productivity and reduce risk exposure, ultimately resulting in cost savings and enhanced claimant satisfaction. Considering the impact an RMIS can make, it is worth choosing a solution that meets all your criteria, provides ongoing tech support and will scale with your business.

You can end your search for an adaptable and intuitive RMIS with Cloud Claims, our flagship claims management platform designed for self-insured organizations. Our scalable, cloud-based solution introduces an incident-based approach to claims management, meaning it streamlines incident reporting to promote data accuracy, enhance decision-making and improve risk mitigation.

Contact us today to learn more about Cloud Claims and schedule a demo tailored to your company.

 

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How Cloud Technology Is Transforming Claims Processing

Cloud computing refers to services delivered via the internet rather than on-site hardware or software. The concept of being able to access programs and data from anywhere, traces back to the 1960s, though the term “cloud computing” was not coined until 1997. Today, cloud computing is a tool commonly used by businesses — including organizations that deal with claims processing.

According to the Top Actuarial Technologies of 2022-2023 report, 69 percent of actuaries use cloud computing or storage frequently or often. This is not surprising, as cloud technology offers benefits ranging from increased efficiency to decreased IT-related costs. McKinsey and Company found that the EBITDA run-rate impact of cloud technology on the insurance sector will be as much as $110 billion by 2030.

Like any business wanting to cut costs and boost efficiency, self-insured organizations are harnessing the power of cloud computing to revamp and optimize their claims management process. Here are some of the ways cloud computing is transforming claims processing:

Enables Organizational Optimization

Cloud technology enables self-insured organizations to operate in a way that is not possible with on-premise solutions. Rather than every reporting party adding more claims management responsibilities to a site manager’s workload, cloud technology allows many sites to delegate tasks to the claims adjusters.

When claims-related tasks are seamlessly assigned to the right people, organizations can process more claims without hiring additional staff or taking site managers away from customers and projects. They can envision and incorporate ways to use cloud-based tools to streamline claims management, and ultimately, they can scale faster.

Facilitates Access to Real-Time Data

Self-insured organizations, insurance carriers and Third Party Administrators (TPAs) handle vast quantities of data to process claims, analyze trends and make informed decisions. This data may be stored in databases as part of a legacy system.

The term “legacy system” often refers to outdated hardware or software applications that a company relies on daily. Typically, legacy systems are no longer available for purchase or can no longer receive updates. They may also struggle to handle large data volumes or integrate with external systems efficiently. Without the ability to integrate with new systems and applications, legacy systems maintain siloed databases and hinder efficient workflow.

An alternative is to migrate data and applications to the cloud. Cloud computing outshines legacy systems when it comes to accurate data capture because it enables access to real-time data. Self-insured companies rely on cloud solutions to easily access and share real-time data across departments.

A simple flow of data allows organizations to make informed decisions quickly to mitigate risk, enhance collaboration between teams and prevent errors related to manual data entry. It also enables self-insured organizations to keep employees updated on claim status. For example, our cloud-based claims management solution, Cloud Claims, provides real-time updates on claim status, fostering increased employee satisfaction.

Considering the advantages of real-time data access, it is no surprise that most businesses aspired to have 80 percent of IT-hosting dollars go to the cloud in a 2021 report.

Increases Claims Management Efficiency

Efficiency is the driving force behind successful businesses because it saves time, resources and money while improving customer satisfaction. The same idea applies to claims management. Efficient claims management allows a self-insured business to maximize its time and resources and improve employee morale.

Thanks to cloud-based claims processing solutions, self-insured businesses no longer need to wade through paperwork or get lost in data siloes. Cloud solutions have transformed traditionally sluggish processes into streamlined operations. Here are some of the ways cloud-based software boosts claims management efficiency:

  • Access data anywhere: As long as the users have an internet connection, they can access cloud-based claims management software from a mobile device. This allows companies to initiate risk management actions at the first notice of loss (FNOL) before a claim is even filed.
  • Store data in a centralized location: Cloud-based solutions seamlessly integrate with many types of internal and external software, allowing organizations to keep all data related to claims and incidents in a centralized location. This provides a complete picture of an organization’s risk and claims management health.
  • Easily collaborate with stakeholders: With the ability to centralize data, cloud-based software can provide a single source of truth. This capability means it is much easier to prevent data silos and miscommunication and simplify collaboration among stakeholders.

Cloud Claims also offers additional efficiency-related advantages, as it:

  • Enables self-insured companies to create multiple claims from a single incident.
  • Makes it easy to capture FNOL data remotely and quickly report incidents using customizable fields.
  • Provides automation features, like triggered email notifications, to save time and keep stakeholders informed.

Reduces the Need for On-Premise Infrastructure

On-premise infrastructure requires organizations to keep servers, storage devices and networking equipment on-site. It also requires resources, like time, money and employees to maintain the systems.

Migrating claims management to the cloud reduces the need for on-premise servers, decreasing costs related to keeping and maintaining hardware. According to Nucleus Research, companies see a $3.43 return for every dollar spent on cloud migration. So, while some businesses are hesitant to invest in cloud migration, many recognize that the cloud brings a higher ROI than on-premise solutions.

Adopting cloud-based claims management software can be a quick and painless process, depending on the vendor and type of cloud computing model you choose. Cloud Claims, for example, is a software-as-a-service (SaaS) platform. This means we handle everything related to software maintenance, including implementing automatic updates and offering unlimited tech support.

Promotes Easy Scalability

A business that utilizes scalable resources is equipped to handle rapid growth efficiently. For self-insured organizations, a scalable claims management system is part of that equation.

Some cloud-based claims processing software, like Cloud Claims, are highly scalable due to built-in features such as unlimited storage and customizable templates. Overall, cloud-based software is more flexible than on-premise solutions and allows self-insured companies to scale up or down to meet changing needs.

Simplifies MMSEA Section 111 Compliance

Cloud computing is not just helping self-insured businesses transform how they process claims — it is also revolutionizing how they comply with MMSEA Section 111.

Organizations that make payments to Medicare beneficiaries must comply with reporting requirements under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007. MMSEA Section 111 reporting can be complex, as it may involve establishing a secure electronic data exchange, collecting detailed information about each claimant and submitting detailed reports. Failure to comply with MMSEA Section 111 reporting can lead to hefty fines.

Fortunately, cloud-based claims management solutions can simplify MMSEA Section 111 compliance by:

  • Allowing your organization to collect, store and access the required documentation easily.
  • Automatically providing a secure data exchange.
  • Reducing human error by decreasing the need for manual processes.

Additionally, your cloud software provider may keep you updated on compliance changes so you do not have to invest too much time in monitoring updates.

We offer MIR Express™️ , a purpose-built, cloud-based solution for Section 111 reporting. To ensure reporting accuracy, MIR Express™ features automated monthly and quarterly reporting submissions and a data pre-validation acceptance rate of 99.9 percent. We keep the product up to date to ensure compliance with MMSEA Section 111.

Choose Cloud Claims to Transform How You Manage Claims

With its ability to increase efficiency, scalability and cost savings, cloud-based claims management software is here to stay. Furthermore, adopting a cloud-based solution can be smooth and hassle-free with the right provider.

For example, Cloud Claims integration and training is a quick process. In some cases, we can have Cloud Claims up and running in a day. We have a 100 percent successful implementation rate, and we will tailor onboarding to your organization’s needs to ensure you feel confident using our SaaS solution.

Ready to learn more? Contact us today to speak with a consultant and schedule a Demo customized to your organization.

 

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6 Key Performance Indicators in the Claims Process

Key performance indicators (KPIs) are metrics used to evaluate and benchmark performance. Their purpose is to help businesses measure and monitor progress toward set goals. If a company looks at its KPIs and discovers it is not on track to reach a specific target, it can then identify and address inefficiencies.

In the claims management realm, self-insured businesses can use key performance indicators to figure out what is working and what may need improvement. For example, by monitoring a KPI that measures incident response time and comparing it to the target, an organization can determine if its team has efficient risk mitigation procedures.

KPIs are not always one-size-fits-all — you can create your own KPIs to match your business’s needs. To develop claims process KPIs, you will generally want to take the following steps:

  • Determine your goals and objectives.
  • Set a benchmark target to help you measure progress over a given amount of time.
  • Consider your current data sources or establish new data collection methods.

Your company can begin making more informed decisions with a few basic KPIs. The following are examples of claims management KPIs:

1. First Notice of Loss Response Time

First notice of loss (FNOL) response time illustrates how quickly claims adjusters respond to a reported loss. This KPI helps pinpoint inefficiencies in FNOL reporting or response. This KPI is especially important for organizations that may wish to intervene on select incidents before a claim is filed.

One way to create a KPI to gauge FNOL-related performance is to compare the average time it takes for claim adjusters to respond to FNOL reports to the number of FNOL reports in a certain span of time. You can then compare that number to your benchmark target and gain some insight into your current position.

For example, envision a KPI that reveals a 10-hour FNOL response time per incident. If your target FNOL response time is eight hours per incident, your next step could be contemplating strategies to streamline FNOL reporting and response. You might explore the causes of FNOL response delays first, like data entry errors. Then, consider adopting a solution that promotes accurate FNOL data capture, like incident-based claims management software.

2. Claims Frequency Rate

Claims frequency rate refers to the ratio of claims to a chosen base within a specific time frame. For example, you might track the number of claims to a certain number of employees over six months to calculate your claims frequency rate. This KPI can help your organization determine the efficacy of its risk management strategies.

To illustrate, imagine your company wants to decrease its claim frequency rate by 5 percent over the next quarter. In this case, you would first create a KPI to measure and monitor your current claims frequency rate.

For example, you might calculate the average number of claims per 100 employees filed in a month. Then, you could benchmark that number against your goal to see if your company is on track. If your claims frequency rate increases or does not move closer to your target, consider ways to decrease the rate. This may mean improving your risk management process, for instance.

3. Claim Closure Ratio

Claim closure ratio compares the number of opened claims to closed claims. It provides insight into whether a company efficiently manages claims. This KPI can help determine if improvements to claim processing efficiency are necessary.

A claims closure ratio of 100%, for example, may indicate that a company has an effective claims management process, closing claims at the same rate as opening them. A lower claim closure ratio means that an organization opens claims at a greater pace than it closes them, which can suggest performance issues or system inefficiencies.

To determine your claim closure ratio, divide the number of claims closed by the number of claims open. Monitor this ratio, which you might convert into a percentage, over a specific time period to understand your organization’s claims processing performance.

4. Claims Cost Per Closed File

Claims cost per closed file (CCCF) measures the average cost of processing and closing a claim. By monitoring CCCF, you can identify patterns leading to increased costs — so you can then take steps to change them.

For instance, CCCF might reveal that claim adjusters are not utilizing automation to streamline their workflows, contributing to labor costs. In this case, it might be worth evaluating your current claims management software for barriers to optimal system use, like user experience issues. If you discover usability challenges, consider adopting a more intuitive claims management solution.

5. Claim Cycle Time

Claim cycle time measures the average number of days to close a claim. It highlights claim processing speed and is another important KPI for monitoring performance efficiency. Additionally, this KPI is important for organizations that seek to optimize claim outcomes by minimizing turnaround time.

You can determine claim cycle time by identifying the number of days it took to close claims within a certain time frame from their corresponding FNOL dates and calculating an average. A lower claim cycle time can protect your reserves and promote claimant satisfaction, whereas a higher claim cycle time can do the opposite. Refining workflows and minimizing manual data entry are some ways to reduce claim cycle time.

6. Subrogation Recovery Rate

Insurance companies miss out on about $15 billion in subrogation dollars annually. Factors like insufficient communication and lack of supporting documents can hinder successful subrogation recovery.

If you are concerned about your company’s subrogation results, consider monitoring your subrogation recovery rate and implementing strategies like enhancing FNOL data collection to improve it.

Subrogation recovery rate measures the amount of subrogation dollars recovered within a period of time. You can compute this metric by dividing the total number of subrogation dollars recovered in a given period by the total amount paid to claimants. This KPI can provide insight into the timeliness and effectiveness of your organization’s subrogation efforts.

Create and Monitor KPIs With Cloud Claims

KPIs give self-insured businesses insight into their processes so they can monitor progress toward goals and make strategic decisions on how to improve. Any self-insured organization, regardless of industry, can benefit from using KPIs to understand where their performance ranks. Fortunately, integrating KPIs into the management workflow can be straightforward and seamless with the right claims processing system.

For example, Cloud Claims by APP Tech is cloud-based claims management software that helps self-insured businesses, Third Party Administrators (TPAs) and insurance carriers create and monitor KPIs. Cloud Claims offers the following:

  • User-friendly, modifiable dashboard
  • Customizable reports and drop-down menus
  • Subrogation, deductible and recovery tracking
  • Widgets to monitor claims from incidents, claims cost per quarter, incident types by month and top incident causes
  • Single location for all claims and incident data
  • Incident-based design enabling incident-related KPI monitoring and streamlined claims filing
  • Easy report and graph generation to communicate or visualize KPI data

Cloud Claims makes it easy to choose which data to track and transfer into graphical representations so you can quickly spot trends and smoothly communicate KPI insights to your team.

Contact us today to schedule a Demo and experience Cloud Claims firsthand.

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