An incident-based approach to claims and risk management helps self-insured businesses get ahead and stay ahead by tracking incidents from the start and capturing critical data that may be lost in traditional systems. These insights can help prevent future losses and create a safer work environment for everyone.
The problem with traditional claims-focused systems
Traditional claims-management solutions often prioritize the claims process itself while leaving incidents and near-misses untracked or as separate, loosely connected data points. In these systems, where incidents exist independently, claims managers are tasked with the tedious work of connecting them to claims in a meaningful way.
On top of the extra effort, critical information can slip through the cracks, creating gaps in risk visibility and making it harder for businesses to proactively identify trends and prevent future incidents.
Simply put, most claims-management systems aren’t geared for effective risk management.
What is incident-based claims management?
Incident-based claims management links all relevant data from the moment an incident happens, providing a more complete picture of workplace risks and enabling organizations to act earlier and more effectively.
When an incident — such as a workplace injury, vehicle accident, or property damage — occurs, it is immediately logged into the system. All new information, including subsequent claim information, is seamlessly tied together in a risk management information system (RMIS). From there, the organization can keep tabs on all related details, notify stakeholders, and take necessary actions to prevent further escalation.
This approach puts incidents at the hub and creates a direct link between workplace safety and risk management. (OSHA compliance, for example, is based on incidents, not necessarily claims.) By tracking all incidents — including those that don’t immediately result in claims — businesses can get a clearer picture of their overall risk exposure and can proactively address issues before they escalate.
Why tracking incidents, not only claims, is a smarter move
Instead of just focusing on claims that have already been formally submitted, an incident-based approach gives you insight into everything — from close calls to formal cases to resolution.
Improved cost tracking: One accident can result in claims across multiple policies (e.g., workers’ compensation, property, third-party general liability). An incident-based approach allows organizations to track all related claims together, even when some are managed internally and others by third-party administrators or carriers. This comprehensive view makes it easier to understand total costs at the incident level, aiding in management decisions, self-insurance strategies, and future policy negotiations.
Reduced redundancy: Traditional claims-only systems often force duplicate data entry when multiple claims arise from a single event. By centralizing incident tracking, businesses eliminate inefficiencies and improve data accuracy. Critical data points — such as date of incident, date reported, and description — are only entered once, improving accuracy and reducing administrative workload.
Shared documentation: Incident-based systems allow photos, documents, and notes to be stored and accessed in one place, ensuring consistency and reducing the risk of missing key information.
Natural data flow: Unlike the oxymoronic “notice-only claim” in traditional systems, data in an incident-based system flows naturally from incidents into claims as events unfold, maintaining continuity and providing real-time insight into risk trends.
Pairing this comprehensive data capture with automated notifications and updates ensures that the right people are alerted as soon as an incident occurs, leading to faster response times and better coordination across teams. And keeping claimants informed throughout the process builds trust and improves their overall experience.
Making the switch to an incident-based approach
Switching from traditional claims management tools or manual spreadsheets might seem overwhelming, but it doesn’t have to be. APP Tech’s Cloud Claims makes it easy to adopt an incident-based approach with a user-friendly platform that simplifies data intake and tracking, customizable workflows that fit your business and all its nuance, plus scalable features that grow with your organization.
Staying ahead of claims and risks requires a smarter approach. An incident-based system not only helps businesses manage claims more efficiently but also provides valuable insights that can prevent future losses. By focusing on incidents instead of claims and by capturing and analyzing data early, companies can improve workplace safety, support their employees better, and reduce claim costs.
Ready to improve your claims process? Contact us. We’re happy to give you a Cloud Claims tour and work together to determine if an incident-based approach is right for your company.
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When a key employee retires or leaves, the natural reaction is to brace for impact. But panic doesn’t usually solve much, and in fact, these transitions can be perfect opportunities to modernize, simplify, and future-proof your operations: Assess the processes heavily reliant on the departing employee’s knowledge, identify areas for automation or system upgrades, and implement new tech-based solutions to streamline workflows and reduce reliance on individual expertise.
Here’s how one company did just that, and why you should, too.
Retirement-induced modernization
Here’s the story of one of our clients (names have been changed to protect their identity): A midsized long-term care company that operates scores of locations nationwide was gearing up for the retirement of a long-time employee, Stan.
Stan is incredibly detail-oriented, fantastic with numbers, and comfortable wading through vast amounts of data. Our client operated their risk management department efficiently for decades under Stan’s stewardship. The only problem: most of Stan’s “system” ran on spreadsheets, shared folders on the network, and email chains. Although everything was clear to Stan, many hours (often late at night!) were spent tying out numbers and generating management reports. Furthermore, Stan was the only guy who knew the secret sauce to keep this system going.
When the company learned that Stan was retiring, they were smart enough to get ahead of the curve and upgrade long before he was actually out the door. They teamed up with us to roll out Cloud Claims. We were able to bring over all that legacy data and put it to work. That made workflow smoother, processes more consistent, and visibility a whole lot better. The payoff? Fewer manual errors, hours per month saved on reporting, and a stronger future-ready operation.
The problem with knowledge walking out the door
When someone leaves your company, they don’t just take their office plants and Employee of the Month plaque — they take a lot of know-how with them, too. And if that knowledge isn’t properly and thoroughly documented anywhere, your team may be left scratching their heads. You’ve probably heard something like, “Oh, Jeanie always handled that,” and now that Jeanie’s retired, nobody knows what to do next. Suddenly, even the simplest tasks feel daunting.
It’s not just about process — it’s also about the tools. If your operations are relying on spreadsheets, email threads, and/or old server-based systems, it’s possible that your team is fighting an uphill battle. These systems may have worked back in the day, but now they’re clunky and siloed, and when a key person leaves, things start to break down. Teams waste time hunting for information, fixing mistakes, or just trying to figure out how to keep things running. All of this leads to delays, frustration, and a lot of extra work that could’ve been avoided.
A smarter way to manage transitions
Here’s the thing: People leaving their roles is predictable. It’s going to happen! But instead of scrambling, smart companies see these transitions as a chance to improve.
It starts with a look inward, taking stock of what you’ve got. Are your workflows tied to one person’s brain? Are you using systems that made sense ten years ago but feel outdated now? Will any of this scale? This is your chance to be honest about what’s working — and what’s not.
Once you’ve got a clear picture, think about what you are doing manually that could be automated. What’s slowing your team down? There’s almost always room to make things easier and more efficient, whether it’s minimizing repetitive tasks or upgrading to tools that automate processes and free up valuable time for strategic work.
When your processes are consistent and easy to follow, it’s way simpler for new people to step in and get up to speed. And if you prioritize modern tools, your team will get much better access to the info they need to drive the business forward.
Technology as an enabler
Outside of the people you hire, technology is your best ally in smoothing transitions and setting up your org for long-term success.
Here are a few key areas where the right tools can make all the difference:
UX/UI modernization. While spreadsheets and legacy systems may have worked for the retiring or resigning employee who built them, new hires — especially from younger generations — expect modern, user-friendly interfaces. A clean, intuitive UI makes it easier for new employees to be productive quickly and ensures they have the context they need to get the job done.
Automation. Manual processes can slow teams down and increase the risk for errors. Automating repetitive tasks, like claims intake, data entry, and reporting, reduces these risks and frees up your team to focus on higher-value work.
Knowledge management. When knowledge is locked in someone’s head or scattered across email threads, it’s hard to maintain consistency. However, using that knowledge and baking it into workflow workflow rules and event triggers is a great way to capture what works and make this know-how available and helpful to everyone.
Cloud solutions. Server-based systems may have worked when everyone was in the same office, but today’s teams need more flexibility. Cloud-based solutions ensure your processes are accessible from anywhere — whether your team is in the field or working remotely. Plus, they require much less IT intervention, as software updates are automated and infrastructure isn’t needed.
Mitigating risk with proactive planning
Don’t wait for someone to hand in their notice. Prioritize proactive strategies to minimize disruption and reduce future risks.
Here’s how to build resilience into your operations:
Cross-training programs. Don’t let knowledge live with just one person. Make it a habit to cross-train employees so that critical tasks aren’t dependent on a single individual.
Employee-friendly tools. Transitioning to modern solutions, like APP Tech’s Cloud Claims, doesn’t just help your processes — it helps your people. Intuitive tools make onboarding smoother and reduce frustration, keeping your team happier and more engaged.
Continuous improvement culture. Foster a mindset where your team regularly evaluates and updates processes. That way, you’re always improving — not scrambling to fix things when someone leaves.
The bottom line: Transitions are inevitable, but they don’t have to be painful.
Employee departures can feel like a challenge, but they’re also a golden opportunity to modernize and future-proof your processes. With APP Tech’s Cloud Claims solution, you’ll reduce reliance on individual expertise, streamline and automate manual tasks, and improve visibility across your operations.
If that sounds interesting to you, request a demo using the link above. We’ll get a sense for what you’re up against, and if APP Tech can help, we’ll show you how.
https://apptechllc.com/wp-content/uploads/App-Tech-Blog-0122@2x.jpg9641920APP Techhttps://apptechllc.com/wp-content/uploads/logo-color.pngAPP Tech2025-01-23 21:42:282025-01-28 21:51:11Don’t panic: How to mitigate risk when (or before) you lose a claims manager
Founded in 2019 by Michael Lang and Joseph Denneler, Esq., Inspector Claim Management (ICM) specializes in providing claims- and risk-management services to home inspectors and other real-estate professionals. With a focus on helping their clients navigate insurance challenges and mitigate risks, ICM quickly established itself as a leader in this niche industry. The company has grown to serve thousands of home inspectors across the United States, with expert guidance and comprehensive claims solutions.
To enhance their service offerings and address unique operational needs, ICM implemented Cloud Claims by APP Tech. This solution gave them a way to scale operations, comply with rigorous security standards, and streamline claims management.
“Cloud Claims is a fantastic system. It provides great, customizable reporting so we can make decisions quickly and confidently. Everything is very user-friendly, and the data is presented in a very easily-digestible format.
“We’ve never thought of switching, because the product and support are outstanding.”
— Michael Lang, co-founder, ICM
Challenges
Specialized needs, scalability and security, affordability, future-proofing
Michael and his team needed a robust claims-management solution, but most of the platforms they encountered were prohibitively expensive or they lacked the specialized features ICM couldn’t live without. For a startup with ambitious goals, affordability and adaptability were non-negotiable.
Furthermore, ICM’s requirements went well beyond basic claims management. They needed a system capable of integrating complex data flows, including monthly EDI data feeds for carriers, weekly policy updates from the sales team, and imported claims data from other third-parties.
ICM needed a solution that could evolve to keep pace with the business, and any system they considered had to meet stringent security standards to satisfy their insurance partners, while still being easy to use and scalable to match the company’s rapid growth plans.
Why APP Tech?
Expertise, flexibility, cost
ICM chose the Cloud Claims platform by APP Tech for its specialized features, flexibility, cost-effectiveness, and its incident-based approach to claims management. According to Michael, he was struck by how well the team at APP Tech understood ICM’s niche needs and their commitment to delivering a solution that fit perfectly. It wasn’t just about finding software; it was about finding a partner who could help ICM build momentum.
Implementation
Smooth data integration, minimal IT burden, focused support
While anticipating the release of Cloud Claims, ICM implemented an earlier, on-prem version of the APP Tech software called IMS. The migration to Cloud Claims, about a year later, marked a turning point for ICM. As a cloud-based solution, Cloud Claims eliminated the need for installation and ongoing IT maintenance. It provided instant benefits like effortless system upgrades, best-in-class security, and enhanced scalability. The team at APP Tech worked closely with ICM to make sure line-of-business integrations worked smoothly from day one.
Results
Since 2020, ICM has seen incredible growth, and has relied on APP Tech’s Cloud Claims to keep pace. The platform handles complex data flows — such as importing policy information and exporting claims data — while its incident-based software architecture eliminates duplicate efforts and provides a single source of reference for all claim information. This ensures ICM can scale with confidence.
Accelerated policy growth: In the last four years, ICM’s policy volume has increased by more than 86 percent, and as their client base continues to grow, the company is handling significantly more claims (a ~12 percent increase year over year) with the visibility and operational efficiencies Cloud Claims provides.
Faster settlements: Cloud Claims helps ICM mitigate risk for their clients, but when an incident does occur, all the information is tracked efficiently, processes are standardized and automated, and settlements are timely. ICM has helped thousands of policy holders recover from losses, and has settled millions in claims, confidently and without hassle.
Cloud Claims at-a-glance
Clean, user-friendly interface for rapid content entry, processing, and auditing
Rich sets of data available across all claims for use by risk management
Custom reporting and analytics based on ICM-determined filters
Workflow and automation for faster claims processing
Enhanced efficiency in monthly reporting for insurance programs
A solution that scales with the business
“Paul and his team are really good — they check all the boxes. They are super responsive when we have questions or need customizations, and without the software itself, our business doesn’t run efficiently.”
I like to joke that I’ve never had a “real job” because I launched APP Tech, straight out of college with a buddy of mine, Peter. At the time — this was 2003 — I knew I wanted to build software, and didn’t really care what the industry was, but Peter’s father owned a group of transportation companies in the Philadelphia area, and so that’s where we started.
This post will cover a few key lessons I’ve learned in the decades since. Peter left the company in 2005 to dedicate himself full-time to his father’s business (we’re still great friends), and I feel extremely blessed to have helped grow this company from these humble beginnings into a successful software business with an amazing team and hundreds of customers across North America.
More than 20 years ago, my APP Tech co-founder and I started with a simple goal: build meaningful, customer-focused solutions that solve real-world challenges. Simple enough on paper, but from the start, our journey at APP Tech has been a continuous learning opportunity, and no doubt that will continue.
Our first software deliverables were a handful of products designed for a single customer in a single industry. From these early projects, our team and our vision grew, and we’ve learned valuable lessons about listening, adapting, and, above all, the importance of building strong, trusting relationships. Here are a few of those lessons.
1. Embrace outsiders: There’s power in new and diverse perspectives
When my co-founder, Peter, and I started our company, we were winging it. Fresh out of college and with zero industry experience, we had one client, Peter’s father’s transportation company. We knew how to build software and we knew how to ask good questions, that was pretty much all we had going for us.
But after only 18 months in business, we landed a contract to build a claims-management solution for Greater Houston Transportation (GHT). At that time, GHT was the second-largest taxicab company in the U.S. This was a major win, and our industry-outsider status turned out to be a critical factor in closing the deal.
We were at a trade show and met a guy named Raymond Turner — a big, tall Texan with a cowboy hat and swagger. He had worked in tech before, but was a newcomer in the claims world. When he walked by our booth, he saw what we were doing and said something like, “This industry is backwards. It’s out of date, and you have a fresh take on this. That’s going to be really good for us.”
He saw that the transportation industry had become insular, in a way, and was in a rut — confined by the way things were done in the past.
Outsiders see things differently, and can draw new conclusions from the same old facts. They notice opportunities that aren’t obvious to people who have spent too long looking at the same problems and solutions.
Entering the claims industry without conventional experience, our team had a fresh approach, which was to focus on the incidents that lead to claims, rather than starting with claims themselves.
As an outsider himself, Raymond Turner saw the value of our fresh perspective, and he hired APP Tech for GHT. After that deal, we managed to land Total Transit in Phoenix, and APP Tech was off to the races.
Valuing the outsider mindset has since become a defining feature of our work at APP Tech, even shaping our hiring practices to favor diverse backgrounds, passion, and potential over narrow industry expertise. We’ve come to learn that this approach drives innovation and keeps the team focused on real-world problem-solving.
2. Adaptability and intention are key: Find what works, adjust, and focus
APP Tech launched with a suite of three software products — vehicle fleet management, HR compliance, and claims management — all built for the transportation industry. But over our first few years in business, we discovered that the need for our claims management solution cut across industries, and there was ample opportunity in retail, property management, construction, and other fields. We didn’t come to this realization on our own, we heard it from our clients and prospective clients first.
At the time, we were hesitant to pull the plug on our other software offerings, but the writing on the wall became clear: Claims management was worthy of our undivided attention. This was the idea worth building our business on.
APP Tech’s “incident-first” claims management approach, developed from an outsider’s perspective, resonated with clients by offering a unique and practical solution that traditional claims systems overlooked. So, we shifted the team to focus on that one product, IMS, which would later become our flagship offering, Cloud Claims.
We went deep on functionality, user experience, and real-world use cases, ultimately delivering a claims-management system that was distinctive, flexible, and highly reliable — across various industries.
This shift from a diversified product lineup to a specialized focus allowed the team to build a pinpointed solution for a widespread need. Many enterprise solutions attempt to cover too many bases, which often leaves them “a jack of all trades, master of none.” We listened to the voice of the customer, pivoted, and found our niche.
3. Get out there: Customer relationships are your greatest asset
The most impactful interaction I ever had with a client came at a trade show. In 2007, I was manning our booth and having a conversation with a prospect. I saw one of our customers, LaMonte Jackson from Total Transit, walk up and kind of stop. He could hear my conversation, and at some point, he stepped in and addressed the prospect. He said something like, “We work with these guys and they are fantastic.” Then he went on to give us a ringing endorsement.
When the prospect eventually left, I thanked LaMonte for his words, and he just looked at me and shook his head. “No, man. It’s all good,” he said. “You guys are great to work with.” And he reached over and he patted my chest. It kind of shocked me. “Never lose this, man. Never lose that right there.”
This meant so much to me, because I really respect LaMonte. He’s a wise man, and he showed me that he really appreciated not just what we accomplished together, but the relationship we built while doing it. It touched me in a way that has affected my life. Sometimes you feel like you’re working so hard, and sacrificing, and you don’t know if the work is good enough, and you don’t know whether anybody really cares or notices. But to get that kind of feedback from a customer, where it’s all about what’s in your heart, that’s better than any compliment you could give me on our software.
And it gave me encouragement to just stay true to that path, not to lose that heart.
Customer relationships are at the core of APP Tech’s approach. We make it a point to have frequent interactions and on-site visits with our clients — and yes, we still go to trade shows! Because face-to-face time provides unique moments, insights into client needs, and lets us see the real-world impact of our work. Being there in person reinforces our commitment to listening and adapting to serve our clients better. It’s critical, especially in industries where clients prioritize trust and personal connections.
https://apptechllc.com/wp-content/uploads/apptech-blog-12-2-copy-2-1.jpg321687webfxhttps://apptechllc.com/wp-content/uploads/logo-color.pngwebfx2024-12-16 21:34:382024-12-18 13:59:383 lessons from 20+ years of building software
Many organizations use Excel as a claims management solution. Consider that over 1.3 million companies worldwide use Office 365 and can access Excel. Despite its popularity, Excel has many limitations and poses risks as a self-insured organization’s primary claims management tool.
Here are reasons why Excel is not a suitable alternative to a database system or claims management software, followed by the benefits of adopting dedicated software.
1. Scalability Issues
As your organization scales and manages more data, it will need a system that can efficiently handle large data loads. Excel is not that system.
Unlike claims management solutions that have unlimited data storage out of the box, Excel has data limitations. It is not built to handle large or complex datasets efficiently, which can delay claims management processes or produce erroneous results.
Excel also does not support scalability because it is not a document management tool. Users cannot efficiently track and store claim-related documents, images or videos within Excel, hindering the ability to connect data to specific incidents, conduct an effective root cause analysis (RCA) and make meaningful policy decisions.
Lastly, the desktop version of Excel is weak at supporting team collaboration or optimizing workflows due to its lack of built-in workflow tools and integration capabilities.
While some may use Excel as a spreadsheet and pricing tool, it is not the best option for capturing accurate incident-related data. With its limited integration capabilities, managers may not input data immediately following an incident, leading to a greater potential for errors or delays.
Excel also cannot create comprehensive audit trails, and tracking changes is a hassle. Users with editing access can easily delete or modify data in Excel. All of this can make it challenging for auditors to pinpoint the source of an error or validate data accuracy for reporting purposes.
There are better tools on the market designed specifically to enable real time, accurate data capture at the first notice of loss (FNOL) and streamline OSHA reporting requirements. Take APP Tech’s Cloud Claims, for example, which can help make OSHA recordable injuries a much easier process. Switching to Cloud Claims helps you stay on top of risk and regulatory compliance — making your job easier and helping you avoid costly mistakes.
3. Integration Issues
Self-insured organizations handle a lot of data and must communicate this information with insights to various sources efficiently. They require digital tools that enable smooth integration with stakeholder systems — if they want to streamline collaboration and prevent the need to rekey data.
Since Excel was primarily designed without the ability for diverse API integration, it does not support seamless connectivity with a variety of other systems without add-ons. With its inherent API limitations, it can be challenging to collaborate with related systems, leading to inefficiencies in incident reporting, risk mitigation, claims management and payment processing.
For example, Excel may be incompatible with other insurance platforms or tools and, therefore, unable to capture carrier loss runs, which are vital to learning about risks and developing mitigation strategies.
4. Steep Learning Curve
While some organizations hold onto Excel for its perceived ease of use, its lack of intuitive, purpose-built design can actually complicate claims management and impede the user experience.
Unlike dedicated claims management software, Excel does not present claims-related information in a meaningful, easy-to-digest way. It often requires users to adapt spreadsheets using complex formulas and techniques, which can be time-consuming or require a certain level of technical skill. Therefore, maximizing its capabilities can get complicated. Some employees may have difficulty learning Excel, particularly its data analytics features or formula creation. Without an intuitive user interface, organization-wide usage and adoption may be limited.
Claims management software, on the other hand, presents specific, claims-related data in an intuitive and easy-to-understand dashboard upon login, allowing users to gain insight quickly. Specialized software does not require digging through workbooks or scanning lengthy spreadsheets. Users can quickly change views with simple drop-downs.
Common Risks of Using Excel for Claims Management
Data accuracy is important in insurance because it can impact risk mitigation and reserve calculations. With that in mind, Excel’s limitations pose risks for self-insured organizations, particularly in the following areas:
Data Consistency and Management
Managing data and ensuring consistency can be difficult and time-consuming in Excel. As a spreadsheet program with limited automation and integration capabilities, Excel requires more manual input than purpose-built claims management software, increasing the risk of human error.
For example, while users can create formulas to automate calculations, they can also easily input inaccurate formulas, leading to countless and costly mistakes. According to a survey conducted in the U.K., 98 percent of office workers have seen an Excel-related error cost their employer money.
Excel is also known for its issues with version control. With Excel, users may create various versions of the same spreadsheet, leading to challenges in maintaining data integrity. For example, someone might edit an Excel spreadsheet simultaneously, leading to data loss or inconsistencies.
Lastly, Excel’s connectivity limitations may make users struggle to manage data centrally, necessitating manual data entry and increasing the risk of human error. Overall, limited data consistency can hinder efforts to conduct effective RCA, impacting the ability to identify and address risks. A centralized, purpose-built platform, by contrast, provides organizational transparency and more defined access control.
Security Concerns
Where security is a priority, Excel falls short. Excel lacks robust security controls, like advanced encryption features and access permissions, which are common in dedicated claims management software.
Excel also does not make it easy to coordinate access permissions on a granular level. Users typically select “read-only” or “edit” access options when sharing their files. Once a person has edit access, they can change any element in the spreadsheet. If the spreadsheet is shared without any restrictions, it can quickly lead to unauthorized access and leaking of sensitive data. Users may also share Excel files over unsecured channels.
Organizations must implement procedures to ensure data security and confidentiality while using Excel, which may be more complicated than if using more robust software.
Real-Time Reporting
Real-time reporting is essential in risk and claims management processes because it prevents delays between teams and enables risk managers to mitigate risks promptly. Although newer versions of Excel allow data entry in real time, it may not meet the demands of self-insured organizations in field applications.
For example, Excel is available in mobile versions, meaning users can enter data from anywhere. However, using a spreadsheet from a mobile device can be cumbersome, and the mobile version of Excel does not offer all the functionalities of the desktop version. As mentioned earlier, since Excel is not a document management tool, users are unable to attach incident-related documentation to spreadsheet data.
Excel is also not inherently built to distribute reports automatically, adding to an organization’s administrative burden and delaying decision-making and collaboration. So, while Excel may be used to capture real-time data in some instances, it is not designed to notify stakeholders of an incident automatically. The longer stakeholders are not aware of an incident, the longer risks may go unaddressed.
The Benefits of Specialized Insurance Platforms and Tools
Unlike Excel, claims management software is purpose-built for claims processing efficiency and consistency. It is intentionally designed to organize claims-related data, optimize and automate workflows, generate real-time reports, and reduce manual data entry. Claims management software is also created with more robust security controls to help organizations comply with privacy standards and reporting requirements.
Claims management software streamlines data sharing to promote seamless collaboration. It also automates repetitive tasks and enables tailored workflows.
For example, Cloud Claims by APP Tech is built to coordinate claims processing while reducing administrative burden. It enables self-insured organizations to create customized, automated workflows that enhance claims and risk management efficiency.
To illustrate, your team can use Cloud Claims to automatically send notifications of incident or claim activity to key stakeholders at various stages in the claim life cycle. This saves employees from having to notify the appropriate parties manually, allowing stakeholders to be aware of new incidents in real time.
Customization Options
Customization allows organizations to tailor claims management software so it is relevant to specific needs and highlights meaningful insights. Cloud Claims features extensive customization options to support an organization’s unique requirements and simplify data management, including customizable drop-downs and, email templates and key performance indicators (KPIs). Customizable drop-downs allow management to tailor data fields and minimize manual data entry. Managers can centrally manage data and ensure accuracy and consistency throughout the organization.
Software customization also allows teams to treat data segments for incidents, claims, parties, bills and policies uniquely. Organizations can analyze each segment and generate focused reports to showcase specific areas, such as incident-related KPIs.
You can customize Cloud Claims in-house to suit your requirements best — no need to work with developers or undergo extensive training to tailor the system.
Cloud Benefits
Cloud-based solutions are designed to promote simple, streamlined and secure communications. APP Tech’s Cloud Claims is securely stored in the cloud, enabling a single point of truth across various policies and data records without requiring spreadsheet coordination. As team members submit incident details to Cloud Claims, management can access this information from anywhere at any time and gain a comprehensive view of their organization’s risk health. Cloud Claims also offers unlimited file storage, enabling enhanced scalability and team coordination.
Lastly, cloud-based solutions like Cloud Claims offer multiple layers of security, including industry-approved encryption features. As a software as a service (SaaS) provider that maintains a SOC 2 Type II annual report, we hold ourselves accountable for protecting our customers’ data, providing robust security and implementing automatic system upgrades.
Mobile Access
Platforms that allow seamless mobile use do more than offer convenience — they enable organizations to proactively mitigate risks and resolve incidents before employees file claims. Cloud Claims is built to allow accessibility from any device, enabling FNOL from the field. This allows claimants or supervisors to submit FNOL data to Cloud Claims immediately after an incident at the site, allowing for more accurate and timely data capture.
Claims or risk managers can access FNOL data from their phone, tablet or laptop to make prompt decisions. If a claim is filed, claimants and other stakeholders can track the claim status through a portal on their mobile devices, reducing the need for back-and-forth communications.
User-Friendly Dashboards
Software is only valuable if team members use it. Thus, it is important to have an intuitive system. Cloud Claims was designed to allow users of various skill levels to gain insights from data and generate reports quickly, encouraging adoption and enthusiasm. The user-friendly dashboard features a straightforward, drag-and-drop configuration for easy customization. Users can arrange the interface to provide instant insight into selected claim activity upon logging in. For example, risk managers can instantly view loss trends, claim status or other key information they want to see in their dashboard.
Simplified and Robust Reporting
Unlike Excel, claims management software is specifically designed to assist self-insured organizations in collecting and analyzing claims and risk data so they can quickly digest information and improve decision-making with actionable insights. Cloud Claims simplifies data analytics and reporting with turnkey reports for common applications like loss runs. Its drag-and-drop features, such as the ability to group by dragging column headers, allow quick and easy customization. Its intuitive, drag-and-drop functionality also enables ad hoc graphs for fast analysis of live data and rapid decision-making.
Incident-Based Design
Traditional approaches to claims management focus on data analysis after a claim is filed. By contrast, an incident-based approach to claims management emphasizes accurate and timely data collection at FNOL to support effective root cause analysis. It enables teams to learn from near-misses, develop proactive risk mitigation and intervene before a claim is filed.
Cloud Claims is uniquely built with an incident-based architecture to streamline incident reporting and promote efficient risk management. With Cloud Claims, stakeholders can upload photos, videos and documents from the field using their mobile device. The software integrates seamlessly with stakeholder systems and notifies the appropriate parties of incidents automatically. Additionally, stakeholders can easily track multiple claims from a single incident to gain insight into the underlying cause and its financial impact.
Cloud Claims does not require re-keying the same information for different claims connected to the same incident. Other features, like the ability to organize documents by tags or email them to stakeholders directly from Cloud Claims, streamline communication.
Try a Modern Approach to Policy Management Systems
Insurance software is built with efficiency-enhancing features and without the limitations of Excel. If your organization is ready to elevate your claims and risk management processes, consider implementing a purpose-built solution like Cloud Claims.
We can help your organization seamlessly transition out of Excel and into Cloud Claims with tailored onboarding and quick deployment. With our 100 percent successful implementation rate, you can be sure the transition will be seamless. Contact us today to start a conversation or schedule a tailored Demo.
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The role of employers and claimants in the claims process is important, and it begins with the first notice of loss (FNOL). The FNOL is the first content that initiates the insurance claim process. It is the moment the claimant notifies an employer about any damage, loss or injury, before the employer can respond to an incident. With the necessary information from the FNOL report, adjusters can begin investigating and managing the incident and any related claims.
It is important for self-insured companies to report the FNOL promptly because it can help them follow reporting regulations, address risks before they escalate and start the claim process for claimant satisfaction. However, obstacles to FNOL reporting can delay the process and complicate claims management.
To help you avoid these challenges, here are the top five obstacles to FNOL reporting and what you can do to overcome them.
1. Incidents Are Not Reported in a Timely Manner
If the incident is not reported in a timely manner, it may delay the insurance claim and impact FNOL accuracy. Cumbersome and time-consuming reporting processes are a key reason for underreported workplace injuries. When incidents are not reported immediately, important details like the date, time and circumstances of the event may be forgotten or miscommunicated.
Inaccurate or incomplete information can hinder FNOL submission to the third party administrator (TPA) or insurance carrier. It also prevents risk managers from thoroughly assessing risks. This may keep them from finding the root cause and taking proactive measures to prevent future incidents.
Supervisors, too, may be unclear on their responsibilities. For example, if an employee waits several days to report a slip-and-fall accident, by the time they do, the exact location and conditions may no longer be clear. The wet floor may now be dry, or faulty equipment may have already been fixed during that time.
The use of paper-based reporting can slow down the routing process further. If an employee fills out a paper incident report, it may sit on a supervisor’s desk for days before being forwarded to the appropriate department. In contrast, electronic reporting allows employees to report incidents directly from the field.
2. The Organization Lacks a Standard Incident Reporting Process
A lack of reporting knowledge is a common reason for underreporting work-related injuries. Without a standard operating procedure (SOP) for incident or FNOL reporting, employees may not know what to do. For instance, staff must know how much time they have to report an incident, who to notify and what details to include in their insurance claim. Otherwise, it may lead to late reporting.
Supervisors, too, may be unclear on their responsibilities. For example, a supervisor may be unsure whether they need to conduct a full investigation or simply fill out a basic report after an incident. The lack of clarity can have repercussions. It can result in incomplete documentation and missed opportunities to address safety issues.
This could lead to noncompliance with the Occupational Safety and Health Administration (OSHA). OSHA has recording and reporting regulations companies must follow. Standardizing the process helps avoid noncompliance issues, such as fines or penalties.
3. Reports Are Incomplete or Arrive Piecemeal by Various Methods
Disorganized or scattered incident reporting can lead to common claims management challenges. Such challenges could include miscommunication, errors, incomplete information and delays. For instance, if a video of the incident is emailed separately and a hand-written form is scanned and sent through another method. This scenario creates multiple points of contact. That can be confusing and lead to missing details.
This piecemeal approach contrasts with completing the process online in a single platform. Using an online reporting platform ensures information is captured and submitted together. This streamlined approach can help improve the claim’s accuracy, accessibility and compliance.
4. Key People or Teams Are Not Engaged Quickly Enough
Communication and engagement with stakeholders are important during the claims process. The lack thereof may lead to delays in notifying the right people. Such inefficiencies may result in missed deadlines or potential complications.
For instance, if an FNOL is sent via interoffice mail instead of an automated system, it may take days for the relevant team to receive and act on it. This delay may prevent supervisors from capturing the data or conducting an investigation. What if an organization uses technology but does not have automated alerts set up? Supervisors may not receive immediate notification of an incident.
As a result, key details might be overlooked, and the claim may not be resolved effectively. Quick engagement is essential for accurate reporting and timely response times.
5. There Is a Lack of Follow-Up on Cases
When an incident is perceived as non-critical or minor, it can lead to delays in FNOL reporting because it is deemed not serious. The delay can result in missed opportunities for early intervention and proper FNOL submission. Also, if an injury is not promptly followed up on, the employee may not seek necessary medical care. This may exacerbate the employee’s injury and complicate the claims process. And as such, it can potentially lead to the employer facing legal consequences.
Also, who holds accountability for the incident? A lack of follow-up means the incident cannot be addressed or prevented in case of repeat incidents. Effective follow-up practices can help with proper claims management, accountability and preventive measures.
The Role of Technology in Claims Processes
Claims management software helps organizations with claim processing by streamlining incident reporting. Designed for self-insured companies, TPAs and insurance providers, APP Tech’s Cloud Claims helps clients tackle FNOL reporting challenges.
Cloud Claims software is equipped with various features, including:
Incident-based design: Users can easily navigate and manage incidents from start to finish.
Customizable forms: Organizations can tailor their reporting process to their specific needs.
Streamlined workflows: These workflows help reduce delays and optimize timely engagement.
Desktop and mobile optimization: The software facilitates real time reporting from any web-enabled device.
Start Streamlining FNOL Reporting With Cloud Claims
Streamlining your FNOL reporting is an important consideration for any business. With the right tools and processes in place, it can help with efficient claims management and risk mitigation.
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Claims processing involves a series of steps and coordination between multiple parties from the first notice of loss (FNOL) to claim closure. Many challenges can arise throughout this process that can impact decision-making and cause delays. For example, a lack of access to real-time data can lead to an inaccurate incident report, which can delay claim validation and hinder decision-making, ultimately preventing a timely resolution.
Addressing challenges with claims processing is important because it can improve claimant satisfaction. It also empowers your organization to identify risk mitigation opportunities, limit risk exposure and prevent loss.
As a self-insured organization, you can make a difference in handling claims more efficiently, whether you manage them in-house or use a Third Party Administrator (TPA) or insurance carrier to process them.
Here are five ways to enhance claims processing:
1. Streamline Data Sharing
Data is at the heart of claims processing. It enables claims adjusters to validate claims and make fast, informed decisions. Data also equips risk managers to identify and proactively address risks to prevent future incidents — helping to lessen claims management and processing workloads.
If your organization frequently experiences delays or confusion related to data sharing, it may be time to assess your current system. What tools do you use to share data? Do they easily integrate with stakeholders’ systems?
Using outdated or inefficient claims management software, for example, could be at the root of data-sharing issues. If this is the case, consider switching to a new software provider or upgrading to cloud-based technology, if applicable.
Cloud-based technology that allows real-time data sharing and integrates with external systems can streamline data sharing between all stakeholders and accelerate the decision-making process. For instance, with a cloud-based solution, an employee or site manager can directly add incident data and supporting documentation, like photos and videos, into the system from their mobile device. Decision-makers can then view the incident data remotely, almost instantly, and take the appropriate action — before a claim is filed.
2. Identify Opportunities to Automate Repetitive Tasks
Automation can help your business optimize the claims process, free up resources and reduce the risk of error. It allows your team to dedicate more time to improving processes and addressing complex claims.
If you want to use automation to simplify claims processing, the first step is identifying which tasks to automate. Typically, repetitive processes that do not require human judgment are worthwhile candidates for automation.
To help you brainstorm, here are some tasks that you may consider automating:
Adding new fields if an incident goes to litigation
Delegating tasks to the appropriate party
Sending notifications to TPAs, claimants, risk managers and other stakeholders
Generating reports and scheduling distribution of reports
Once you have identified automation opportunities, consider what tools you will use to make it possible. For example, you could adopt claims management software with automated features. If you are considering investing in claims management technology, look for a solution that simplifies automation so users are motivated to use this capability. Features like intuitive navigation and drag-and-drop fields facilitate easy customization of automated tasks, which can encourage users to make the most of automation.
3. Keep Communication Channels Open and Clear
Establishing clear communication channels between your organization and your TPA is essential to streamlining the claims process because it fosters collaboration and enables you to resolve issues and queries quickly. There are various steps you can take to build a simple and standardized communication method.
First, discuss communication methods and expectations with your TPA or insurance carrier. Strive to have an open conversation that allows you to set clear expectations and goals.
Also, consider the technology you use to communicate with stakeholders and whether it facilitates or hinders communication. Claims processing software that offers a cloud-based, centralized platform and seamless integration with other systems can make it easier to relay information as well as receive loss runs from your carrier.
With such a solution, you can efficiently generate financial impact reports based on loss-run data, and stakeholders can access important information, such as incident details and policy provisions, at any time to answer questions quickly or make prompt decisions. Creating a single source of truth can also prevent confusion and miscommunication.
4. Regularly Monitor and Review Key Performance Indicators
If you work with a TPA to process claims, monitoring your partner’s performance can be beneficial. By doing so, you can ensure that the TPA is adhering to your guidelines and pinpoint inefficiencies leading to delays. You can then communicate your insights to your TPA and collaborate on improving processes.
One way to measure how well your TPA handles claims is to track and review key performance indicators (KPIs). KPIs are customizable metrics that allow you to assess performance in specific stages of claims processing.
For example, you might monitor your TPA’s claim cycle time, which measures the average number of days it takes to close a claim and reveals processing speed. If you discover a high claim cycle time, there may be workflow inefficiencies affecting turnaround.
The claim-cycle-time KPI can help start a conversation between you and your partner to identify the root cause of slow claims processing. For instance, you might discover that manual data entry is leading to more errors, impacting claim cycle time. In this case, you and your TPA can determine a strategy to address frequent data entry errors and reduce claim cycle time.
Similarly, you can use KPIs within your organization to identify and address bottlenecks affecting your TPA’s workflow. For example, you might establish a KPI to measure incident response time. This KPI can reveal whether your team responds to incidents promptly. If response times do not meet a predetermined target, you may need to evaluate the tools your organization uses to report incidents.
5. Leverage Configurability to Tailor Workflows
You can take advantage of your system’s configuration capabilities to tailor workflows to users’ needs and minimize manual tasks. Depending on the level of your software’s configurability, you may be able to modify the following to streamline claims management:
Data fields: Adjust fields and drop-downs so employees can easily record relevant claims-related information, like status codes and policy coverage classes.
Email templates: Customize email templates to standardize and expedite communications with TPAs and other stakeholders.
Report templates and filters: Tailor reporting features to enable simplified and meaningful report generation and promote informed decision-making.
Automated tasks: Choose the tasks you wish to automate and modify to meet your team’s workflow requirements.
If your current software is not configurable, consider if it is time to switch to a vendor that offers a configurable solution. Claims management software with user-friendly, no-code configuration tools allows you to easily modify your system to suit your needs. In other words, you will not have to ask a software developer for assistance in customizing your system’s templates, fields and forms.
Intuitive configuration options save you the cost of working with a developer to complete reconfiguration tasks, allow for faster implementation of reconfigured features and give you more control over your workflows — ultimately enabling improved collaboration with your TPA and facilitating streamlined claims processing.
Optimize Claims Management With Cloud Claims
As a self-insured organization, harnessing claims processing strategies that strengthen your partnership with your TPA can be valuable. Taking steps to streamline data sharing helps prevent bottlenecks on both ends and allows you and your partner to focus more on improving.
That said, optimizing claims processing can be challenging without the right tools. You can trust Cloud Claims to transform how you manage claims.
Cloud Claims is our claims and risk management solution designed for self-insured businesses. It supports efficient claims processing by providing these and other advantages:
Seamless integration with internal and external systems
Simplified incident reporting
Automation and customization capabilities
Compatibility features for use on mobile devices
Are you interested in learning more? Please get in touch with us to discuss your needs and schedule a tailored Demo.
On October 11, 2023, the Centers for Medicare and Medicaid Services (CMS) published the long-awaited final rule stating how and when the agency will impose penalties when responsible reporting entities (RREs) fail to comply with Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (MMSEA). The final rule will be applicable on October 11, 2024, and the earliest CMS will impose a civil monetary penalty (CMP) is October 2025. CMS will not impose these penalties retroactively.
The main takeaway from the CMS provisions is it will conduct random audits to identify untimely reports. In the final rule, CMS does not mention penalizing organizations for exceeding error tolerance thresholds or providing contradictory information, contrary to what was initially proposed.
Still, Section 111 compliance is not something to take lightly. CMS will apply a specific CMP amount to each day of noncompliance — which could potentially have a significant financial impact on an organization. We will cover aspects of the final rule that are important to know as a self-insured organization so you can take action now to avoid penalties later.
What Are Section 111 Reporting Requirements for NGHPs?
If you are a self-insured organization that provides workers’ compensation, liability or no-fault coverage, and your company covers the medical expenses of a Medicare beneficiary, you likely fall under the non-group health plan (NGHP) RRE category. As an NGHP RRE, you are required to comply with NGHP-specific Section 111 reporting mandates. CMS provides a user guide to help NGHPs navigate reporting requirements.
The point of Section 111 reporting is to improve the enforcement of the Medicare Secondary Payer provisions of the Social Security Act. These provisions prohibit Medicare from making claims-related payments if a primary plan has already paid for costs or plans to cover expenses. Section 111 reporting helps CMS ensure it pays for covered items and services only after the primary insurer, such as a self-insured organization, has made payments.
Who Must NGHPs Report To?
In general, NGHPs must transmit claims information to CMS electronically through the Benefits Coordination and Recovery Center (BCRC). The BCRC plays a role in managing CMS databases and collecting claims data on behalf of CMS. However, before submitting data, you must first register as an RRE on the Section 111 COB Secure Website.
They have assumed ongoing responsibility for medicals (ORM).
They have paid the total payment obligation to claimant (TPOC).
You must report claim information quarterly unless there is nothing to report.
What Must NGHPs Report?
As an NGHP, you will need to submit details about the claimant, the services provided and the payments made. This includes the following:
Claimant’s Medicare ID or social security number, date of birth, and gender
ICD diagnosis codes
Your organization’s taxpayer identification number
Total amounts paid to the claimant and when they were paid
When Would CMS Impose Section 111 Civil Monetary Penalties?
CMS states in the final rule that it will only impose CMPs if it identifies an occasion where a TPOC or ORM has not been reported timely.
Generally, NGHPs have a year to submit a claims record after making a settlement. If the NGHP provides a record a year after the settlement date, and CMS randomly selects the untimely record during an audit, the NGHP could face CMPs.
How Are CMPs Calculated for Section 111 Noncompliance?
CMS considers whether your organization is a group health plan (GHP) RRE or an NGHP RRE. Unlike GHP entities, which face a penalty of $1,000 for each day of noncompliance, NGHPs are penalized under a tiered system and face a cap on the amount of CMPs that can be imposed. Penalties are adjusted annually to account for inflation.
The tiered method is as follows:
If a record was submitted over a year but under two years of the required reporting date, CMS will impose a penalty of $250 for each day of noncompliance.
If a record was submitted two years past the reporting deadline but under three years, CMS will impose a penalty of $500 for each day of noncompliance.
If a record was reported three or more years after the deadline, CMS will impose a penalty of $1,000 for each day of noncompliance.
The current penalty cap for a single occurrence of noncompliance is $365,000 in a year, adjusted annually. Therefore, if there are multiple instances of noncompliance, CMS can impose up to $365,000 per year, or more when adjusted for inflation, for each instance.
How Will CMS Identify Instances of Noncompliance?
Rather than use an automated process to monitor all RRE submissions, as considered in the proposed rule, CMS plans to assess a random sample of 1,000 records annually or 250 randomly selected reports quarterly. The number of GHP and NGHP records audited is proportional to the volume received.
For example, if CMS receives 300,000 NGHP records and 700,000 GHP records in a quarter, 70 percent of the 250 audited records will consist of GHG submissions, and 30 percent will be NGHP submissions.
Are There Exceptions to Section 111 Mandatory Reporting?
CMS finalized a few safe harbors to protect RREs from penalties under certain circumstances. RREs will not be penalized if the following safe harbors apply:
Untimely reporting resulted from a technical issue outside of the RRE’s control.
Reports were submitted late due to an error caused by CMS.
Claimants did not cooperate in providing the required information, leading to untimely reporting.
Additionally, CMS acknowledges that other situations may make it inappropriate to impose a penalty and encourages RREs to file an appeal if they feel a penalty was unwarranted.
Since CMS has more authority over NGHPs than GHPs, it can also consider “good faith efforts” if an NGHP does not submit a claims record in a timely manner. Good faith effort refers to the NGHP’s documented attempts to obtain claimant details, like social security number, without success. NGHPs must attempt to acquire the necessary information three times to be exempt from Section 111 reporting requirements based on good faith effort.
How Can a Self-Insured Organization Mitigate the Risk of CMPs?
Complying with Section 111 can be challenging. It may be difficult to determine whether a claimant is a Medicare beneficiary, for example, or to obtain the necessary information. Keeping up with reporting timelines may also be tricky without a well-defined process.
To stay on schedule with Section 111 reporting and avoid CMPs, follow these tips:
Simplify Timeliness
The key to saving your organization from Section 111 noncompliance is to submit records on time — but that can be easier said than done. Using a tool like MIR Express™ ensures you do not miss quarterly submission deadlines.
MIR Express™ is a cloud-based Section 111 reporting solution designed specifically to meet the needs of NGHP RREs. It automates monthly and quarterly submissions so you can provide timely records with less effort.
Streamline Data Collection
Collecting the required claim details does not have to be a time-consuming process. Consider integrating your claims management system with a reporting solution to populate claims data into your reports and reduce the need for manual data entry.
For example, MIR Express™ fully integrates with most other claims management systems, including APP Tech Cloud Claims, providing a complete, streamlined solution.
Ensure Accuracy
Even though CMS does not explicitly state that it will penalize organizations for submitting incorrect claimant data, accuracy still matters. Errors can lead to reporting delays and impact timeliness.
With MIR Express™, you can rest assured record submissions are accurate. MIR Express™ provides data pre-validation with a 99.9 percent acceptance rate.
Achieve Section 111 Reporting Compliance With MIR Express™
Although MMSEA’s Section 111 can be complex to navigate, simplified reporting is possible with MIR Express™. Our one-of-a-kind solution will help your organization comply with Section 111 reporting requirements with less hassle and more peace of mind. When you combine this tool with Cloud Claims, you can enhance your entire claims management and risk mitigation workflow.
We would love to discuss your organization’s needs and how we can help as your software solutions partner. Contact us today to begin the conversation.
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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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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.
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.
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.
