Claims management can be a complex and time-consuming process rife with challenges, from ensuring claim data integrity to maintaining contact with claimants. In addition, self-insured organizations and third-party administrators (TPAs) are under significant pressure to process claims as quickly as possible.

Regardless of an organization’s current position, streamlining the claims management process is achievable. Purpose-built technology, like customizable claims management software, helps organizations implement strategies to resolve claims faster, mitigate and prevent repeat incidents, and keep key stakeholders informed.

8 Effective Claims Management Strategies

Claims management strategies aim to maximize efficiency, mitigate risks and eliminate unnecessary steps, ultimately reducing costs and improving stakeholder satisfaction. The following strategies can help your organization improve workflows and accomplish these objectives.

1. Enter Accurate Data at the First Notice of Loss

Entering data into your system accurately with the First Notice of Loss (FNOL) is crucial to preventing settlement delays and promoting claimant satisfaction. Claim adjusters can leverage technology to simplify accurate data collection.

For instance, once an employee submits an FNOL report, an adjuster can use mobile-compatible claims management software to gather data at the incident site. They can take photos and videos, collect witness contact information and document environmental conditions, all while entering this information into their organization’s system via their mobile device. This capability reduces the need to manually enter FNOL data later, preventing redundancy and decreasing the risk of error.

Depending on your organization’s structure, you might also give employees access to a mobile app that integrates with your system so they can directly enter FNOL data immediately following an incident — while the details are still fresh in their minds.

2. Simplify Incident Reporting

Removing barriers to reporting is essential to identifying risks and resolving issues, like workplace safety challenges, before they become greater problems. It also puts the claims process in motion and ensures deadlines are met.

For example, prompt reporting is integral to being able to initiate post-incident drug testing and determine if substance use contributed to the incident. Depending on your state’s workers’ compensation laws, a failed drug test could impact the employee’s claim, potentially saving your organization from related costs.

With an intuitive, customizable system, you can make it easy for adjusters to report incidents and document details quickly and accurately. Claims management software with customization capabilities allows you to preset fields and forms, some of which may populate automatically, and prompt adjusters to add information that aligns with your organization’s reporting policies. With a tailored system, adjusters do not have to question what data to enter to follow the relevant policy. Instead, they can enter data quickly and feel confident in their process. Fields that automatically populate can help reduce errors as well.

Choosing software that tracks deadlines and alerts users if information is missing also provides an advantage, allowing you to ensure adjusters have added the necessary details before settlement or litigation activities.

3. Maintain Clear Communication With Key Stakeholders

Keep communications clear with key stakeholders, like TPAs, managers, claimants and service providers, to encourage smooth claim processing and prevent delays. Your system plays a major role in achieving timely communication and keeping stakeholders informed.

For example, a claim management system can alert managers or supervisors in real time when an incident occurs, allowing them to take action and address the cause of the incident quickly. It can also integrate with a partner’s systems to simplify communications and ensure everyone is on the same page.

You can use claims management software to communicate with claimants and keep them informed on the status of their claims. Some claimants may prefer digital notifications over speaking to an adjuster on the phone, so your technology can help make the process less stressful.

4. Streamline Claims Processing With Integration

Consider how integration with other systems, partners and vendors can help with data integrity and reduce manual data entry and analysis. For example, for claims involving employees, keeping accurate contact information, safety certifications and pay rates can help expedite the claim. For claims involving property or assets, integration with your current systems to track property can help with tracking inventory and recovery efforts.

Many organizations enlist the assistance of vendors such as medical bill review providers or TPAs to help process their claims. Claims management software can integrate directly with these types of external systems to minimize the burden and errors of data re-entry and consolidate your data for easy and accurate analysis and reporting.

5. Ensure Your Claims Management System Aligns With Your Policy

Your claims management system must align with your policy so adjusters can make informed decisions quickly and easily. It should also ensure payments are disbursed according to your policy’s coverage limits.

Ideally, you will be able to configure your software to reflect your policy’s limits. Your system should track payments, automatically adjust balances and notify adjusters of impending deadlines so they can act promptly and ensure providers are paid and settlements are reached in a timely manner.

6. Simplify Processing With Automated Tasks and Tracking

If team members do not know who is responsible for processing a claim or completing a task, the claim may sit in a queue longer than it should. You can help prevent stalled claims with the power of automation.

Use claims management software that automatically assigns tasks to the appropriate adjuster. Set task reminders and notifications to ensure adjusters meet critical deadlines. Lastly, the system should track assigned tasks to monitor the progress of a claim so you can keep stakeholders updated or investigate and address delays.

7. Take an Incident-Based Approach

Today’s self-insured organizations prioritize preventing incidents and claims from happening in the first place. An incident-based approach to claims processing helps these entities achieve risk management goals while streamlining workflows.

Incident-based claims management revolves around real-time incident reporting, reducing manual data entry and incorporating risk management. Accurately capturing incident details is critical to minimizing the chance of recurrence. An incident-based approach empowers self-insured companies to find patterns and avoid repeat incidents, cutting costs and protecting employee morale.

Incident-based claims management software allows adjusters to log incidents, such as work-related injuries or property damage, even in the absence of a claim. Stakeholders like regional managers can set the system to provide immediate notification so they can take corrective action and prevent additional incidents.

Adjusters can also use an incident-based system to enter data for multiple claims that arise from the same incident. This feature reduces duplicate content and minimizes error.

With a comprehensive, incident-based claims management solution, all documentation related to an incident is digitized and centralized for easy access. For instance, a company’s risk managers can access the software and learn about incidents at one location to prevent them from occurring elsewhere.

8. Adopt Flexible Claims Management Software

Self-insured companies no longer need to conform their workflows to rigid structures or preset fields. Instead, they can adopt configurable claims management software to support their unique needs.

Customizable software allows your company to tailor workflows to suit your processes and automate tasks to remove time-consuming manual work. With a flexible solution, you can customize the user interface to simplify navigation and boost adjuster engagement, efficiency and satisfaction. An adaptable system also scales with your business as you grow and can handle large volumes of claims when needed.

Streamline Your Entire Workflow With Cloud Claims

Although claims processing is complex, the right technology can help you implement effective strategies that simplify the process. By leveraging technological tools, your organization can optimize workflows, stay compliant and process claims efficiently, ultimately improving your bottom line.

At APP Tech, we support this goal by offering Cloud Claims — a flexible, incident-based claims management solution designed to streamline and track claim activities. We tailor Cloud Claims to fit your organization’s unique workflows and provide features and benefits including:

  • Automated notifications
  • Customizable dashboard, templates, fields and drop-downs
  • Desktop, tablet and mobile device compatibility
  • Unlimited storage for claim documents such as PDFs, photos and videos
  • Access to support teams that understand MMSEA Section 111 compliance

Request a Demo to explore Cloud Claims, or visit our blog to discover more tips for a smoother claim management process.