Leading Out Loud: Workers' Comp

We ask two industry experts about the latest trends for workers' comp including technology and talent

August 30, 2023 Photo

[Editor's Note: The following content is sponsored by Helmsman Management Services and Foundation AI.] 

What are the latest trends facing claims departments? What technology is having the biggest impact on workers’ comp claims? And finally, what are carriers and law firms doing to attract and retain talent?

What is the biggest issue or trend facing workers’ compensation claims departments in 2023?  

Kevin Gunderson, Helmsman Management Services: For years we talked about rising medical costs, and how inflation trends have put a new pressure on medical costs in recent times. An issue that is proving to be just as impactful as rising medical costs is managing insurance programs in a time of continued staffing pressures. The administration of claims handling requires talented, engaged, empathetic, critically thinking, and solutions-oriented adjusters; maintaining that level of care and administrative oversight is putting pressure on the entire industry. Helmsman has taken considerable steps to develop a culture of stability and we are seeing favorable trends in our staffing as a result.  

Vivek Rao, Foundation AI: Workers’ compensation departments are experiencing significant resource depletion due to manual processing of an ever-increasing volume of documents, inbound emails, and attachments. Valuable staff time and financial resources are being consumed by inefficient, inaccurate, and labor-intensive document processes. Moreover, claims departments are unable to fully leverage the critical data contained within these documents, as very little of it is captured in a reusable format. Furthermore, the mounting burden of mundane document processing tasks hinders claims organizations from allocating their employees to value-adding work, exacerbating the persistent retention and staffing challenges many organizations face, and impairing their ability to focus on continuous improvement efforts.

To address these issues, workers’ compensation claims departments must embrace technology that drives efficiency, reduces costs, optimizes data utilization, and empowers their staff to create tangible value for the organization.

Inflation is rising everywhere, and medical care costs are no exception. What kind of strain is this causing on the system?

Kevin Gunderson, Helmsman Management Services: There are two strains on the system. One is the cost of medical care, and the other is the staffing dynamics in healthcare. Helmsman focuses our efforts on items that will improve claims outcomes, which in turn improves the overall claim costs. This starts with getting the right care in a timely fashion. By focusing on the right care and using our available data and resources we can help shorten the recovery time for the injured employee. 

For example, soft tissue injuries benefit from limiting surgical intervention; this can help reduce costs by avoiding unnecessary surgeries and shortening the recovery time for the injured worker. Helmsman leverages curated PPO networks (including Outcome Based Networks) to help ensure the employee is receiving timely, high-quality care that is focused on a healthy return to work. Likewise, by knowing what medical interventions are most effective we can help fast track those treatments, again leading to a timely return to work, benefiting the employee and employer. 

What kinds of technology are having the biggest impact on workers’ compensation claims? If you could “disrupt” the workers’ compensation industry, what would you focus on, and what would it look like?

Vivek Rao, Foundation AI: In the workers’ compensation claims realm, a wide array of technologies exists to boost efficiency, accuracy, and the customer experience while reducing costs and improving overall outcomes. Artificial intelligence (AI) and machine learning, robotic process automation (RPA), data analytics and predictive modeling, self-service portals, and telemedicine and remote healthcare are among the impactful solutions available today.

To disrupt the status quo, Foundation AI has developed a practical technology solution that drives significant improvements and efficiencies while balancing against the industry’s hesitance towards embracing radical change. Recognizing that the day-to-day workload of workers’ comp claims is unlikely to ease up and that additional staff may not be readily available, the key lies in providing a technology solution that addresses identified pain points and inefficiencies, fixes broken and labor-intensive processes, and delivers meaningful, measurable results without causing upheaval.

To achieve this, the solution(s) should seamlessly integrate into the department’s existing technology stack and require minimal effort to implement. Additionally, it should offer a short learning curve and a more efficient workflow for the team, ensuring smooth adoption and usage. By meeting these criteria, the solution can effectively address the challenges faced by claims teams and help them navigate their workloads more efficiently.

Kevin Gunderson, Helmsman Management Services: Our focus is on having every adjuster spend their time adding value to the outcome of a claim. This requires active and empathetic listening, critical thinking, applying medical expertise, and managing the trajectory of the claim. Helmsman is using advanced analytics, predictive modeling, and AI to provide more insights to our adjusters and to reduce administrative time so that they have more time to focus on the needs of the specific claim.

Across the industry for insurers and law firms alike, finding and retaining top talent is becoming more and more difficult. What are you doing to keep hard-to-find talent and focus them on value-creating tasks?

Kevin Gunderson, Helmsman Management Services: Helmsman continues to invest in our talent and technology to build an engaged, high-performance culture of stability. Providing claims professionals with opportunities for personal and professional growth, the tools for success from industry-leading training to sophisticated predictive models that get the right professional on each claim is key to retaining top talent. Onboarding and training new hires in cohorts, allowing for flexible work arrangements, dedicated training support throughout careers, and tools for continuous professional growth also help reinforce a culture of stability.

Vivek Rao, Foundation AI: One of the key benefits of the Foundation AI solution is that it solves many of the staffing challenges facing not only workers’ compensation claims teams, but also the defense firms they partner with. The most significant benefit is removing the labor-intensive and manual nature of processing inbound documents, emails and attachments. Let’s face it, you didn’t hire your staff to spend dozens of hours a week processing mail, opening emails and downloading attachments, and figuring out what they are, who should get them, and how urgent they are. And trust me, your staff doesn’t enjoy doing that either.

If you’re going to keep your people, you need to challenge them and let them grow and contribute in a meaningful way to the organization. For new people, you want to enable them with technology that allows them to do their job quickly, accurately, and efficiently. A happy, productive, and challenged staff is one that wants to stay and grow with your organization.

The other benefit we’re seeing is that providing process consistency really helps to build a stronger, more effective staff. If every document, email, form, and attachment that comes into the department is processed the same way, every time, you’re not wasting cycles fixing errors, training and retraining staff, tracking down lost documents, and missing critical dates. You’re freeing your people up to do what makes sense for your department. Achieving this level of streamlined operations may seem idealistic, but it really is possible when you harness technology that is specifically built to solve these types of challenges. K

Kevin Gunderson is vice president & manager, WC Examining, at Helmsman Management Services. kevin.gunderson@helmsmantpa.com

Vivek Rao is chief executive officer of Foundation AI. vivek@foundationai.com

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