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Enhancing Workers Compensation Claims Efficiency Leveraging Document Indexing and Claims Severity Categorization

Expert.ai Team - 8 December 2023

workers compensation

In the dynamic landscape of insurance claims processing, the need for efficiency, speed and accuracy is paramount. As insurance carriers strive to streamline their operations and provide better customer experiences, the adoption of cutting-edge technologies becomes crucial. In this context, integrating document indexing and claims severity categorization capabilities alongside or in advance of the implementation of systems like Guidewire or Duck Creek is a strategic move.  

The advantages of working with next-generation insurance workflow automation providers like Guidewire and Duck Creek position insurers to operate more effectively in the complex landscape of claims management and underwriting. Unfortunately, the adoption and implementation of these systems often takes significant lead time, sometimes years to complete. This leaves companies who have gone through lengthy vendor selection processes…waiting (with anticipation) for value realization.  

As insurers wait to complete these deployments, they often delay adopting other operational improvements. This is a missed opportunity. In fact, adding complementary capabilities like document indexing and claim severity triage can deliver great value prior to completing a Guidewire or Duck Creek deployment and pay even greater benefits once their workflow automation systems are live. 

In this blog post, we will delve into the advantages of embracing these technologies concurrently. 

Why Before? 

Focusing solely on improving one step in a process, without considering the entire process, can lead to missed opportunities.  

Deploying an insurance automation platform has the overarching goal of optimizing the underwriting or claims process. Yet when the optimization exercise is too focused on one step of the process, you may lose sight of improvements that could impact the overall process or end-to-end workflow. Here, the danger is that you over-invest in technology that is limited to a specific step, while neglecting other areas that may benefit from improved automation and handling approaches. 

Luckily, there are improvements and capabilities that you can adopt that are much broader in scope.  

Document Indexing to the Rescue 

In the claims process, agents are responsible for collecting and reading through hundreds or more documents to set up a claim. A bodily injury claims packet typically includes a mix of structured documents (ACORD forms or accident reports) and unstructured documents (attending physicians’ statements, treatment notes, legal correspondence, policy documents, etc.), some of which may be duplicates. 

Adopting a document indexing solution introduces nearly instant efficiencies in your claims intake process and sets the stage for more advanced capabilities down the road.  

By understanding the record types and the content contained in claims documentation, reviewers can eliminate up to 30% of reviews as duplicate and unnecessary before they ever reach a system of record. Categorizing documents before automatically uploading them to your insurance platform is also good data hygiene. It also helps reduce time spent manually inspecting uploaded files to determine if they are actually duplicates. 

The Benefits of Document Indexing 

In insurance claims processing, document indexing can increase efficiency and reduce processing times before the deployment and roll out of insurance platforms like Guidewire, Majesco and Duck Creek. Adopt document categorization capabilities before or after an insurance platform deployment to take advantage of:  

  • Faster Access to Information: With document indexing, relevant information is tagged and organized systematically. This ensures that adjusters can quickly access the necessary documents, reducing the time spent searching through vast amounts of data. 
  • Improved Accuracy: Manual document sorting is prone to errors, leading to potential delays and inaccuracies in claims processing. Document indexing minimizes the risk of errors by automating the categorization process, enhancing overall accuracy. 
  • Enhanced Customer Experience: Swift claims processing is a key driver of customer satisfaction. Document indexing enables insurance carriers to expedite the assessment and settlement of claims, resulting in a positive experience for policyholders. 

To learn more about best practices in Automating your Claims Processes, check out our white paper. 

Automating Claims Severity Categorization: A Game-Changer 

Another activity that slows down processing is claims severity categorization. This process requires agents to assess the extent of damage or loss associated with a claim. When done manually, this can be a time-consuming and resource-intensive process that hinders efficiency and scalability. Also, the subjective nature of human judgment could introduce inconsistency and bias, leading to unreliable assessments.  

These risks are especially relevant for workers’ compensation claims where diagnostic changes demand vigilance and adaptability, which manual processes struggle to maintain. Inaccuracies and delays in severity categorization can impact claims processing, customer satisfaction and overall operational effectiveness.  

For example, once an AI-driven automated approach to claims severity categorization is in place, or when implemented alongside a Guidewire ClaimsCenter deployment, this can offer insurance carriers several advantages: 

  • Prioritization of High-Impact Claims: Claims severity categorization allows insurers to prioritize high-impact claims that require immediate attention as early as at FNOL. This ensures that critical cases are addressed promptly and helps to set more accurate severity reserve amounts earlier in the process. 
  • Resource Optimization: By categorizing claims based on severity, insurers can allocate resources more efficiently. This helps in optimizing the deployment of claims adjusters and other resources, ensuring that the right expertise is dedicated to the most critical cases. 
  • Proactive Risk Management: Identifying and categorizing claims based on severity provides insurers with valuable insights into potential areas of risk. This proactive approach enables carriers to implement risk mitigation strategies, ultimately reducing the frequency and impact of future claims. 

Start Adding Value Now 

Start adding value to your insurance processes now while simultaneously adding even greater value to your future Guidewire or Duck Creek deployment. Here are just a few of the KPIs that you can be improve in just a few weeks: 

  • Improved accuracy and consistency of initial claim loss reserve forecast estimates  
  • Faster routing of high-severity claims to supervisors 
  • Increased rate of straight-through claims processing 
  • Reduced claim loss reserve variability 
  • Reduced number of duplicate claims and document reviews 

As the insurance industry continues to embrace digital transformation and new AI-driven approaches, forward-thinking insurers should consider document indexing and claims severity categorization as strategic investments. Not only can they complement existing systems, but they should be considered for deployment prior to insurance platform adoption. In doing so, insurance carriers can position themselves as industry leaders, providing unparalleled service to their policyholders while optimizing internal operations for sustained success. 

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The expert.ai Platform for Insurance provides insurance teams with a way to automate the repetitive tasks associated with document reviews, extraction and assessments, freeing up time to focus on de-risking underwriting decisions, determining coverage and conducting preliminary claims investigations.

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