Improving Unrepresented Third Party Claim Settlements Quickly and Easily

Claims adjusters are extremely busy – with many assigned more than 100 claims per month. But most adjusters are working on more than just adjusting the claims assigned to them and are frequently assigned other tasks. Unfortunately, over-worked adjusters who are asked to complete additional work beyond their core duties tend to be less productive, effective and accurate than if they were only working on the claims assigned to them.

One extra task that carriers often assign to their third party bodily injury adjusters is negotiating directly with providers on claims when an attorney doesn’t represent the claimant. By asking adjusters to add this task to their plates, carriers are hoping to see improved results on claims where they would otherwise pay the medical bills at the full amount charged by the treating providers. But in reality, asking adjusters to negotiate on their own isn’t usually as successful as it might seem at first.

Though carriers might see some improved outcomes, results tend to be inconsistent, since most adjusters aren’t skilled or trained in provider negotiation best practices. In addition, their adjusters are even more bogged down than before, leaving them even less time to focus on their core job – adjusting claims.

Carriers who ask their adjusters to do this are on the right path – having adjusters negotiate results in better outcomes than doing nothing at all on these claims – but there is a much simpler, more consistent and less time-consuming way to improve outcomes on unrepresented claims: partner with experts who are trained in negotiating on behalf of a carrier.

Partnering with a negotiation service instead of negotiating in-house is a no-brainer. Carriers who have taken this approach already are saving time, while seeing improved and more consistent results on unrepresented third party claims.

Why partner with a negotiation service?

Impactful solutions and results

By partnering with a negotiation service, carriers can see an estimated 20-30 percent improvement in savings on average. Specifically, this can make a significant difference for carriers that previously weren’t successful in negotiating unrepresented claims.

For example, a negotiation service can be very successful in negotiating facility bills. In a span of six months, a negotiation service successfully negotiated more than 3,000 facility bills from third party claims on behalf of auto insurance carriers. On average, each bill totaled approximately $3,500. Expert negotiators were able to secure an average savings of $800 per bill when successful – that’s about $3 million in total savings from the original charged amount.

Easy implementation and a simple workflow

Implementing a new solution to an insurance carrier’s claims processing workflow can sometimes pose challenges and difficulties such as long implementation processes and high IT costs. However, a negotiation service overcomes those challenges given its easy implementation process and minimal start-up costs. Negotiators can help insurance carriers achieve impactful results without significantly changing workflows or adding tasks to their adjusters’ already busy schedules.

Here is a simple example of how a negotiation service can easily fit into an insurance carrier’s workflow:

1. The adjuster sends a claim (a single bill or group of bills) to the negotiation service by leveraging existing integrations or through a simple web portal, customized to what fits best for the carrier’s workflow.
2. The negotiation service successfully negotiates the bill(s).
3. Adjusters receive the negotiated bill(s) back to them in their adjuster workspace in a timely manner.
4. The adjuster arranges for payment of the bill(s) at the negotiated price.

Choosing a negotiation service

It’s important to remember that not all negotiation services are created equal. There are three main areas to keep in mind when choosing a negotiation service: data, technology and expertise.

Data

Data is the key to a successful and powerful negotiation service. An abundance of data can provide valuable insights that can save time in the negotiation process, and show negotiation patterns. By working with different providers across the country, there are records on the processes and outcomes of each negotiation. This type of data provides insight to negotiators in advance of provider outreach. Specifically, a negotiation service should keep track of who the correct contact is at each facility, as well as whether or not certain providers are difficult to negotiate with and other information regarding how past negotiations have gone with each and every provider. Negotiators can use different tactics and methods for more successful negotiations by having this information in advance.

Technology

A robust technology platform takes all of the data a negotiation service collects and makes it actionable. Negotiators should work with technology solutions that collect, analyze and display important data and history on each provider to help streamline the negotiation process. This type of technology keeps turn-around times low and negotiations successful.

Expertise

In order to successfully implement a negotiation service, expert negotiators with a history of results are going to be the final piece of the puzzle. A successful negotiator should be trained in best practices, have experience in calling providers on a daily basis and building relationships within the provider market. Specifically, this type of expertise provides better and more consistent outcomes for insurance carriers.

Insurance carriers are filling a major gap in their claims process by choosing to partner with a negotiation service for unrepresented third party claims. These services help carriers achieve better results on unrepresented claims quickly and efficiently, without disrupting workflows or adding to their employees’ already-packed work days. While relying on an adjuster to negotiate with providers may seem like the best way to settle a claim, taking the time to identify the right negotiation service usually pays off in the long run.

Monica Zylstra is vice president of Service Operations, providing strategic direction and oversight to a global service operation supporting both auto casualty and workers’ compensation customers. Her focus is on process optimization, workflow design and implementation, service delivery models and global partner management.