Workers’ Comp Study Reveals Top Ways to Close Claims Performance Gap

A five-year analysis of more than 1,700 claims executives benchmarking data by Rising Medical Solutions identifies the top three practices claims organizations should adopt to join their more successful peers, or risk falling further behind.

Just 24 percent of claims organizations are high performers, according to the Workers’ Compensation Benchmarking Study. A new white paper released by the study group – “How to Close the Claims Performance Gap: Top 3 Findings in 5 Years of the Workers’ Compensation Benchmarking Study” – asks, what do the other 76 percent need to do to catch up?

The report provides a clear picture of how outcome-based activities that dominate top claims strategies. Co-authored by study program director Rachel Fikes and industry journalist Peter Rousmaniere, the report reveals how high performers outpace lower performers up to 10 times more in their use of certain key practices.

“With so many competencies claim departments are often asked to excel at, it can be difficult to decipher exactly which practices will actually move the needle,” said Fikes. “For those organizations that choose to close the performance gap, the data is clear on how to narrow the divide between average and superior performance.”
Top claims performers:

1. Focus on medical and return to work management and compensability investigations. Respondents indicated these were the “top three most critical to claim outcomes.”
2. Invest more in equipping and training claims staff. According to the white paper, “higher performers are more likely to raise staff performance expectations, spend money on training, and nurture mastery throughout their adjusters’ careers.”
3. Invest in technology. The authors wrote, “the most successful claims organizations are far more likely to have higher IT budgets, utilize predictive modeling, and invest in other metrics-gathering tools and techniques.”

Higher performers also tended to measure various core competencies, claims outcomes and utilize predictive analytics.
Better closing ratios was also found to be indicative of a well-run claims organization. The report stated that, “Claims experts agree that a claims ratio of 101% or higher is a reliable sign that the organization is managing claims outcomes effectively.”

The key takeaway from the latest study analysis is that workers comp claims organizations need to focus and measure key core competencies in order to improve performance.

Source: Rising Medical Solutions