Chicago, IL (WorkersCompensation.com) – Industry experts have been espousing the benefits of an advocacy-based claims model for several years. But it turns out, those in a position to effect this employee-centric idea don’t have the ability to do it.
“…72 percent of frontline claims professionals report they do not know what an advocacy based claims model is,” reports a new study. “Given the significant industry focus on advocacy-based models, there is clearly a disconnect between theory and practice.”
The 7th Annual Workers’ Compensation Benchmarking Study published by Rising Medical Solutions includes survey results from 1,282 frontline claims professionals, matched against opinions from more than 1,800 claims leaders who have participated in previous studies. The focus on professionals who directly handle workers’ compensation claims was intended to get their perspectives on issues facing the industry.
“Adding frontline intelligence to the study’s cumulative data can help organizations advance claims management and talent practices, as well as confront the increasing stakes of attracting young professionals to our industry,” said Rachel Fikes, chief Experience Officer and study program director at Rising.
The talent shortage is seen as the most significant challenge facing claims organizations today. One reason is the national unemployment rate, which has remained fairly steady in recent years and has averaged 3.6 percent this year.
“The converging forces of the aging U.S. population and retirement of Baby Boomers creates an even greater exposure for the workers’ compensation industry,” the report says. “Compounding these issues is a pending mass exodus of experienced claims professionals – juxtaposed against the continued challenge of attracting young professionals to the industry. Success in this area will require organizations to think outside of traditional talent management and recruitment strategies.”
The report delves into several key trends and offers recommendations to address them. One, for example, relates to caseloads.
“The results indicate that 53 percent of frontline claims professionals report indemnity claims caseloads of 125 or less and 20 percent report caseloads greater than 150. Compare that to the 2017 study of claims leaders, in which 60 percent report caseloads of 125 or less and 9 percent report caseloads greater than 150,” the report said. “This data could represent growing caseloads, or a disconnect between claims leaders’ perspectives and operational reality. Caseloads can be impacted by technology, the level of administrative support, or soft market expense management.”
Another focus area is on the key processes that drive claim outcomes. Compensability investigations is ranked as the most important competency among frontline professionals, while claims leaders surveyed in 2017 ranked it third behind disability/return to work management and medical management.
“The impact of compensability investigations on claim outcomes, including delivery of timely medical care, return-to-work, and claim resolution, cannot be overstated,” according to the report. “The potential impact, if this competency is not efficiently and effectively executed, is significant. According to a Lockton Study of denied claims, 67 percent of claims originally denied are converted to paid claims within a year and cost on average 55 percent more than the original claim. This should give organizations pause to consider when more formal compensability investigations are actually needed, as well as the hidden cost to claims from unnecessary frictional delays.”
Time spent on compliance and administrative activities is seen as detracting frontline claims professionals from other, more strategic efforts; such as communicating with injured workers and other stakeholders, proactive coordination of healthcare services and RTW.
“Organizations should determine which administrative tasks and/or regulatory compliance activities can and should be automated,” the authors suggest. “The time and attention of claims professionals should be allocated to higher-level tasks and more strategic responsibilities.”
The study reveals several areas where better and more consistent training could help claims professionals. One was to remove barriers to desired claim outcomes. RTW within anticipated benchmarks was rated as the most important claims outcome and the lack of RTW options/accommodations as the biggest obstacle to optimal outcomes. “Organizations should consider focused training on the importance of RTW, the impact on human capital, and positive employer/employee relationships,” the report said.
Other areas where more training could help included:
- Using metrics. Newer claims professionals have more confidence in the use of metrics to impact claim outcomes. “Organizations could consider two primary conclusions: a need to ‘upskill’ claims talent to better understand and leverage metrics, or that metrics need to be retooled to be more actionable/meaningful to claims operations.”
- Jurisdictional knowledge. More than 40 percent of claims professionals indicated they need more training on differences in laws and regulations among jurisdictions.
- Soft skills. While more organizations are investing in soft skills training for their frontline claims professionals, only 25 percent provide training on empathy “a critical skill when dealing with people who are injured,” according to the report. “To be effective, claims professionals need more than traditional training focused on financial controls and legal/regulatory compliance. They must be skilled communicators and adaptable to cultural differences.”
- Medical management. “On average, 30 percent of frontline participants do not receive adequate training in key areas of medical management, such as evaluating medical treatment, interpreting diagnostic tests, identifying co-morbidities, and understanding psychosocial risk factors and mental health issues,” the study said. “Frontline claims professionals indicate the greatest training needs are in understanding psychosocial risk factors and mental health issues. Participants with less than five years of experience demonstrate significantly higher training needs across all key areas. Given the significance of psychosocial risk factors and mental health issues, organizations should consider equipping claims professionals with this necessary training. Additionally, utilizing screening tools and/or predictive modeling can ensure risk factors are identified early.”