How Claims Guidance is Turning Examiners into Superheroes

How Claims Guidance is Turning Examiners into Superheroes

As claims management undergoes a once-in-a-generation modernization, frontline examiners – the lifeblood of an organization – are now being empowered to have immediate and outsized impact on cases like never before.

In a recent virtual panel hosted by EvolutionIQ and the International Claim Association, three senior claims leaders who have been driving innovation and forward-thinking at their respective companies for decades first outlined the ways in which examiners are being overwhelmed due to lack of bandwidth for ever increasing caseloads, more complex cases, and no clear line-of-sight regarding which actions to prioritize and when.

“We need to innovate in that space and really elevate our employee experience, especially those of claims examiners, into a position of truly being able to impact people’s lives and make a difference,” said Cheryl Paine, Assistant Vice President at Principal Financial Group. As an examiner, “you’re holding people’s livelihoods in your hands whether it’s a disability or life [insurance] decision.”

Added Kathy Serunian, AVP at Disability RMS / FullscopeRMS / SunLife: “I think change within a claims group that’s very busy can be very daunting for claims professionals.” The default reaction to new technology solutions is, “don’t interrupt my flow” she explained. “But at the same time they’re craving ‘how can i do this more efficiently?’”

Michael Saltzman, co-founder and COO at Evolution IQ, noted that much of an examiner’s time is spent looking for ways to make an impact, such as helping a claimant find a resolution opportunity. “That searching is not the most fun part of being an examiner,” he said. “When you think about what technology has offered over the last five years, there is automation, ripping information off of claims forms, digital claim intake, robotic process automation – all of that is very separate from the examiner experience. It kind of does its thing off in a corner and then something comes to a screen the examiner is using. But what if we combine the two? What are the opportunities for what we are calling ‘claims guidance’ – where the examiner and the technology are actually more partnered together?”

Theresa Kowalchick, Vice President Operations at Reliance Standard pointed out that, “When you’re sitting as a case examiner or claims adjudicator and you’re looking at maybe 80 to 140 claims sitting in that block and a lot of it is just task driven off of calendar notes, you’re trying to figure, ‘Where do i go today? On what claims do I focus? Where do I go on my list?’”

She said that when you look at the technology available, if there is something that says, “Hey, here’s this claim over here that has a great possibility for returning back to work. Isn’t that the impact you want to have, not only for your organization but for that individual who is disabled? If there’s a tool available that could highlight that claim for me in that block of 80 to 140 claims, I think that’s welcome. It takes that extra pressure off the examiner to look through all of their cases one-by-one to identify that opportunity… Which files do I want to manage? What interactions do I want to have with our clinical and vocational partners? That’s very helpful.”

Regarding, “What’s in it for me” from an examiner’s point of view, she added: “I think all claims examiners really look to: What am I getting at the end of the day? Do I feel I accomplished something? Have I achieved anything? Well, if they have the tools available to point them at those correct files then they’ve achieved something. They’ve returned somebody back to work. They’ve helped them get on the right track or the right claim path they need to be on. I definitely see what’s in the industry today in terms of guidance as an opportunity for examiners.”

Watch the full webinar here: