Some employees get paid disability insurance coverage as part of their benefits package, and they’re entitled to unpaid leave under the Family Medical Leave Act (several states now offer paid leave), but few think twice about the coverage until they need to file a claim, for pregnancy or a medical emergency, for example. Then, they’re caught in acronym soup and a world that still asks for paperwork, with the feeling that they’re effectively an adversary with the insurance company. In short, the experience is failing consumers and employers.
But forward-thinking insurers are changing the paradigm. They’re adopting modern tech platforms and digital tools that speed up enrollment and optimize claims processing for disability and leave of absence claims. Insurers can take that decision that took more than a week and do it in minutes, cutting employees their disability checks faster.
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One of the reasons it takes more than a week for a claim to process is that the employee typically go through multiple calls to find out how to file a claim, next a claims manager has to make sure the employee qualifies for coverage, and then a nurse and/or doctor has to review medical charts to predict how long the employee is expected to be disabled.
Over 80% of all claims come in via archaic channels—paper, fax, mail, telephone. In some cases, nurses print out digital medical records and fax them to insurers, where someone digitizes the fax so a claims manager can read it on a screen.
In most cases, a person is still touching every case for review. In reality, over 95% of claims end up being approved. They can use tech to spend less time to make a decision.
There’s a better way.
Rebuilding the digital experience
Insurance companies need to build out digital channels, and employers need to direct their employees to take the digital path. That starts with onboarding. When employees sign up for disability coverage in the first place, a user-friendly, personalized interface can help them get the right coverage. It can be prepopulated with advice tailored to each employee. For example, an employee might see the message, “People like you choose 4x coverage.” It’s easy to click to enroll or click to choose different coverage.
The claims process comes next, with new technology powering a great customer experience. Instead of calling 1-800, waiting on hold, and getting mad because they need their paycheck, an employee can go online to the insurer site and file a claim. Employees can submit documents and complete electronic authorizations like HIPAA releases online. Intake specialists, assisted by AI, can approve low complexity claims and assign complex claims to specialist claims managers. Through API connectivity, the insurer can check the employee’s date of hire and hours worked, for example.
When it comes to the clinical review step, an AI tool can aid clinical decision making and speed up the process. The tool can pull out the salient points of the medical records and provide a summary to the clinician and the claims manager to help them decide more complicated cases.
Moving towards instant claims decisions
In the new digital environment, some claims don’t have to be touched by a claims manager—for example with pregnancy. Employees who are going to have a baby can attest to that, and then get an instant “Congrats! Your payments are going to start on xx.xx.xxxx” message.
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The good news is that insurers are moving towards instant decisions—they just have to get past the pain points.
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Tech transformation leads to value
By using predictive analytics and AI, insurers can drive better, high quality claim management outcomes. Claims managers (we call them “navigators”) can communicate proactively with employees about return-to-work preparations, keeping the durations of claims in check. For the employer, there’s better transparency, with near real-time intelligent and predictive insight of global operations. A dashboard can show employees on leave amount paid, average days out, etc.
In one case, we helped a large retail organization that faces over 1,000 maternity leave cases annually with 30% open at any given time, rebuild their digital experience. Before the overhaul, employees had to deal with multiple points of contacts at the employer, employers ended up with inadequate paperwork submissions by employees, and the whole organization suffered from limited knowledge of the rules around disability and leave.
By introducing new digital tools for employees to submit claims electronically, and by providing dedicated caseworkers to follow employees until they returned to work, the employer saw an 88% reduction in claims processing time, 15% reduction in costs and a 38% increase in employee satisfaction.
For insurers who have been holding back, the time to take a step forward and embrace digital transformation is now. Employees will be happier, employers will be happier, and insurers will reap the rewards.
James R. Reesing
Senior Managing Director – Accenture Operations, Insurance Operations Business Lead
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