How one change can save millions, improve efficiency and increase customer satisfaction
Haywood Marsh, General Manager for NetClaim
Spend just a few minutes with Haywood Marsh, general manager for NetClaim, a division of Navex Global, and you’ll likely learn your company is hemorrhaging a fortune. In fact, he may tell you you’re at risk of losing your client base — forever.
Marsh would know.
As an innovator in the claims processing industry, he’s seen firsthand the impact that upgrading to digital contact centers can make on a company’s bottom line and reputation. In many cases, it reduces from a month to 30 minutes the amount of time it takes to analyze and process claims, all while putting an end to widespread fraud and wasted capital. Companies love it because they’re saving money; customers love it because it saves time and exponentially improves their experience.
Forward-thinking carriers are beginning to take note that a modern claims intake strategy is the wave of the future. Start upgrading your processes now, Marsh warns, or you could be left behind.
Q: How are call centers and claims processing matters currently handled by most?
A: The matter is typically handled in two ways. First, it could be managed internally and handed off to either the insurance carrier or the third-party administrator. Or it could be managed by outsourced contact centers, which usually lack sophisticated systems that allow for things like flexible scripting. This is incredibly important based on how the policy is underwritten and how carriers and TPAs want to capture relevant information that allows them to properly reserve as well as adjust correctly and quickly. You also need integrity checks built into whatever system you’re using to ensure people can quickly get the correct information. A lot of the time, that doesn’t happen.
Q: How do you correct these outdated processes?
A: Companies need to break apart the monolith and embrace microservices to allow them to engage with experts in the claims intake process. This is important because, as the claims adjustment process gets much quicker and shorter, a lot of what used to be done later in the process — such as subrogation potential assessment, litigation potential assessment or fraud identification — is going to be pushed to the point of intake.
You really need people who are technologically savvy in the intake process. But they are not always your inside team or your generic call center.
For example, let’s say you have an injured worker who’s still on-site. If you have the right kind of intake people and you escalate it correctly, you can get the employee in touch with a nurse triage vendor that allows the insured to get the correct type of medical care. You can get the employee to a drug testing facility to ensure that alcohol or drugs weren’t ingested before the accident. You can get the right adjuster on the phone to reduce the chance the worker contacts a lawyer. All of this is important because the faster you get the right type of medical attention, the lower the cost of that claim. But more importantly, it also can release the company from liability.
Q: What exactly is a digital call center, and how does it solve problems for businesses?
A: We call it a contact center, as opposed to a call center, because you really want to have omnichannel intake capabilities. That’s the hallmark of a digital contact center.
We not only take phone calls but also receive emails or communicate via fax, especially with the government or government contractors, because it’s perceived as more secure.
Most importantly, we intake via mobile-enabled web forms that are adaptable to every device and every web browser, so people in the field can submit claims in as close to real time as possible. We also accept feeds from other systems, transform the data and make sure it’s disseminated correctly through the system.
In addition to omnichannel intake, it is important for a digital contact center to have a robust software package so the client’s required workflows can be coded into their system. The software package must have flexible scripting and dynamic, or branching, logic to allow the intake specialist to adapt the question set based on previous answers.
A critical subsection of that — and something that differentiates us and ensures quality information from the onset — is to make sure you have built-in integrity checks, so if the person is talking about a head injury, the system prevents you from coding the wrong body part, which is something that happens surprisingly often without these systems in place.
The third feature of a digital contact center is automatic escalation. Escalation criteria are built into the system, and as soon as the person hits “submit” on the claim, it automatically escalates to the correct people, so you’re not waiting days or weeks to get claims. You’re getting it to the correct people in under a day or in even just a few hours.
Q: What is the machine learning rule, and why is claims management at the epicenter of digital transformation in insurance?
A: Artificial intelligence and machine learning (AI and ML) are becoming increasingly prevalent across all markets. Where we see it really adding value is in the identification of claims issues.
In the claims life cycle, you go from intake to auto reserve, then to adjustment, subrogation, litigation, resolution and finally audit.
But a lot of things happen later, such as identification of fraud, which accounts for 10% of all payouts in the insurance industry.
Subrogation opportunities as well as litigation potential are usually identified fairly late in the process, too.
Eighty percent of the information you need is captured at the point of intake. We are currently exploring how to apply AI-ML at the point of intake, so instead of waiting 30 or 60 days to identify all those issues, you identify them on Day One. You’ll then have enough information to flag a claim and see if it’ll become an issue in any one of those areas.
In other words, you help your insured get back to work or get paid out quickly AND help the ultimate payer reduce their costs and improve their loss ratio.
Q: What other benefits do companies receive from adopting a digital contact center?
A: Customer experience is a big benefit of this technology. Think of it this way: This claim might be the only experience the customer has with the organization. Therefore, you really want to make sure you’re working with experts.
Also, if the contact center isn’t digitally enabled, then you likely have a quality issue. You’re not able to get timely responses on claims, which puts you at regulatory or audit risk. You’re probably not getting the quality of information you need, either. In terms of being more efficient and improving your economic impact, you really need someone who concentrates on this part of the business.
Q: Can you share an example of how a company was able to use a digital contact center and how it improved quality across the board?
A: We recently had a large insurance carrier come to us because their claims process was taking way too long. They were getting claims days, or even weeks, after the fact. The correct people within the organization weren’t finding out until much later as well, because there was no built-in automatic escalation or dissemination.
Fortunately, we were able to set up an entire team, develop a program and implement it for hundreds of customers within weeks. As a result, we got their turn to 30 minutes.
Another good example is when we took over the intake for multiple, large stand-alone companies that owned their own captive insurance companies. We were able to eliminate all of their data entry redundancies by correctly integrating 99.9% of the information the first time.