Technology Adoption for Workers’ Compensation Claims

Technology continues to play a major role in all aspects of the insurance industry, and the area of ​​workers’ compensation is no exception. AI enables insurers to manage large amounts of data about workers and recurring injuries, recovery times and best practices. It also allows injured employees to communicate with carriers and care providers almost instantly and learn about co-existing conditions that could affect their recovery process. Better and earlier communication can significantly change outcomes for employees and employers, while reducing bottom line costs for insurers.

Digital Insurance reached out to Leah Cooper, global digital director at Sedgwick, in a written interview to ask what she sees in terms of technology adoption in workers’ compensation, as well as the importance of balancing insurtech with human interaction on these statements. . Cooper leads the company’s research and development efforts, led the team that created the company’s multilingual cloud-based platform, and is also exploring practical yet strategic uses for GenAI as part of the toolkit.

DI: How has the use of technology in the workers’ compensation space changed in recent years?

Cooper: The advent of generative AI has shaken everyone’s expectations about how quickly and in what ways companies can realize savings by automating routine tasks. In the workers’ compensation arena, this is not as simple as clicking a button because the industry is highly regulated and very set in terms of our method of claims administration. However, many companies in our industry are taking advantage of GenAI right now. They can use it to summarize documentation and speed up claim resolution time, use GenAI to analyze and detect fraud, and even evolve customer support options by automating answers to questions about the status of a claim.

All these great advances do not and will not replace the need for people to make decisions about claims. Judgment calls should always remain in the hands of people who can react thoughtfully and empathetically beyond what a set of rules and logic can do. However, technology can better position humans to do this: if you can read what’s in a document using GenAI and combine that with predictive models or other intelligent tools, then you can empower a reviewer to hurry up and solve it claims more efficiently and accurately than ever before. In addition, with better insight into data and risks, companies can allocate their resources more effectively. Allowing administrators to pay attention to requests that require the most support and the highest level of human intervention is one of the most significant benefits that technology can provide.

DI: What are some of the biggest challenges in claims management in this area for workers, employers and insurance companies?

Cooper: One of the biggest challenges facing technology today is adoption. How do we foster trust in these new tools, which have had some notorious stumbles? Can they be safely and effectively incorporated into our well-established processes? Governance of a company’s AI and the ability to determine the right technology for a given function. There is such incredible potential. But successfully implementing new technology requires extensive collaboration, planning, change management, legacy technology integration and quality assurance – all working in tandem to transform the business. We, as leaders and innovators, will continue to be tested to recognize How we can review our legacy processes and then find the time and resources to do so.

DI: What are the most valuable types of tools or technologies affecting workers’ compensation claims management? How do they change this area?

Cooper: Generative AI is the obvious choice here, for the reasons mentioned above. But GenAI is just one tool in an arsenal of options here: predictive modeling, fraud detection capabilities, sentiment analysis, real-time data exchange via application programming interface (API), all of which combine to form a technology-enabled workflow that can support examiners in new and exciting ways.

DI: Are you finding that workers are comfortable with the increased use of technology to manage their claims?

Cooper: The launch of new technology is best when it incorporate the views of the people who are in the trenches every day – namely, the claims professionals and the injured workers they support. Technology-based tools have transformative potential; they can bring greater efficiency to workers’ compensation claims and facilitate better access to care. Consumer-centric self-service platforms provide convenient and secure online access to real-time information about claims and cases so that injured workers can be more proactive and informed about their claims. But insurers, employers and service providers must carefully balance the efficiency of new technologies with the risk of losing the personal touch. The employee experience is important and needs to be individualized.

Despite its many benefits, technology is no substitute for personal interaction. At Sedgwick, we believe the best way to use technology is to leverage its capabilities to perform manual tasks, giving our testimony professionals more opportunities to provide empathy through meaningful human connection and engagement. This approach is essential when it comes to more complex claims. For example, providing individualized, compassionate care after an injury or illness is crucial, and technology can further enhance the process. Along with automating basic functions such as eligibility, AI can serve as the backbone for predictive models developed to identify when an individual might benefit from a clinical intervention, such as a call from a nurse case manager or a review of its prescriptions.

DI: What concerns you about technology adoption in this space?

Cooper: With all new, exciting and fun technology, companies will race to implement it, hoping to realize savings almost immediately. There are some dangers here. First, any technology deployment must adhere to the same rigorous IT security standards and data protection rules as traditional software development. Rushing to introduce tools like GenAI without ensuring your data and practices are locked down can put privacy and security at risk. Second, this rush to implement can make it difficult to establish return on investment (ROI) and set realistic expectations for digital transformation. Creating valid metrics to quantify success will be necessary to ensure that those technology investments actually transform the business.

DI: What excites you most about how technology is changing the practice of workers’ compensation?

Cooper: At the end of the day, the benefits of technology are a win-win: administrators can streamline operations and achieve efficiencies like never before, employers should see the impact of these efficiencies on administrative costs and care for their employees and claimants. should see better customer service options, improved user experiences, and faster resolution of complaints.

We will never escape the need for human connection, especially in complex claims. In many scenarios, people who come to Sedgwick for help after a workplace injury are scared. They need a partner, an advocate, to tell them they will be taken care of. It’s our job to figure out how to meet people where they are. Maybe that’s with improved digital platforms, communication channels, and prompt resolution — or maybe it’s with a better, more informed way to engage with them one-on-one. Technology is just one way that can help us treat people the way they want to be treated.

See more:Using artificial intelligence to streamline workers’ compensation awards

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