High-performing comp claim managers showcase best practices

Twenty-four percent of claims organizations in workers compensation are classified as “high performers,” while the majority lag behind with lower claims-closure ratios, according to a white paper released Wednesday by Rising Medical Solutions.

Rising, a Chicago-based national medical financial solutions firm that provides medical cost containment and medical care management services to the workers compensation industry, spent five years polling more than 1,700 claims executives to inquire on best practices that lead to high claims closure ratios, according to the paper.

The study ranked respondents by claims closure ratio, a comparison of opened claims versus closed claims. For example, a closure ratio of 75% means that for every three claims closed, four are opened, the study states. “Organizations with a closure ratio of 100% run a tight ship, closing claims at the same pace they are opening new ones. Claims experts agree that a claims ratio of 101% or higher is a reliable sign that the organization is managing claims outcomes effectively.”

The survey found that measuring success and outcomes are some factors that separates the high-performing organizations from the rest. “Higher performing claims organizations are five times more likely to measure their performance in core competencies, six times more likely to measure claim outcomes based on evidence-based treatment guidelines, and 10 times more likely to measure claim outcomes based on evidence-based disability duration guidelines,” the study said.

Organizations that invest in claims talent also outperform their competitors, the study found.

“When it comes to arming adjusters with decision support tools known to improve claims outcomes, they do so four to five times more than lower performers,” the study states. Also, “higher performers are notably more engaged in developing their claims staff. In response to the industry’s talent crisis, higher performers are more likely to raise staff performance expectations, spend money on training, and nurture mastery throughout their adjusters’ careers.”

Advocacy-based models are also more prevalent, with higher performing organizations four times more likely to be utilizing the approach, the survey found.

The survey also found that high-performing claims closers invest in better tools and techniques, warehousing data to more efficiently integrate claims and medical bills, utilizing outcomes-based data, measuring provider performance and using predictive analytics at eight times the rate of lower-performing organizations.

“With so many competencies claims departments are often asked to excel at, it can be difficult to decipher exactly which practices will actually move the needle,” said Rising’s study program director Rachel Fikes in a statement. “For those organizations that choose to close the performance gap, the data is clear on how to narrow the divide between average and superior performance.”