Claims Management

Payers Benefit From Newer Claims Technology

The shift from legacy to cloud-based systems is unlocking new benefits and new possibilities for employers and other claims payers.
By: | March 7, 2017 • 5 min read

The retirement of baby-boomer age computer professionals is helping drive more workers’ comp claims payers to abandon older, legacy-type claims management systems for nimbler software as a service (SaaS) technology.

The shift is occurring as the aging computer professionals, along with claims adjusters who spent their careers working with the assistance of the older legacy claims systems, are replaced by millennials accustomed to newer, smarter technology.

Tim Davidson, director of return to work solutions, Riskonnect

“The people who have been maintaining these legacy systems, as well as your adjusters who are used to using those systems, are getting older and exiting the business,” observed Shahin Hatamian of Mitchell International Inc. “You are bringing in younger people who don’t know how to use that legacy system and they want something that is easier to use, more configurable, and a little more automated. That is where newer systems come into play.”

The newer technology also accommodates a younger, less-experienced adjuster workforce with automation that eliminates more of their decision making.

Several other equally pressing reasons are pushing claims payers to continue a migration away from legacy systems to SaaS platforms. For one, more services now developed to improve workers’ compensation claims outcomes are created on these platforms, allowing for easier data interchange between claims payers’ systems and other services the claims payer uses.

“You would be hard pressed to not want to take advantage of the benefits of SaaS,” Hatamian said.

Legacy systems typically rely on in-house server technology for information storage and often were developed to meet a specific company’s needs. Their ongoing use, modification and maintenance usually requires the expertise of people familiar with that system.

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“There are a group of legacy systems that have more attractive, contemporary user interfaces, but they are still built on architectures that are fairly rigid and require a lot of custom coding,” said Aaron Shapiro, executive director of sales, marketing and legal at Origami Risk.

By contrast, SaaS systems are cloud based and accessed via a web browser. While much of their updating can be done simultaneously for many customers, they also allow ease in customization, according to proponents.

“From a claims management standpoint there are so many moving variables at any point in time. … There are a plethora of people involved in the whole claims process.” — Tim Davidson, director of return to work solutions, Riskonnect

The newer technology’s flexibility allows easier configuration to meet a purchaser’s unique workflows, rather than requiring the purchaser to flex their operations around the technology, Shapiro added. It can ease risk managers’ connection with other company departments, such as safety, and with their company’s operations managers for quicker action on data revealing workers’ comp claim drivers.

“That leads to much higher engagement in the operational field,” Shapiro elaborated.  “Where you have a risk manager that has a collaborative relation with field operations and safety there is an opportunity to automatically trigger workflows the second there is a report of injury.”

Shahin Hatamian, Vice President, Product Management and Strategy, Mitchell International Inc.

Similarly, information can be more easily shared with outside parties such as third party administrators, nurse case managers and other workers’ comp service vendors relaying information that may prevent a claim from growing more expensive.

“That is what SaaS products do,” said Nicholas Toal, vice president of business development and sales at JW Software. “It’s a solution that tries to make the workflow seamless,” eliminating challenges claims payers frequently encounter when attempting to connect older systems with third party claims services.

Factors driving the shift away from legacy systems to SaaS also include ease in updating the newer systems with state regulatory changes and less disruption when employees leave a company employing the technology, said Tim Davidson, director of return to work solutions at Riskonnect.

The most pressing reason for moving to SaaS, though, is the ability to connect with many sources of information — including industry trends and service provider data — impacting a claim, Davidson said.

“From a claims management standpoint there are so many moving variables at any point in time,” he elaborated. “It is not just the injured employee or employer. You are dealing with medical providers, you are dealing with bill review, you are dealing with nurse case managers, independent medical examiners. There are a plethora of people involved in the whole claims process.”

Multiple Benefits

Improved integration of information from all those sources can help adjusters and other end users make better decisions, Davidson said.

Tom Ryan, market research leader, Marsh’s Workers Compensation Center of Excellence

Meanwhile, newer technology companies have emerged offering risk management information systems with “a broader platform of service capabilities,” said Tom Ryan, market research leader at Marsh’s Workers Compensation Center of Excellence. Those capabilities include data analytics and the conversion of data into highly customized reports and dashboards for workers’ comp claims management.

Simultaneously, employers are increasingly knowledgeable about the data management capabilities of risk management information systems, Ryan added.

“So a lot of employers are looking for more customized dashboards and tools to manage workers’ compensation,” Ryan said.

RMIS systems, and their dashboard technology for managing claims, have improved significantly over the past two to three years, added Duane Pifer, senior consultant and data analytics lead in the integrated casualty consulting group at Willis Towers Watson.

But the systems typically provide relatively stagnant information, Pifer added. Employers and other claims payers could benefit, he said, should the next generation of technology products allow claims payers to receive more interactive claims information delivered in smaller, more frequent, notifications, like those that social media sites push out concerning a user’s network contacts.

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In that way alerts pushed-out to cell phones or tablets, for example, could inform employers of organizational changes — such as increased employee turnover in a specific production unit — that would likely impact claim filings, Pifer said.

Similarly, information could alert claims payers when claims are nearing a certain status point, such as a specific expense level.

“It is that kind of information, in small chunks, that Is intuitive that the user wants to see,” Pifer said. “I think the technology is beginning to get there and I know some RMIS have apps that provide that. But it is not widespread yet.”

When it comes to both RMIS and claims management systems, however, there is widespread agreement that the newer platforms are much simpler to use.

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

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R&I Profile

Achieving Balance

XL Catlin’s Denise Balan stays calm and focused when faced with crisis.
By: | January 10, 2018 • 6 min read

In the high-stress scenario of kidnap or ransom, the first image that comes to mind isn’t necessarily a yoga mat — at least, not for most.

But Denise Balan, senior VP and head of U.S. kidnap & ransom, XL Catlin, who practices yoga every day, would swear by it.

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“I looked at these opposing aspects of my life,” she said. “Yoga is about focus, balance, clarity of intent. In a moment of stress, how do you respond? The more clarity and calmness you maintain, the better positioned you are to provide assistance in moments of crisis.

“Nobody wants to be speaking to a frenetic person when either dealing with a dangerous situation or planning for prevention of a situation,” she added.

“There’s a poem by [Rudyard] Kipling on that,” added Balan’s colleague Ben Tucker. “What it boils down to is: If you can remain calm, you can manage through a crisis a lot better.”

Tucker, who works side by side with Balan as head of U.S. terrorism and political violence, XL Catlin, has seen how yoga influences his colleague.

“The way Denise interacts with stakeholders in this process — she is very professional and calm in the approach she takes.”

Yin and Yang

Sometimes seemingly opposite or contrary forces may actually be complementary and interconnected. In Balan’s life, yoga and K&R have become her yin and yang.

She entered the insurance world after earning a juris doctor degree and practicing law for a few years. The switch came, she said, when Balan realized she wasn’t enjoying her time as a commercial litigator.

Denise Balan, senior VP and head of U.S. kidnap & ransom, XL Catlin

In her new role, she was able to use her legal background to manage litigation at AIG, where her transition from law to insurance took place. She started her insurance career in the environmental sector.

In a chance meeting in 2007, Balan met with crisis management underwriters who told her about kidnap and ransom products.

She was hooked.

Because of her background in yoga, Balan liked the crisis management side of the job. Being able to bring the calmness and clearness of intent she practiced during yoga into assisting clients in planning for crisis management piqued her interest.

She then joined XL Catlin in July 2013, where she built the K&R team.

As she became more immersed in her field, Balan began to notice something: The principles she learned in yoga were the same principles ex-military and ex-law enforcement practiced when called to a K&R-related crisis.

She said, “They have a warrior mentality — focus, purpose, strength and logic — and I would say yoga is quite similar in discipline.”

“K&R responders have a warrior mentality — focus, purpose, strength and logic — and I would say yoga is quite similar in discipline.” — Denise Balan, senior VP and head of U.S. kidnap & ransom, XL Catlin

Many understand yoga to be, in itself, one type of meditation, but yoga actually encompasses a group of physical, mental and spiritual practices. Each is a discipline. Some forms of yoga focus on movement and breathing, others focus on posture and technique. Some yoga is meant to relax the mind and create a sense of calmness; other yoga types make participants sweat.

After having her second child and working full-time, Balan wanted to find something physical and relaxing for herself; a friend suggested yoga. During her first lesson, Balan said she was enamored with it.

“I felt like I’d done it all my life.”

She dove into the philosophy of yoga, adopting the practice into her daily routine. Every morning, whether Balan is in her Long Island home or on a business trip, she pulls out her yoga mat to practice.

“I always travel with my mat,” she said. “Daily practice is the simplest form of connection to routine to maintain my balance — physically and mentally.”

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She said the strangest place she has ever practiced was in Lisbon. She was on a very narrow balcony with a bird feeder swarming with sparrows overhead.

After years of studying and practicing, Balan is considered a yogi — someone who is highly proficient in yoga. She attends annual retreats with her yoga group, where she is able to rejuvenate, ready to tackle any K&R event when she returns.

In 2016, Balan visited Tuscany, Italy, where she learned the practice of yoga nidra, a very deep form of meditation. It’s described as the “going-to-sleep stage” — a type of yoga that brings participants to a state of consciousness between waking and sleeping.

“It awakens a different part of your brain,” Balan commented. “Orally describing it doesn’t quite do it justice. One has to practice Nidra to fully understand the effect it has on your being.”

Keeping a level head during a crisis is key in their line of business, Tucker said. He can attest to the benefit of having a yogi on board.

“I’ve seen her run table-top exercises where there is this group of people in a room and they run an exercise, a simulation of a kidnap incident. Denise is very committed to what we’re doing,” said Tucker.

“She brings that energy. She doesn’t get flustered by much.”

Building a K&R Program

When Balan joined XL Catlin, she was tasked with creating the K&R team.

Balan during a retreat in Sicily, Italy, 2017

She spent time researching and analyzing what clients would want in their K&R coverage. What stuck out most to Balan was the fact that, in these situations, the decision to purchase kidnap and ransom cover is rarely made because of desire for reimbursement of money.

“I asked why people buy this type of coverage. The answer was for the security responders,” she said.

“These are the people who sit with the family. They’re similar to psychologists or priests,” Balan further explained. “Corporations can afford to pay ransom. They buy [K&R] because it gives them access to these trained and dedicated professionals who not only provide negotiation advice, but actually sit with a victim’s family, engaging deep levels of emotional investment.”

“I’ve learned to appreciate all moments in life — one at a time. The ability to think clearly and calmly guides my work, my practice and my personal life.” — Denise Balan, senior VP and head of U.S. kidnap & ransom, XL Catlin

Balan described these responders as people having total clarity of purpose, setting their intentions to resolve a crisis — a practice at the very heart of yoga. She knew XL Catlin’s new kidnap program would put stock in their responders.

“I’ve worked closely with the responders to better understand what they can do for our clientele. These are the people who run into danger — warrior hearts married to dedication to our clients’ best interests.”

But K&R is more than fast-paced crisis and quick thinking; Balan also spent a good deal of time writing the K&R form and getting the company’s resources in order. This was a huge task to tackle when creating the program from the ground up.

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“A lot of my day-to-day is speaking with brokers and finding ways to enhance our product,” she said.

After a few months, she was able to hire the company’s first K&R underwriter. From there, the program has grown. It’s left her feeling professionally rewarded.

“People don’t often get that opportunity to build something up from scratch,” she said. “It’s been an amazing experience — rewarding and fun.”

“She brings groups of people together,” said Tucker. “She’s created a positive environment.”

Balan’s yogi nature extends beyond the office walls, too. Her pride and joy, she said, are her kids. And while it may seem like two large parts of her life are opposite in nature, Balan’s achieved balance through her passions.

“[Yoga] has given me the ability to see beyond only one aspect of any situation” she said. “I’ve learned to appreciate all moments in life — one at a time. The ability to think clearly and calmly guides my work, my practice and my personal life.” &

Autumn Heisler is a staff writer at Risk & Insurance. She can be reached at [email protected]