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.

More from Risk & Insurance

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Risk Management

The Profession

Verizon’s risk manager David Cammarata loves when his team can make a real impact on the bottom line.
By: | May 2, 2017 • 4 min read

R&I: What was your first job?

I was a financial analyst with the N.J. Casino Control Commission.

R&I: How did you come to work in risk management?

I was told at a Christmas luncheon in 2003 that I was being promoted into a new job.

R&I: What is the risk management community doing right?

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I think the risk management community is getting a lot better at utilizing big data and analytics to manage risk. Significant improvements have been made, but there is still much more room for improvement.

R&I: What could the risk management community be doing a better job of?

I think that the insurance and brokerage communities need to really start thinking about what this industry is going to look like in 10 years. They need to start addressing how they are going to remain relevant. I think that major disruptions to existing business models will occur and that these disruptions combined with innovation and technological advances may catch many of today’s industry leaders by surprise.

David Cammarata, assistant treasurer, risk management and insurance, Verizon Communications Inc.

R&I: What was the best location and year for the RIMS conference and why?

San Diego, any year.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

I think the advent of cyber risk and cyber insurance. For several years it has been, and it continues to be, the main topic of discussion at industry meetings.

R&I: What emerging commercial risk most concerns you?

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I think the most scary scenarios include a nuclear, biological, chemical or radiological event, a widespread global health epidemic and/or a widespread state sponsored cyber shutdown.

R&I: How much business do you do direct versus going through a broker?

We do almost all of our business through a broker.

R&I: Is the contingent commission controversy overblown?

No. It’s a conflict.

R&I: Are you optimistic about the U.S. economy or pessimistic and why?

Optimistic because hopefully President Trump’s policies (lower taxes and less regulation) will be pro-business and good for the economy.

R&I: Who is your mentor and why?

My dad, who passed away many years ago. He was very influential during the formative years of my career. He taught me how important integrity and reputation were to your brand and he had a very strong work ethic.

R&I: What have you accomplished that you are proudest of?

I would have to say raising two awesome kids. My daughter is graduating from James Madison University this year as co-valedictorian. My son is finishing his sophomore year at Rutgers and has near perfect grades. But more importantly, both of my kids have turned out to be really good people.

R&I: How many emails do you get in a day?

A lot.

“I love it when the risk management organization is able to contribute in a way that makes a real impact to the corporation’s overall objectives. On several occasions we have been able to make real contributions to the bottom line.”

R&I: What is your favorite book or movie?

“My Cousin Vinny.” That movie makes me laugh no matter how many times I watch it.

R&I: What’s the best restaurant you’ve ever eaten at?

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My dad used to take me to a place called Chick & Nello’s. It was an Italian place that did not have a menu. They came to your table and told you the two or three items they were making that day. The food was out of this world.

R&I: What is your favorite drink?

Iced tea. The non-alcoholic kind.

R&I: What is the most unusual/interesting place you have ever visited?

I can think of several places but for me it would be a tie between India and Italy. India just has such a different culture and way of life and Rome has breathtaking historical sites.

R&I: What is the riskiest activity you ever engaged in?

Well, one of the best thrill rides I’ve been on was Kingda Ka at Great Adventure. It feels risky but probably isn’t all that risky. I flew in a prop plane with my brother-in-law one time … that felt kind of risky. I have also parasailed, does that count? I think it definitely has to be driving on the N.J. Turnpike day in and day out.

R&I: If the world has a modern hero, who is it and why?

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What about the Fukushima 50? I don’t think I could have done what they did.

R&I: What about this work do you find the most fulfilling or rewarding?

I love it when the risk management organization is able to contribute in a way that makes a real impact to the corporation’s overall objectives. On several occasions we have been able to make real contributions to the bottom line.

R&I: What do your friends and family think you do?

I don’t think they really know. My children see me as dad; others just see me as an executive with Verizon.




Katie Siegel is a staff writer at Risk & Insurance®. She can be reached at [email protected]