CorVel’s Jason Wheeler Shares How Recruitment, Automation, and Working with Adjusters Improve Claims Quality
It’s no secret that talent shortages are impacting vast swaths of the American economy. Sectors such as transportation, health care, and education are particularly hard hit.
Insurance is no exception. The Great Resignation and the Silver Tsunami are placing pressure on insurance carriers, brokers, and their risk management partners to maintain a high standard of customer service and care while still managing their own challenges with recruiting and retaining top-quality talent.
How carriers and their risk management partners handle claims is crucial. After all, claims payment is the product that insurance sells. In the area of workers’ compensation insurance, maintaining claims-handling excellence, no matter what economic cycle we are in, is a top priority.
Out of necessity and also to provide the best claims management experience possible, third-party administrators, medical management companies, and others are increasingly turning to technology to assist claims managers in their important work.
TPAs are stepping up their efforts to use predictive analytics to flag any obstacles that may delay recovery early on, ensuring that injured workers receive the best care possible and keeping claims costs down by preventing minor issues from becoming catastrophic.
These new tools help claims adjusters by giving them more time to focus on the important work of forging better communication channels with injured workers, giving them the support and understanding they need to navigate the claims process without resorting to the expensive and sometimes acrimonious process of litigation.
In light of this, Jason Wheeler, Vice President of National Sales and Account Management at CorVel, sat down with Risk & Insurance® to discuss how automation and other new technologies can help workers’ comp claims adjusters prioritize claims quality and be true advocates for injured workers.
Risk & Insurance: Can you tell our readers a little bit about yourself and your experience with claims quality assurance?
Jason Wheeler: I’m based out of Nashville, Tennessee, and my mission with CorVel is overseeing growth and client retention. I’ve been with CorVel for ten years, and I was in account management and sales before moving into this role six months ago. I started my career out of college as a claims professional for a large carrier before working in risk management for a national restaurant company.
R&I: What does claims quality entail? And why is it so critical for workers’ comp professionals to ensure that workers have a quality claims experience?
JW: It’s always been important, but it’s perhaps more important today than ever. The increased interest and need stems from a perfect storm of factors over the past couple years: a pandemic that created employee retention challenges and disrupted recruitment and training. A shortage of incoming talent coupled with an aging industry workforce. Working from home and the challenges that come with that. It’s all impacted consistent service delivery, or what we would call claims quality.
Today, there’s more of a focus on the quality area of the business, which is exciting for us. It’s tremendously satisfying to be a part of an organization that’s investing valuable resources on people and processes, and ensuring top-quality service delivery.
Claims quality assurance, which I have a particular passion for, gets into the nuts and bolts of claims delivery — strong and timely initial contacts, thorough investigations, proactive versus reactive claims handling, adherence to claims special handling requirements, and all the state regulations, federal and local guidelines that govern claims administration.
One of the core customer service pillars is responsiveness. It may sound obvious and basic, but when you’re not responsive, it can magnify issues that aren’t that substantive when they’re being handled properly. As a former adjuster, I understand the pressures that accompany the job. We want our adjusters to have the time to be responsive and proactive and ultimately generate the best outcomes for the clients. Reducing the total cost of risk while caring for people. For our carrier clients, that means providing them with tools that allow their adjusters to be more efficient.
R&I: What does it look like when an adjuster is proactive in a claim? What benefits can that have?
JW: This is where caseloads and efficiencies come into play. You have to ensure adjusters have the right caseloads and the tools that enable them to be proactive. They need to be able to make the calls, have the time for human interactions, and not be burdened with administrative tasks.
Since controlling medical costs is such a key part of managing claims effectively, adjusters need the capacity to monitor treatment to ensure care is delivered on time using medical best practices.
Proactive claims handling is vital to impact return-to-work. A sound return-to-work strategy can transform a claims program. At the restaurant company I worked for, when return-to-work became a focus, we saw the cost of the workers’ comp program drop by 25% over the same period even as the number of stores doubled. For example, quickly identifying when light-duty restrictions are issued and proactively communicating with the employer to bring the employee back to work within those restrictions can be a game changer.
Another area where proactivity is crucial is litigation. Litigation avoidance is the priority. We reduce litigation by our early intervention services coupled with quality adjusting. If there is litigation involved, we ensure our adjusters are paying attention, staying on top of the attorneys, and limiting litigation costs.
A good claim is an appropriately closed claim. Adjusters need to be there to prevent a claim from stretching out over a longer period than necessary.
R&I: How do services like telehealth, case management, and other technologies contribute to closing claims appropriately and swiftly?
JW: At CorVel, for example, every claim begins with our Advocacy 24/7 nurse triage. We were one of the first TPAs to bring in our nurses to answer the phone at the very start of the claim.
By having a nurse answer the phone for an injured worker, you can forestall any adversity that could plague the claim. By creating that point of contact, we’re showing workers that we care about them. That alone reduces litigation by roughly 60 percent.
The use of telehealth expedites treatment and provides real-time information for the adjusters. Years ago, when I handled claims, a folder landed on my desk; by the time it got there, it was already a couple of days old. Once I had the folder, I’d have to spend two or three days investigating and finding out what’s going on. Just imagine how much that delayed the claim!
At CorVel, when an adjuster gets a file, the injured worker has already spoken to our nurse and might already be receiving treatment with a telehealth provider. The adjuster has all these details at their fingertips up front, and they can be proactive with that knowledge.
R&I: A consistent theme throughout this conversation has been a strong focus on customer service. How does CorVel encourage adjusters to be responsive to every party involved with the claim?
JW: That’s accomplished through claims system efficiencies and checks and balances. One example is what we call operational excellence, which is a suite of dashboards we utilize to ensure claims handling exceeds client expectations. We confirm compliance with initial contacts, plans of actions, and prompt system alert actions, and overall it allows us to maintain operational excellence on a national level. We have multiple scorecards that are transparent to our clients that give them visibility into the quality of our work.
The checks and balances work in conjunction with claim system efficiencies. These efficiencies allow adjusters the time to be responsive. Automation keeps things on an efficient and effective track.
Risk and claims managers can be hesitant when they hear that word automation. When you look back through history to when we first began to automate tasks, it created concern: Is this going to eliminate jobs? Is this going to cut out the workforce?
That’s not what we’re looking to do. We’re looking to automate tasks in a way that’s never been done before. By doing that, we seek to transform the claims industry and the claims process by enabling the adjuster to shed unnecessary tasks and focus on what’s really important: the timely and complete recovery of an injured worker.
Let’s use the claim review process as an example. The countless status reports and binders full of paper can take adjusters and account managers hours to create. We’re avoiding much of the repetitive and time-consuming aspects of the process with our Claims Summary feature in our CareMC system.
It’s a feature that removes the burden of tedious paper status reports from the claims professionals and allows account managers and our clients to be more intentional and strategic with the claims they’re choosing to review.
CareMC Edge Insights provides instant access to all claim information including medical status, drug history, documents, the return-to-work plan, reserves, financials, and notes. With Insights, our clients will have total visibility into these key data elements they can effortlessly navigate through the details of the claims.
R&I: How do you strike that balance between increased technological efficiencies and having the human touch in claims to make sure it’s a good experience for everyone involved?
JW: At CorVel, we focus on the system efficiencies that allow the professionals more time to make the decisions that move the needle — more human interactions and less checking boxes. We couple that with a training and mentorship program.
CorVel is introducing a claims cohort program that lets us identify candidates who might not otherwise consider claims as a career, and provide training on the fundamentals of the position with a cohort and an opportunity for a career path.
Having claims mentors and having the right mix of new faces and experienced faces on the team can go a long way. Our supervisors don’t carry caseloads so they’re able to mentor and guide new employees. We have a leadership program as well for those who want to advance in the company.
I believe it’s important to listen to the claims professionals. We have the advantage of owning our claim system and all of the managed care services, which allows us to make meaningful changes. We can leverage data and outcomes to enhance what we do every step in the claims process.
R&I: What is the future of claims quality? What improvements do you think we’ll see in the next few years? What kinds of tech are you focusing on?
JW: Automation over the next three to five years is going to be key as we continue to remove some of the mundane claims management tasks from our to-do lists.
Today, we’re utilizing data process mining that identifies any bottlenecks in the claims management process and helps us know where to focus our efforts to enhance efficiencies and achieve the greatest impact. We’re automating tasks that are objective and repetitive with the goal of optimizing the team member’s time.
As we see the future of the claims industry, I think automation could even allow for an increase in caseloads for claims professionals, because there would be fewer touches and tedious tasks for them to do in a day. They’ll be able to be more involved with the injured workers and more invested in the customer programs.
R&I: What challenges do you think the industry may face over the next few years that quality claims management can really help mitigate?
JW: We’re going to see professionals begin to age out of the industry. We need to ask: are we replacing them and how are we doing it? Is the automation we’ve spoken about allowing for fewer, more efficient, and perhaps even higher-paid claims professionals? Are we hiring college grads and entry-level professionals? Are we bringing in people from different companies?
With intuitive systems and technology that promote more quality, the claims role itself could be transformed. We’ll soon see video calls with injured workers, mobile tech for on-the-go decision-making, and higher and more effective caseload capacities that allow claim professionals to be more knowledgeable and invested in clients’ unique programs.
R&I: How do you help bring people into workers’ comp claims management?
JW: Young workers today want a sense of purpose. They will walk away from jobs that lack meaning. They have to be proud to work for you and they need to feel their voices are valued, regardless of their position.
Research suggests baby boomers are not nearly as concerned as millennials about their work having a special meaning or purpose. Purpose is the biggest gap in employee experience for younger professionals. Our industry is still focused on the baby boomer generation in many ways.
It’s not necessarily a bad thing, but when you’re trying to attract a 24-year-old in today’s world, claims isn’t always an attractive culture. We shouldn’t ignore baby boomers or other generations; instead, we should work to close all the gaps and create a good workplace for everyone.
Of course fair pay is always an employee priority. I believe there are creative opportunities with total compensation that can be attractive, more than just a salary or wage. Profit-sharing, bonus potential, incentives for high performance and achievements, etc., are areas we have to consider as we look at ways to attract people to our industry.
Finally, there’s work-life balance. It’s becoming a cliché, but it rings true with the younger professionals more than ever before. I believe that in some ways, especially COVID, the industry has gone too far toward viewing remote work as the be-all, end-all solution.
We’ve lost balance on the other end of the spectrum. People are spending too much time at home and it’s impacting their mental and physical health. The younger professionals want the remote work, but they also want to feel connected with their peers socially.
It’s necessary for our health, in my opinion, to stay connected with each other. The old frustration with people wasting time at the water cooler has now come full circle where we’re realizing that the “water cooler” was a way for people to stop, take a breath, and have human interactions with their peers.
I think that needs to be a part of our work lives — not in a 9-to-5 kind of way, but certainly with some level of consistency. Flexibility in work environments and work hours is important, and taking this seriously will help the up-and-coming professionals experience a healthy workplace that they’re attracted to, will speak highly of, and choose to grow their careers.
At CorVel our purpose is care and we know that providing every injured worker timely, compassionate care is top priority. This purpose drives what we do together every day, which is to return injured employees to the workplace. &