Navigating the Data Deluge: Workers’ Comp Experts Discuss Ways to Harness Technology for Better Claims Management

Explore how new innovations in data collection and management can affect workers’ compensation claims outcomes.
By: | September 20, 2023
A person in a nurse's uniform holds a tablet overlaid with a graphical representation of health care data

More data is available today than ever before, and this vast amount of information brings new opportunities and outcomes — and introduces new risks. A session with a panel comprising industry experts who sit in various roles along the insurance value chain will address these issues and more at National Comp in Las Vegas on September 21.

Sharing their insights are Max Koonce, chief claims officer at Sedgwick; Joan Vincenz, managing director of operations risk at United Airlines; Dawn Watkins, chief risk officer at Los Angeles Unified School District; and Michele Maffei, director of workers’ compensation at Publix Super Markets. They will take the stage for an insightful panel entitled “What Do We Do with All This Data? Opportunities and Outcomes to Explore.”

As data is being used in new ways across the insurance ecosystem, the panelists will discuss and debate the value, opportunities and risks of this influx of information. We spoke with Max Koonce to hear his thoughts on the opportunities for data and innovation in claims management in advance of the session.

Risk & Insurance: Why is it important to talk about opportunities involving data usage and how it relates to managing workers’ compensation claims?

Max Koonce: We have seen significant shifts in many aspects of the employment environment over the last several years — generational workforce changes, expectations of remote work options, and increasing mental stress on our population in general. At the same time, the amount of data available to project trends and tendencies within all aspects of our daily lives increases exponentially.

The workers’ compensation profession has a tremendous opportunity to continue to enhance the value that data can bring to supporting improved outcomes for injured workers — “right resources at the right time.”

In this session, we will focus on opportunities for the inclusion of greater data elements in the process and discuss how those data elements can provide trends indicating claim behavior tendencies and which resources can be utilized to ensure support to the injured worker, thereby pushing forward to the best possible outcome.

R&I: What is the focus of your session?

MK: The amount of data available to project trends and tendencies within all aspects of our daily lives is increasing exponentially; a recent article stated that 3.5 quintillion bytes of data are created every day. In our session at National Comp — “What Do We Do with All This Data?” — we intend to explore some of the ways utilization of data can enhance outcomes for those within the workers’ compensation process.

With improved intake and claims systems, more data and information are captured today than ever before. The challenge before many industry professionals is what data to collect, how to collect it, and how to assess and leverage the resulting information.

This is where technology — along with machine learning and artificial intelligence — is making an undeniable imprint on the industry. Technology allows for the identification of defined patterns within data sets and puts more actionable information in the hands of claims professionals quickly.

R&I: What is particularly interesting about the future of claims handling and data?

MK: Data validity, data diversity and data volume help bring a level of specificity to the analytical approach that supports a more definitive workflow/process. This allows artificial intelligence to be aligned closely with each individual claim.

Consider that we have five different generations within the workforce, each with different expectations that must be incorporated into the workers’ compensation process to achieve the best possible outcomes. Our advocacy approach coupled with our analytics allows us to take these expectations of claimant experience into consideration.

With the continued evolution of technology, plus the best clinical resources for optimal medical results, we will be able to continue to fine-tune the workflow/process for the individual claim, providing guidance to the examiner.

Each claim is based on its own unique facts and circumstances, and continued enhancement of the technology and the data that is evaluated will allow us to ensure each claim has an approach that is specific to that claim for the best possible outcome for that claim.

R&I: What are some of the innovative ways you are seeing technology change claims management?

MK: Leveraging our expertise built from over 50 years of working with the country’s leading employers, the insights gained from handling millions of claims, and a depth and diversity of claims data unrivaled in our industry, Sedgwick is focused on pushing claims technology to the next level.

We have built technology to do more than just reveal meaningful trends in claims data; we use our data to drive decisions that ultimately lead to improving outcomes for those involved in the claims process. This involves looking at specific characteristics of every claim, and then addressing concerns early to provide guidance toward the best possible outcome.

To do that effectively requires utilization of smart technology and automation embedded within our advocacy approach. This includes a combination of AI-based tools such as predictive modeling, document digitization and rules-based decision engines. The combination of these tools, backed by Sedgwick’s proprietary algorithms, enables technology to inform decisions and appropriately direct the care path.

With this analytical approach, we can harness the value of the information we gather to prompt the right action at the right time, resulting in continuous improvement and better overall outcomes.

“Right action at the right time” not only relates to action taken by the examiner but also incorporates the best, most appropriate resources (when needed) to support that action or direction — a return-to-work specialist, medical case management, behavioral health support et cetera. &

“What Do We Do with All This Data? Opportunities and Outcomes to Explore” will be held on Sept. 21 at 3:15 p.m. Learn more here.

Abi Potter Clough, MBA, CPCU, is a keynote speaker, author and business consultant focused on Insurtech, leadership and strategy. She has over 15 years of experience at a Fortune 500 company with expertise in P&C claims operational leadership, lean management consulting, digital communications and Insurtech. As the past chair of the International Insurance Interest Group of the CPCU Society, Abi remains involved in many international initiatives and projects. She has published two books about change management and relocation. Abi can be reached at [email protected].

More from Risk & Insurance