4 Ways Predictive Analytics Can Help Mitigate Large Losses

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By Constitution State Services
4 minutes
Predictive Analytics Can Help Mitigate Large Losses

Data and analytics are transforming the art and the science of managing claims. Predictive analytics models can help detect fraud, reduce attorney involvement, and pinpoint the most effective resolution strategies for each claim.

A third-party administrator that has sophisticated modeling tools and data resources can help apply analytics to manage claims today – and anticipate emerging risk trends to help protect your business in the future. From a workers compensation perspective, these analytical models and tools are helping companies achieve a high degree of accuracy in paying pharmacy and medical costs, as well as helping improve return-to-work outcomes.

Constitution State Services uses AI-enabled models based on millions of data elements, including structured and unstructured data, to predict potential outcomes. As a carrier-owned third-party administrator, Constitution State Services' Claim professionals benefit from insights based on trends, patterns and behaviors identified at the local and national level from Travelers' extensive data resources.

Data drives actionable insights

Knowing when to access and act on the data is critical to making the most of those insights. It's where the art meets the science. Constitution State Services integrates analytical tools into the claim workflow to deliver the right data insight at the right time. Investing in talent, including thorough training at the Claim University facility in Windsor, Conn., helps ensure that Claim professionals appropriately act upon insights from the models when resolving claims.

Equipped with data from predictive models, Claim professionals can act decisively, negotiate with confidence and work to achieve the best possible outcome on any claim. For example, in a liability claim, knowing when to connect with an injured claimant and explaining the claim process in easy-to-understand language can help reduce the likelihood of a lawsuit.

Here's a look at four ways that Constitution State Services is using predictive analytics to improve claim resolution and contain lost costs.

Four ways predictive analytics can improve claim outcomes

1. Predicting chronic pain in workers compensation

An estimated 50 million adult Americans suffering from chronic pain. Claim data analysis showed that chronic pain and opioid use can significantly complicate recovery and delay an injured employee's return to work. That led to the development of the Travelers Early Severity Predictor®, a predictive model that helps Claim professionals identify injured employees who may be at higher risk of developing chronic pain, which could lead to opioid use and result in dependency.

Identifying these potential chronic pain claims early in the claim process allows our Claim and medical professionals to engage critical resources. Compared to other carriers that may rely on reactive models to flag claims involving injured employees who have already developed a chronic pain condition, the Early Severity Predictor is a truly predictive model that helps positively impact the experiences of real people as well as claim outcomes.

2. Detecting fraud

Through its affiliated relationship with Travelers, Constitution State Services has access to predictive fraud models for all lines of business. Fraud models can alert Claim professionals about anomalies, such as an individual claimant who displays signs that are inconsistent with an injury. In addition to individual cases, predictive analytics also helps identify medical schemes, staged accident rings and provider rings that have the potential to impact multiple claims.

With nearly 300 investigators ready to be deployed, Constitution State Services can evaluate potential claims for legitimacy and identify potential fraud in the process. CSS offers dedicated teams, staffed by experienced Claim professionals who have years of experience with the company.

3. Forecasting escalation

Identifying a claim that is likely to escalate in severity allows Constitution State Services to put the right resources in place at the right time. Knowing in advance that a claim has the potential to increase in complexity, we can use advanced loss resolution strategies to better align experience with exposure.

Constitution State Services also uses an automated social listening platform to gather publicly available data that may prove important to the resolution of a claim. Getting a more complex case in the right hands early helps deliver the best possible outcomes, as well as a positive claim experience.

4. Anticipating attorney involvement in auto and general liability claims

In general, attorney involvement in a claim increases the cost of the claim. Constitution State Services uses the proprietary Attorney Propensity Predictive Model to help them understand what claims are more likely to lead to attorney involvement. When alerted, Constitution State Services can make sure the right resources are assigned to then proactively work with a claimant to help them understand the process in order to help reduce the likelihood of attorney involvement.

Constitution State Services also uses as an Attorney Analytics model to evaluate attorney strategies, which helps our Claim professionals manage liability claims in a challenging legal environment.

Working with a Third-Party Administrator

Contact CSS to learn more about how we can help you anticipate claim risks and guide you through a process to mitigate them.

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Our robust Risk Management Information Services (RMIS) dashboard, e-CARMA®, lets you see real-time claim status information, along with customizable views of data for more relevant, actionable insights.