Balancing Big Data and Claim Professionals to Optimize Outcomes

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By Constitution State Services
55 minutes

Chapter #1 | Chapter #2 | Chapter #3 | Chapter #4 | Chapter #5 | Chapter #6 | Chapter #7 | Full Webinar Video

Now more than ever, big data, AI and predictive models are transforming how third-party administrators (TPAs) manage claims for large firms – but technology is just the start. Constitution State Services professionals explore what it takes to operationalize the balance between big data and Claim professionals to achieve optimal results.

Chapter #1

What to look for in a team of Claim professionals

Attracting the right talent is key to developing a team of Claim and medical professionals, according to Todd Mattiello, Vice President of Claim Account Executives. As the environment changes, continuous training and development opportunities can help prepare the team to manage more complex claims.

Learn more about training and development for Claim professionals.

Chapter #2

How are some TPAs using predictive modeling today?

TPAs are leveraging their own first-party data, as well as third-party data in predictive models, according to Kevin Mahonney, Vice President of Analytics and Research. For example, advanced social listening can help confirm or contradict elements of a claim to detect fraud.

Learn more about predictive analytic models.

Chapter #3

What is the balance between the technology and the Claim professionals?

Too much reliance on the human element can be a missed opportunity to augment the understanding of the Claim professional with data, according to Rich Ives, Vice President, Workers Compensation Claim. It's also important not to over-rely on technology. That balance between the nuance of human skill and predictive analytics can help optimize claim outcomes.

Hear more about finding the balance.

Chapter #4

What sort of models combine technology and human skill?

The Early Severity Predictor® model helps determine when injured employees could decompensate into chronic pain, which could lead to opioid abuse and dependency. Our medical staff intervenes to develop a personalize level of care that can help injured workers avoid opioid addiction.

See more about the Early Severity Predictor.

Chapter #5

Pitfalls of a one-size-fits-all approach

Listening, understanding and offering up solutions can help TPAs optimize results throughout the course of a relationship with a customer rather than taking a more one-size-fits-all approach.

Learn more about working with a third-party administrator.

Chapter #6

What are some tools and models on the horizon?

Artificial Intelligence is starting to proliferate across claim and provider fraud detection, helping TPAs understand connections between providers, attorneys and injured employees. It's also helping identify claims that are likely to become outliers, which can help determine the need for extra attention from Claim professionals.

Learn more about promising new tools.

Chapter #7

How does advanced social listening help TPAs?

Advanced social listening offers relevant information on claimants that helps Claim professionals evaluate the validity of a claim. For example, an injured employee could post a photo on social media about a top road race result when they are out of work, which may help contradict a workers compensation claim.

Learn more about ways that TPAs are using social listening.

Balancing big data and Claim professionals to optimize outcomes

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