Bring Together Art, Science & You in TPA Predictive Analytics
Leveraging data is a mission-critical aspect of claim management, but there are other factors beyond the science of predictive analytics that can play into having highly effective claim management processes with your third-party administrator.
Having trained professionals who understand predictive models, how to interpret the data, and the best way to act on it is the art of claim management. It's a discipline that requires flexibility, judgment and nuance. And embedding insights directly into the life of the claim process leads to real strength.
Here are some considerations to help your company maximize the impact of that relationship.
Five key questions to ask your TPA:
1. Are your objectives from using actionable analytics clear?
2. What biases might exist in different analytical models (e.g., geographical, industry segments, consistency of data, etc.)?
3. What is the right balance for your organization between data-driven insights and human interpretation and application of the insights? Are your people trained and developed to make insightful decisions?
4. Field-tested changes ensure ongoing success. What is the process for making changes to your approach to claim management based on field-tested results?
5. How is your team collaboratively brought into your claim management processes?
Without competent, effective experienced Claim and medical professionals, it doesn't matter what else you bring to the table. The longevity of our Claim and medical professionals lends itself to really getting to understand our customers, and our ability to build our relationships with those customers, which to me is critically important.
Todd Mattiello
Vice President, Claim Account Executives at Travelers
We collect somewhere around 1,500 elements on each of our more than 30 million claimants that we've had over the past 10 plus years. That's about 45 billion structured data points that we have on our claimants. I think those TPAs that are going to be most successful are the ones who have the market share and the data to be able to really appropriately use analytics to triage and handle claims.
Kevin Mahoney
Vice President, Analytics and Research
If you have too much reliance on just the talent aspect, just the human aspect of that process of claim handling and medical management, then what you miss is the ability to augment the understanding of that claim professional to actually expand upon their knowledge and their expertise. Carriers who will be really successful in this space are those who can have that excellent balance of both technology and human skill and capability.
Rich Ives
Vice President, Workers Compensation Claims
This checklist of five questions can help you test the effectiveness of your TPA’s predictive analytics.
