Disability claim scoring provides a 1 to 10 score of the likelihood of a claimant’s return to work within a specified time. As with all Claim Analytics models, scoring models are built using the client’s own data.
Why claim scoring?
Scoring instantly divides the claim block into ten different categories – objectively and automatically. Management can implement a strategy for each category, focusing resources to maximize outcomes.
How does it work?
Claim scoring is typically implemented in three phases: clean-up, maintenance, and segmentation.
- Clean-up addresses mature claims. A typical pilot project begins with a small team (2-4 employees) for the clean-up phase.
- Maintenance introduces claim scoring to the rest of the claim handlers as a tool to optimize resources. Maintenance also introduces Opportunity Reports to the claim handler. These reports highlight claims with high recovery potential.
- Segmentation incorporates claim scoring into the ongoing management of all claims. Segmentation offers opportunities to:
- use claim scores in assigning claims
- make decisions on timing/use of rehabilitation and
- maximize claim handler and other resources.
Clean-up: Finding potential opportunities in mature claims
The first step is for the assigned small team to work with the Opportunity Reports. These reports identify cases where there are potential missed opportunities for recovery or offsets. These tend to come from two types of claims:
- High-score mature claims – potential missed opportunity for return to work.
- Low-score mature claims – potential opportunity for SSDI/CPP offsets.
Maintenance: Introducing claim scoring to all claim handlers
The next step is to introduce claim scoring to all claim handlers. During this phase, claim handlers focus on claims that are approaching their predicted duration.The start-up team uses the information in the Opportunity Report to help each claim handler:
- See which claims have a high potential for recovery as they approach the predicted duration.
- Accelerate the application for other sources of income for claimants unlikely to recover.
Segmenting: strategizing by score
The final step is to categorize new claims into one of three buckets, each with an accompanying strategy, as illustrated in the graphic below.
Most clients have chosen to use the Claim Analytics Portal by this point; it offers online secure dissemination of scoring information to every employee in the department.
Click image to view larger version.The overall outcome
Please refer to our testimonials; they tell the story better than we can. Overall, by helping claim handlers to invest their time where it will make the greatest difference, disability claim scoring promotes improved outcomes.