October 20, 2015
How to Manage Claims Across Silos
There is growing interest in taking an integrated approach to casualty claims and benefits programs, breaking down the silos.
The long-minimized and largely untapped synergy between casualty claims and benefit programs may offer opportunities for both industries.
Some argue that these worlds are just too different and distinct to bring together, whether through simple alignment or partial to full integration. Managers are often more comfortable in their own functional areas, and sometimes crossing over can stretch expertise and focus. Fundamentally, however, claims are claims.
There’s been a shift in thinking and a growing interest in a more collaborative, aligned and even fully integrated services approach – one that takes many forms but that at its core incorporates a more combined strategy from date of incident through claim closure. The targeted goals for this approach are:
- Ensuring an appropriate employee experience throughout the life of the claim
- Targeting and delivering optimal outcomes
- Minimizing the cost of risk associated with the reasons employees are under medical care or unable to contribute productively to their employer’s mission
On its face, the value of collaboration seems obvious. From both an employee benefits and risk management perspective, providing care for the individual is of the utmost importance. One of the main objectives is ensuring the right outcomes, which includes leveraging the basic skills of investigation, verification, documentation and equitable resolution that are common between these two realms.
The nuances and distinctions that exist between them are not insignificant, but the key goals are the same – caring for people under medically related distress (regardless of source), minimizing disruptions to workforce productivity and closing claims efficiently and effectively with fairness to all parties and their respective goals and objectives.
Although these objectives have varying levels of importance in each field, they are fundamental to process effectiveness in both. This is not to say that there aren’t peculiar and unique aspects of each that require certain expertise and skills to achieve specific goals.
However, while blending skill requirements among a common group of claims professionals can be challenging, it is not rocket science. Defining and filling positions to enable successful claims handling in both worlds is eminently doable. The biggest hurdle may in fact be the necessary collaboration between these typically distinct functional areas and their leaders.
Many employers are already effectively managing employee injury and disease exposures. There are discernible trends emerging toward fewer silos and more performance-oriented measurements that are focused on short- and long-term strategies. Those companies taking a more collaborative approach can benefit from key elements such as:
- Compassionate care that puts employee interests first
- Integrated reporting and measurement across departments
- Robust analytics that result in prescriptive actions with impact
- Innovative tools targeted to specific process opportunity areas
- A more holistic focus on the care of affected employees
- The over-arching goal of a healthy, productive workforce
So whether or not you have direct responsibility for both functional areas, I urge you to lead the charge that would leverage this opportunity for the benefit of your organization.