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Self Insured companies typically have a high retention whereby they pay up to a certain amount of every claim and some specified aggregate amount of the total claims. As a consequence they have a great interest in the total cost of claims. Companies often choose to self insure because they believe they can manage the total cost of risk less expensively and can better control the claim process. The Management Information Warehouse can be an invaluable tool for them in many ways. Here are a few examples:
Self Insured Companies- Strategically manage the claims process by fully understanding the drivers of claims costs and characteristics of claims that lead to those costs.
- The MIW can be used to create service level commitments that focus on the variables affecting claim outcomes.
- The MIW can be used to better manage ultimate cost of risk thus creating more accuracy in reserving.
- The data can be used to streamline claim operations by focusing on those characteristics or variables that have an impact on outcomes. The aim is reduced claim costs while achieving better results.
- The data can be used to more effectively manage other cost containment vendors.
- The data can be used to identify providers who consistently get the best outcomes for given diagnoses and use this information with the network to better focus treatment modalities or to set up physician panels where appropriate.
- Ultimately the data can be used to identify the cost drivers of claims and strategically build a plan around those variables. The result is intentional management of claims cost drivers rather than fortuitous outcomes.
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Solutions:
Data Analytics and Data Mining/Predictive Modeling provide unlimited opportunities for knowing what drives your business and provides the means to strategically address those drivers. Here are a few examples of Claim Insights solutions to control payout, expense management, and productivity.
Predictive Modeling:
Predictive modeling explores cost and business drivers, creates special studies, and identifies target variables. We help companies advance from claims processors to powerful claims management organizations.
Insurance Carriers