Workers Compensation Claims Process
The client is a US-based law firm specializing in workers’ compensation claims representing employers, insurance carriers, and third-party administrators. Since 1991, they have defended all kinds of workers compensation claims and willful misconduct claims on behalf of their clients. Due to the increasing number of fraudulent claims, they also specialize in defense against fraudulent claim filing.
The Challenge
The existing traditional claim management tools involve multiple systems, paper files, and manual processes that inevitably require time- and resource-intensive activities. As a result, the client experienced a significant lag time in their ability to handle each claim efficiently. Additionally, with little transparency in the workers compensation claims process, the lack of a standard procedure for claim handling, and ineffective communication and collaboration, the client realized that traditional systems were causing a significant negative impact on maintaining a competitive advantage.
The client wanted to address these issues by streamlining and better managing the entire workers compensation claims process, from First Report of Injury (FROI) to settlement/resolution and closure, all on a single claims management platform that is robust, scalable, and reliable. Having developed top-notch InsurTech solutions for enterprises across the globe, Experion Technologies was committed to redefining how the client handles workers compensation claims management.
Our Solution
Team Experion visited the client’s headquarters in the US and collaborated to understand the existing problems and pain points they needed to address. Our team captured the business objectives and laid down a strategic roadmap and action plan to create a market-winning comprehensive claims management platform based on these inputs. This project was planned as a multiphase engagement, where different modules would be developed and tested in each phase before proceeding to subsequent phases. For example, during the first phase, Team Experion started working on the billing module. The client was paying a hefty user license fee and was considerably consuming the attorneys’ time and efforts. The billing module streamlined the entire billing process from calculating billing charges and accepting recurring payments to sending timely invoices automatically.
During the next phase, Experion developed and delivered an independent document scanning module, which replaces the existing third-party software. This module helps employees scan and organize case documents securely and efficiently. As a result, records, reports, images, bills, case sheets, and other paper documents can easily be transferred to a digital format, saving space, adding data security, and allowing for improved information-sharing capabilities.
In the next phase, Experion will work on the case management module to help them create cases to record, track, and assign. It will also enable them to define processes clearly and encourage users to follow all necessary steps of the claims process to complete a case. Upon completion, the case management module will show how cases should be categorized, the types of processes to choose from, specifying case statuses, and more.
Upon completion of this engagement, Experion will deliver a web-based workers compensation claims process management platform that seamlessly integrates and simplifies enterprise claims management processes, enabling them to compete and stay ahead in the insurance marketplace.
Business Impact
- Streamlined the entire workers compensation claims process.
- Enhanced the customer experience.
- Offered intelligent reporting and analytics.
- Achieved superior operational and business efficiency.
- Improved claims processing times and reduced the cost of claims processing.