Memphis, TN – Sedgwick, the leader in technology-enabled claims and productivity management solutions, is excited to introduce Performance 360, a new approach to quality that takes the assessment of claims management performance far beyond meeting basic industry compliance requirements. With Performance 360, Sedgwick is changing the game.
Performance 360 offers a holistic approach to measuring claim outcomes that can reduce costs and drive better results for clients by concentrating on program performance as well as conventional compliance principles.
“We are taking traditional industry standards to the next level by shifting the focus from a primarily compliance-based process to a more outcomes-focused approach,” said David A. North, president and CEO of Sedgwick. “With our team’s experience and insight, we are setting the stage to redefine quality in our industry.”
The established industry standard for compliance auditing consists of a retrospective review of claims handling activity. But in the fast-paced claims industry, to be able to effectively impact the outcome of a claim, and use that data to improve current claim files, auditors need to evaluate the work as close as possible to when it is performed. Performance 360 features a continuous review cycle with audits scheduled earlier in the claims lifecycle – a fresh approach that will maximize opportunities to improve results for clients.
In addition to this fresh approach to compliance auditing, performance will be managed separately – a key difference in Performance 360. Performance reviewers will evaluate the performance of key claim metrics in three distinct categories – communication, proactive engagement and result – to determine whether claims are on the path to the best possible outcome. Based on these evaluations, Sedgwick will implement performance score carding to ensure claims are moving toward resolution and achieve the best financial outcomes for clients.
By combining a continuous audit cycle to measure compliance to industry, client, carrier and regulatory expectations with performance reviews to evaluate claim outcomes, Performance 360 will provide a complete picture of claim handling quality.
Sedgwick’s predictive modeling process is another differentiator. By segmenting claims into tiers based on their likely exposure as well as the anticipated work effort required to resolve the claim, Sedgwick’s team leader will be able to better focus the bulk of their efforts on the claims that will most benefit from increased supervision. And with an increased use of automation claims professionals will have the ability to achieve the best possible claim outcomes. Performance 360 will be implemented across all lines of business serviced by Sedgwick.
“By continuously evaluating what we do and how we do it, we are strengthening the impact our professionals have on claim outcomes. With modifications in our compliance activities and increased focus on ultimate claim outcomes, we will improve the overall experience for our clients and their employees,” said Darrell Brown, Sedgwick’s chief performance officer.