By Rachel Fikes, Chief Experience Officer & Director, Workers’ Compensation Benchmarking Study, Rising Medical Solutions
Over the past decade, claims departments have faced enormous challenges and opportunities, including changing workplace dynamics stemming from the global pandemic, employee turnover and labor shortages, an accelerated focus on digital transformation, escalating claims severity, and greater social accountability for the treatment of injured workers. Yet, looking back, it may seem that “everything and nothing has changed.” Somewhere in between is reality.
On the tenth anniversary of the Workers’ Compensation Benchmarking Study’s inaugural publication, the latest study reprises survey questions used since the study began, revealing the trajectory of how claims management has (or has not) progressed over the past decade—ultimately delivering a 10-year industry report card.
Key to the study’s decade of research is an ongoing examination of how high-performing claims organizations surpass trendlines and less successful peers in navigating persistent industry challenges and opportunities across the four (4) major drivers that influence claim outcomes.
Using these drivers as guideposts, I have endeavored here to condense 10 years of investigation with claims executives and frontline professionals—which has resulted in more than 1,000 pages of text, tables, and graphs—into just four (4) key takeaways. The first two (2) takeaways will be covered in this article, and the remaining two (2) in next weeks’ article.
Key Takeaway #1: Top Performers Invest More in People
High-performing claims organizations (those with closure ratios ≥101%) invest more heavily in their workforce than lower-performing peers. With the shrinking labor market and worsening claims staff attrition rate, this may be the most critical differentiator of successful claims organizations right now, with talent strategies acting as a key driver for all other claims strategy prioritization.
The study findings below confirm the heartburn many claims organizations have been feeling. In the past 10 years, the number of organizations who are experiencing a 10 to 20% frontline turnover rate has nearly doubled. And the number of organizations who are experiencing a 20 to 30% turnover rate has nearly tripled.
So, how does our industry do more with less talent in the short-term? And how do we reverse the trend in the long-term? Technology, greater process efficiencies, training, and flexible and purposeful work are a big part of the answer.
Talent acquisition and retention is significantly influenced by the ability to offer claims staff the option to work from home. Even before the pandemic, in our 2019 survey of frontline staff, claims professionals indicated that remote work options were one of the most highly valued benefits affecting their current and future employment considerations. For many claims leaders, the pandemic altered the perception that claims organizations could effectively function in a remote work environment. However, while some claims organizations may anticipate a return to in-office operations, either full-time or in a hybrid model, the study reveals that higher-performing organizations are much more likely to provide claims professionals with increased flexibility in remote work arrangements compared to lower-performers AND be more mindful of potential negative impacts on camaraderie and innovation, indicating a willingness to address these aspects of the remote working environment to achieve positive results.
Higher-performing organizations report lower attrition rates compared to peers, and are also more likely to:
- Offer formalized training programs for both new and senior-level claims professionals
- Conduct more frequent training sessions, including soft skills training encompassing customer service, active listening, and communication skills
- Provide well-defined career paths that offer clear growth opportunities
- Incentivize claims staff with bonuses and performance-based strategies
Key Takeaway #2: Top Performers Focus on What’s Most Important
Frontline claims professionals are called to be experts at a myriad of core competencies—from case reserving to litigation management and compensability investigations to medical management—which all compete for their time and attention.
Out of 10 key competencies survey participants could rank as most critical to claim outcomes, three (3) have consistently risen to the top, with disability/return-to-work management, medical management, and compensability investigations historically identified as most crucial to success, albeit not always in the same order. In the 2022 study, however, claims resolution unseated compensability investigations to take the third spot, which communicates a possible industry shift towards less adversarial claims management approaches.
For frontline staff, it is what high-performers do within top core competencies that make them different. Namely, they make it easier for claims professionals to focus on these key areas of success. Specifically, high-performing organizations are much more likely to define, align, measure, and reward daily operational best practices that propel performance within top core competencies and ultimately lead to desired and superior claim outcomes. Driving such key performance indicators (KPIs) and incentives to the frontlines makes it clear where they should be spending their time.
For instance, high-performing claims organizations are much more likely to incorporate injured worker satisfaction as a pivotal measure of claims management effectiveness and resolution. This highlights an inclination towards advocacy-based, worker-centric claims models, as does the fact that higher-performers are much more likely to:
- Demonstrate awareness of advocacy models
- Have an operational advocacy model in place
- Leverage various advocacy model initiatives, such as empathy training, leveraging worker-centric technology/tools, and emphasis on workers’ compensation as a benefit delivery system
Finally, when focusing on what’s most important for superior claim outcomes, top performers’ more prevalent adoption of advocacy-based claims models also supports what’s critically important to claims talent—meaningful work.
In the study’s 2019, pre-pandemic survey of nearly 1,300 frontline professionals, participants clearly demonstrate a service- and purpose-oriented attitude. From defining a “good claims outcome” as getting employees back to work and health over other measures (such as lack of litigation), to identifying injured worker engagement and transforming the claims profession towards advocacy as the top impact areas of a worker-centric model—we can quantifiably see frontline staff leaning into the profession’s helping and purposeful aspects. Add the pandemic experience into the equation, and purposeful work has only increased in importance. Organizations that recognize this need in their talent value proposition and claims culture will have a clear competitive advantage.
For the remaining two (2) takeaways from 10 years of Workers’ Compensation Benchmarking Study research, stay tuned for next week’s article as we delve into technology and medical management findings. And, as always, if you would like to obtain a copy of the study(s), it is available to all industry stakeholders without cost or obligation as a contribution to the workers’ compensation community. It may be requested and downloaded here.
About Rachel Fikes
Rachel Fikes is a 20-year insurance services veteran who leads Rising Medical Solutions’ Workers’ Compensation Benchmarking Study, a national research program she has directed since its inception in 2013. Now the industry’s largest survey of claims leaders and frontline claims professionals, the annual study identifies and quantifies industry priorities, challenges, and strategies. With its potent method of validating how and what higher performing claims organizations are doing compared to industry peers, the study uses its data findings to advance benefits delivery in workers’ compensation.
In her Chief Experience Officer role at Rising Medical Solutions, Rachel is responsible for creating centralized value for the company’s two primary constituencies—clients and employees. Understanding that optimizing the customer experience requires an aligned employee experience, Rachel works collaboratively with all business units, as well as externally with clients, to deliver increased value to all stakeholders and to cultivate a culture of advocacy.
About Rising Medical Solutions | We Make Lives Better.
Rising Medical Solutions (Rising) is a national managed care firm that provides medical cost containment and medical care management services to the workers’ compensation, auto, liability, and group health markets. Rising’s mission is to “make lives better,” by taking the pain out of the healthcare experience for those providing, receiving, and paying for medical care.
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