What do your claims analysts do?
You hired claim professionals to adjudicate insurance claims: to determine eligibility and liability accurately, to calculate payments swiftly, and to ensure that the entire process works smoothly. You probably hired or developed the best claims analysts you could, with excellent skills, strong background knowledge, and—depending on the insurance area—specialized training; and you pay them accordingly.
Yet in a recent survey, claims analysts report spending only 31% of their time on claims analysis and decisions—the crux of their job. So what are they doing instead?
Claims analysts spend too much time on non-claim-related tasks
In February 2021, SALT Associates and RGA released the results of a survey of US insurance carriers, detailing employees’ views on claims management and job satisfaction. Claims staff reported spending 39% of their time on lower-level work activities, including administrative tasks, letter writing, and compiling claim reports. Another 10% of analysts’ time is spent in meetings. And a surprising amount of time is lost jumping back and forth between multiple unconnected technologies.
When we engage with companies to identify inefficiencies in their operations, we usually see the same three factors preventing claims analysts from focusing on the work activities they were hired for. These top three inhibiting factors typically include: handling routine correspondence, workflow interruptions, and organizational bureaucracy.
Think of the number of letters involved in managing a claim. Approval letters, letters to accompany payments, required status updates—an analyst may send six or seven letters while administering a single claim. Most of these letters can be automated or streamlined by using templates, especially if the carrier has a system to capture data in a structured way, so it can be reused to fill in specific fields.
Also, consider the multiple systems analysts use for various work activities. They may be viewing claim information in one system, managing their workload in another, then writing letters and releasing payments in still other systems. All this hopping around means that analysts are typing the same information repeatedly, in addition to logging in and out of different portals and searching through various systems to find the information they need. Integrating or consolidating some of these systems can dramatically reduce the time spent on non-productive tasks.
As for organizational bureaucracy, if it can't be eliminated, it can certainly be reduced. While some meetings are necessary, others are pro forma: frequent one-on-ones with different levels of management, group meetings that go out to a set list instead of the specific people needed, and meetings that could have been an email.
What do non-claim-related work activities cost?
Those skills you value in your claims analysts do not come cheap. Though it varies by region, the average claims examiner earns a professional-level salary. For medical professionals working in healthcare claims, that number is even higher. If a substantial percentage of their time is going to tasks that do not fall into their job description requirements—or if most of their work is at the lower end, rather than the higher end, of that description—a large amount of preciously, costly resource time is lost. Multiply that inefficiency by four, six, or eight when you have a whole team of analysts sitting in a meeting when you only needed two.
Misguided or nonproductive resourcing is hard on a business’s bottom line, but it also impacts employees' mental and emotional wellbeing. In the RGA/SALT study, only 35% of claims staff said they felt highly valued by their employers, and only 28% said they were very satisfied with their work. Common concerns included “feeling like I work in a call center,” “the stress of wearing too many hats,” and sensing that “claims is perceived as an afterthought.”
When lower-level administrative functions take up too much of claims analysts’ time, they do not see themselves as valued team members. Feeling respected and empowered is difficult when you are repeatedly asked to do work that is below the level of your ability and training. Low morale and high employee turnover can be expensive challenges.
Organizations can learn to use their current resources to improve productivity.
When we discover these problems with our clients, we advise and make recommendations around technology, automation, and efficiency. The types of focused investments that allow claims analysts to concentrate on making claims decisions have a substantial ROI in terms of recouped resources.
However, going down this path does not necessarily mean buying a sizable new technology platform. As consultants, we can provide an outside point of view and broader industry expertise to help an organization learn to use its current resources most efficiently. This advice might include digitizing data using software already in place to drive the automation of correspondence. An organization may have a terrific labor force but not match employees’ skills to their work activities. More functional software may already be in use in another part of the company and available for adoption in claims.
While every situation is different, the diversity of our experience allows us to bring in both tested solutions and new ideas for making claims administration more efficient. An audit from a third-party perspective can help you identify opportunities to reduce or eliminate non-productive time and keep your claims analysts focused on what you hired them to do and where they add the most value —claim adjudication.