What is claims consulting?

What is claims consulting? – A blog article by Swift Claims Consulting Services LLC. Make Swift your first call when it comes to difficult claims whether if you are an attorney, engineer, city official, commercial property owner, and so on. We are here to help you with all your claims consulting needs. We hope you enjoy this article and find it to be informative.

Swift Claims Consulting Services - What is claims consulting?
Swift Claims Consulting Services – What is claims consulting?

So what is an insurance claims consultant?

A claims consultant is an insurance claims adjuster that helps protect their clients from insurance fraud. As claims consultants, we perform the typical job duties of a claims adjuster while also conducting specialized investigations on complicated insurance cases.

What happens in the event of a large loss – what does a claims consultant do exactly?

In the event of a large or complex loss, generally speaking, an expert claims consultant will do these four things among many many sub-tasks connected to these four items.

  • Support and guide you through the claim presentation, negotiation and settlement process
  • Attend meetings with you to review and analyse loss information and agree on strategies
  • Take full advantage of our established relationships and negotiation skills to allow constructive communication on difficult claim issues
  • Introduce other internal or external specialist suppliers of claims and legal services for specific tasks 

Okay so we just made that sound really easy, but there is a lot happening in the background to have it all seem painless and stress-free for you. A claims consultant will have in-depth experience in areas such as financial lines, property & business interruption, various liability lines, and of course understanding how specialty lines come into play.

Here are the most popular offerings of a traditional claims consulting agency.

Claim Inventory Workout – Thanks for continuing to read “What is Claims Consulting” by Swift Claims Consulting Services LLC

A claims consultancy will bring a focused approach to claim closure, designed to reduce legacy liabilities and improve the balance sheet. By reviewing the claim inventory workout, this tool works well with any line of casualty claims, although a primary focus is on workers’ compensation where tail claims and regulatory requirements make prompt and efficient claim resolution a greater challenge for organizations.

Understanding how to utilize line-specific and jurisdictional expertise to assess outstanding claims and bring a fresh perspective to resolving older claim files is important too. This approach can:

  • minimize administrative involvement in claims programs;
  • reduce internal and external claim administrative costs;
  • avoid deterioration of an organization’s claims inventory;
  • improve insurer performance and reduce collateral requirements;
  • reduce liability from discontinued operations;
  • and impact and reduce costs associated with chronic medical pain cases.

Workers’ Compensation Assessment

Many claims consultants (such as Swift Claims Consulting Services LLC) use proprietary outcome-based audit tools is designed to identify excessive costs in a workers’ compensation program. These tools can calculate lost economic opportunity and provides a quantified result, which can lead to the implementation of process changes designed to improve financial results.

Through the assessment, claims consultants can help organizations make better business decisions on where to invest in program improvements, based upon the identification of potential savings opportunities.

Operational Assessment

Through the process of getting an operational assessment. A good claims consulting agency, like Swift Claims Consulting, will look at the organization’s policies, procedures, and practices. By doing this, it will help identify areas where improved performance equals reduced costs.

A good claims consulting company will assess the quality of written programs, as well as measure the effectiveness of and compliance with these programs. In addition to a review of written material, the consultants will complete interviews of key personnel and often conduct a claim audit utilizing the workers’ compensation assessment tool(s).

The operational assessment can also be expanded to include pre-loss efforts to address the complete impact of program strengths and opportunities for casualty claims.

Claim and Managed Care Vendor Selection

When selecting a new program vendor—whether claim administrator or managed care a great claims consulting agency can assist an employer with its decision making using a multi-phased vendor selection process. The process should include identifying the vendor that can best provide quality service, aggressive pricing, and both positive claim and medical outcomes.

Furthermore, this process needs to include:

  • a needs assessment
  • development of the request for proposal
  • identification of vendor candidates
  • and scoring of written and oral responses

By having a streamlined RFP process, it can hopefully start leveraging a claims consultant’s proprietary vendor analysis and selection tool(s). Thus, it contains a database of all major insurers and claims administrators with standard company information to allow for the creation of an RFP tailored to an organization’s specific needs. If you are getting confused – don’t sweat it just give us a call at 386-800-1902.

Variable Cost of Risk Evaluator

In the final stage of the vendor selection process for a workers’ compensation program administrator, organizations can rely on the claims consulting agency’s proprietary variable cost of risk evaluator assessment to help them evaluate vendor outcomes and identify project costs.

This assessment leverages the claims consultant’s database of most major vendors’ book of business data to determine paid medical costs and claim administration fees for competing finalists. They should also assist in contract negotiation and implementation of the new vendor program.

Renewal Evaluation Software

Another useful tool the consultant should be bringing to the table is some type of renewal evaluation software. This software tool allows the claims consultant to specify the effect of implementing a new price option on a company’s annual medical cost.

This information should be very helpful to a risk manager in making the right price choice for its program. The analysis is done specifically for each company, using actual medical bill history, instead of an estimate of medical charges.

Non-Subscription Feasibility Evaluation and Implementation

Opting out of workers’ compensation is an intriguing, yet daunting, proposition for many employers including those located in the state of Texas. Having a good claim(s) consulting business on your side. They should have developed a process to assist employers with:

  • evaluating the feasibility of becoming a non subscriber;
  • assessing an existing non subscriber program;
  • and program implementation.

A veteran team of claims consulting experts will bring with them a specific product offering(s) that could include a baseline assessment of all pre-and post-loss activities, economic modeling, and a process to set up and launch new programs. Swift Claims Consulting works nationwide and will be glad to help you with all your consulting needs – follow us on Facebook.

Case Management Assessment

An experienced claims consultant has developed a case management assessment tool that has a track record for working. By leveraging a proprietary methodology to evaluate the quantity of case management referrals and the quality of those services, an experienced claims consultant can come in a get right to work.

This platform combines data analytics and auditing to quantify the value and impact of nurse case management services and also to identify any medical leakage. Using these outputs, organizations can focus on improving their workers’ compensation program outcomes and their overall return on investment.

Return-To-Work Program Solutions – What is Claims Consulting?

A top-notch claim consultant firm will have a number of product offerings to deliver return-to-work solutions. The solutions should offer a variety of buying styles and employer needs.

From frontline supervisor training to customized return-to-work programs, a detailed oriented claims consulting firm can supply consultants that can assist with:

  • evaluating the needs of an organization’s employee occupational absence issues;
  • analyzing the effectiveness of an existing return-to-work program
  • designing a return-to-work program if one does not exist
  • advising during the program’s execution with company leadership
  • recommending program options that meet the goals of the organization.

Claim Audits

Another consulting solution a good reputable claims consulting agency should offer is auditing. This is a variety of workers’ compensation, general liability, and auto claim audits. A consultant should recommend the following when looking at offering auditing services for your company.

Here is a brief list of auditing work for claims which can include:

  • a best practice audit, which evaluates claim handling against industry-recognized best practices;
  • a reserve analysis, which focuses on:
    • the adequacy of reserves;
    • a financial process audit,
    • specifically targeting the policies and practices utilized for claim payments
    • determining the reserves needed for the impact of Sarbanes-Oxley requirements.

While there are standard protocols built into each of these audits, they can be expanded and customized to meet specific needs. A good sharp claims consultant needs to be ready to sit down with you and explain what audit is best for your situation. Need us to help – give us a call at 386-800-1902

Custom consulting solutions are possible with Swift Claims Consulting Services LLC. We hope you have learned a little bit from this blog article and if you liked it – we have many more like this one to share with you.

A little bit about us, we can work with an organization in support of any claim program issues through our custom consulting solutions approach. This can be achieved through a blend of any of the aforementioned product offerings, as well as through outsourcing, data analysis, and the development of customized solutions focused on gaining a greater understanding of the program
issues and the overall program cost reduction potential.

Our consultants also can focus on medical treatment and medical costs, helping an organization develop strategies, address cost drivers, and integrate solutions into its workers’ compensation program. So reach out to us today at 386-800-1902 to get started.