The workers’ comp sector is attracting more claims employees new to the industry, training them more, and giving them more access to technology, according to Rising Medical Solutions LLC’s latest benchmarking study.
“Frontline claims professionals, with their expertise, empathy, and efficiency, have long been the cornerstone of effective claims management. Yet, despite their pivotal role in driving positive outcomes, their collective voices are rarely the subject of industry-wide analyses,” states the report. “For only the second time in the study’s history, and the first time since the COVID-19 pandemic reshaped our work environment, the 2023 Workers’ Compensation Benchmarking Study turns its focus to these essential professionals.”
Trends
The study found that 53% of claims leaders report indemnity claims caseloads that are at 125 or less, a decrease from prior study results. Furthermore, “the data shows a modest increase in caseloads that are 151 or greater with 26% reporting higher average indemnity caseloads.
Significantly, the survey’s demographics show a positive talent trend. “The results reflect that 30% of respondents have five years or less experience in workers’ compensation claims adjusting, and 51% have 10 years or less experience, a moderate increase from the 2019 study, indicating a positive trend in attracting and retaining new talent.
The study focuses on four indexes: core competencies; talent development and retention; technology and data; and medical performance management.
Prioritizing Core Competencies
The top core competencies most critical to claim outcomes remain consistent throughout the study years, according to the report. “Claims leaders and frontline staff rank compensability investigations, disability/return-to-work (RTW) management, and medical management in the top three (3) capabilities most critical to claims outcomes. However, frontline claims professionals consistently rank compensability investigations as the most important. The top capabilities are intrinsically linked since proactive medical management impacts the quality of care an injured worker receives, as well as timely return-to-work and ultimate claim resolution.”
Furthermore, the results of the study show that 80% of organizations are “utilizing systems to direct and manage best practices, a notable improvement from prior study results,” according to the report. “The study reflects an increase across most systems/tools to drive best practices, with state fund/mutual fund and insurance carrier companies being more likely to leverage multiple systems and tools. Historical study data demonstrates higher performing organizations are much more likely to utilize workflow automation, predictive analysis, and prescriptive analytics than lower performing peers.”
Predictive and prescriptive technologies have become increasingly important, as “key decision support tools in the management of workers’ compensation claim outcomes,” the report notes. “Using these tools allows organizations to quickly identify and strategically intervene in claims with a probability to incur high claim costs, litigation, and other key drivers of claim severity.”
The 2023 study results also demonstrate that “80% of organizations are utilizing systems to direct and manage best practices, a notable improvement from prior study results,” states the report.
Lastly, administrative and regulatory compliance burden is still an issue, the report states. “The data shows a modest decline in participants that report spending 30 to 40% or more of their time on regulatory compliance and administrative tasks compared to the prior study results. Yet, nearly half of claims professionals, or 46%, report spending 30 to 40% or more on administrative tasks, and 23% allocate 30-40% or more of their time on regulatory compliance,” states the report.
“Excessive focus on internal and/or external compliance and administrative tasks to the detriment of other objectives such as communicating with injured workers and key stakeholders, proactive coordination of healthcare services, and a RTW will negative impact claim outcomes. Organizations should determine which administrative tasks and/or regulatory compliance activities can and should be automated.”
Talent Development and Retention
Remote work improves productivity and morale, but team dynamics might suffer, the report states. “Frontline claims professionals rank a remote work option as the most important benefit that could impact employment decisions. The results show remote work does not negatively impact productivity, with 97% reporting either no impact or improved productivity, an increase from the 2022 results of claims leaders,” survey results show. “Similarly, 94% report either no impact or improved impact on employee morale. However, like claims leaders, frontline claims professionals report a greater effect on team dynamics with 14% reporting a negative impact in this area.”
The 2023 results also show that investment in training has improved, with 72% of organizations providing training for new hire claims staff with minimal to no experience, a notable increase from the results of the 2019 survey of frontline claims professionals. “Higher performing organizations are more likely to offer new hire training for claims staff. Additionally, 87% report ongoing skills training and development, a slight increase from the 2019 survey of frontline claims professionals, and a notable increase from the most recent survey of claims leaders in 2022.”
Furthermore, knowledge of advocacy-based, injured worker-centric claims models increases. “The results reflect a modest increase in frontline claims professionals’ knowledge of advocacy-based, worker-centric claims models from the 2019 survey, with 39% reporting awareness.”
Lastly, a defined career path for frontline claims professionals increases, as the results show that 54% of organizations offer a career path with growth opportunities to frontline staff, an improvement from 2019 results and consistent with recent claims leader survey results from 2022.
Impact of Technology and Data
Strategies to improve claims professional efficiency needs better integration, states the report. “The 2023 results show an increase in the number of systems frontline claims staff utilize in the daily management of claims, with 55% reporting they use five…or more systems, an increase from 42% in the 2019 survey of frontline professionals, clearly demonstrating the need for efficiency improvements.”
Additionally, utilizing analytics to manage claims has increased, as the 2023 data shows that 72% of frontline claims professionals use analytics to manage claims—an increase from prior study results of claims leaders in 2022, as well as the survey of frontline staff in 2019.
Medical Performance Management
“Medical management programs most critical to claim outcomes remain consistent,” according to the report. “Aligned with the prior survey responses of frontline professionals, the 2023 results show frontline staff report nurse case management, utilization review, and return-to-work services as the top medical management capabilities most critical to claim outcomes.” Since the study launched in 2013, claims leaders consistently rank nurse case management, return-to-work services, and nurse triage as the top three medical management programs most critical to claim outcomes.
Furthermore, return-to-work and patient functional outcomes continue to rank as the most important measure of quality, the survey states. “Consistent with prior study results, 48% of frontline staff identify return-to-work/patient functional outcomes as the most important measure of provider quality,” as well as the use of evidence-based care.
CLM Experts Weigh In
“The 2023 study takes an in-depth look at the state of insurance industry talent and draws connections to claims management, highlighting just how important it is to close the talent gap,” says Jones Jones’ Managing Partner Sarah Thomas. “Workers’ compensation work is dynamic and lively, and by attracting the right talent, we not only demonstrate the availability of a dynamic and exciting career path, but also how we can improve worker safety, as well as control costs. The results from this study show that the workers’ compensation industry is taking steps in the right direction by attracting talent and supporting them where necessary,” she concludes.
“We are in a critical junction as claim leaders to understand the intersection between our people and our technology. They must be thought of together if we are to successfully implement the tools that our claim professionals need, while teaching them and investing in their careers,” says Jeanette Hernandez, CEO, Claim Connect IQ "This study is a holistic approach to help you improve results in your Workers' Compensation business. Whether you are seeking information regarding people, process or technology, you will glean industry insights from the study."
Michele R. Punturi, Esq., director, workers’ compensation department, Marshall Dennehey, added, “the study highlights that implementing structured processes—such as return-to-work programs, medical management protocols, and strategic claims reviews—significantly reduces financial losses, enhances employee well-being, and improves outcomes. Adopting a proactive approach to return-to-work initiatives begins with educating and training supervisors and managers on these policies, given their critical role and direct connection with employees."
Punturi continued, "we are encouraged to see that jurisdictional case law training remains a priority for workers’ compensation claims professionals, as indicated by the study results. Given that workers’ compensation regulations vary by state and evolve rapidly, leveraging legal expertise is essential. To ensure our clients stay informed, we distribute a monthly digital newsletter and statewide alerts on trending workers' compensation topics. Additionally, we host a monthly webinar series to provide in-depth analysis of relevant cases and discuss their potential impact on our clients' operations.”