time. This ability to better segment claims
by severity and align adjuster skill set
can help to increase morale, reduce case
workload and can improve the overall
speed and quality of claims file handling.
The industry’s acceptance and adoption
of CPMs has moved well beyond concep-
how CPMs can help them enhance job
performance, then they are more likely
to feel at ease and understand that they
are part of the post-implementation plan
and solution. Their value is not being
questioned. Rather, their insights are be-
ing acknowledged and institutionalized
The insights gleaned from a CPM can give claims
professionals additional time to focus their energy on the
claims that matter most. With more time to focus on the files
that truly affect claimant and financial outcomes, they can
better manage caseloads and do more with less.
tual debate to a more focused implementation and benefit realization discussion,
and this is anticipated to continue to gain
momentum. Has your organization considered both the cost and human capital
implications of implementing a CPM?
Facilitate Higher Acceptance
of Model Insights
The effectiveness of a CPM—or any
large technology change program for that
matter—is contingent upon claims handlers adopting the tool and embracing
change. As Spencer Johnson said in the
book Who Moved my Cheese?, “If you do
not change, you can become extinct!” Ultimately tools don’t adjust claims, people
do. Whether your claims organization is
thinking about adopting a CPM or you
are in the midst of implementing your
own models, there are some key success
factors to consider. First, the organization needs to communicate the upcoming changes to the claims professionals.
Communication is important, not only
to adjusters and claims department, but
to the entire organization. Transparency
regarding any changes can reassure the
claims handlers of the changes ahead. It is
critical to communicate that a CPM is another adjusting tool to help enable them
do a better job—for example, considering
fifty or more predictive factors that no
human being could process alone.
The adjusting process, however, is still
very much a combination of art and sci-
ence, where the insights of claims han-
dlers will always be needed. Employee
engagement in large transformational
programs can directly affect morale and
retention. If claims handlers understand
while being better equipped to do their
job. When all is said and done, CPMs
are merely another tool for the adjusting
toolbox, albeit an effective one.
Models don’t adjust claims,
people do. The better
claims handlers understand
the true motivation and
business objectives of
implementing a CPM, the
better the outcomes can be
for all involved.
nology. This can be done by facilitating
focus groups, surveys, roundtable discussions, or simply water cooler conversations with the organization’s champions.
Oddly enough, it is very important to
engage the users that are the most vocal
opponents of model adoption early in the
process. Why? Because when these earlier doubters “buy-in” to the benefits of
leveraging claims predictive models, they
often times become the strongest supporters of change. From models we have implemented to date, these “converts” have
become an ardent force in rallying their
A third factor is the development of
education and training materials to help
end-users with the adoption and acceptance of the output and insights provided
by a CPM. When it comes to education and training, it is more than teaching claims handlers how to work with
the model’s output. It entails translating
model benefits into a language to which
claims handlers can relate: positive impact on case load closure and quality.
Questions to ponder include:
E How will the model’s output positively affect the day-to-day activities of the
E What information and insight is new,
or what information is being looked at
E Will the claims handler have less or
more capacity based on his or her skills?
E What is the best way for the claims handler to use the time earned from the efficiencies afforded by the model?
E What additional activities will he or she
need to undertake to support or complement the model’s outputs?
With these three key factors “top of
mind” and addressed, the claims organization can be much better positioned to
realize the full financial value and positive claims handling workflow benefits
expected from the implementation and
roll-out of a CPM.
How Models Help Change
What does a claims handler need
most? Odds are, most professionals
would answer “more time in a day.” The
use of models can help by freeing up time
for a claims professional to focus more on
examining the right files at the right time.