The worst possible thing CAN happen.
When it does it can be very expensive.
As an executive, you can't wait for quarterly, semi-annual or annual audits to find out your adjusters are performing ineffectively.
With a few clicks, you can now measure performance
of adjusters across an ENTIRE block of claims.
Daily. Weekly.
New Management Tool
ClaimMeasure represents a new tool that uses information identified and extracted from claim notes. New reports are created - including a composite score for every claim - which provide measurement of claims and adjusters' relative efficiency
Operational Metrics
Identifying events and activities that happened, did not happen or may happen creates the ability to measure the performance on individual claims and of internal adjusters or TPAs handling the claims for an entire population rather than just a typical sample audit
Technology that Reads & Interprets
Using technology to read and interpret sentence data creates enormous advantages for measuring the activities and events that are occurring in a population of claims
Increase Productivity
The decisions people make about claims are documented in claim notes. Measuring the information written in the notes is a measurement of the knowledge people are applying to claims
ClaimMeasure Benefits:
Faster Access is possible because in addition to reading claim notes faster than people, the aggregation of results is virtually automatic
New Knowledge is created by measuring the entire population of claims and creating a view of events and activities never before possible
Consistent Measurement of claim handling practices is possible because technology can routinely read every sentence in every note in every claim
ClaimMeasure Objectively Measures Events and Activities in Claim Notes
One Score - Many Details
Claim Score:
Adjuster Score:
ClaimMeasure Key Features
The Power of SARA
The signature metric of ClaimMeasure is the ratio of Substantive Actions to Routine Activities (SARA)
A Substantive Action is a meaningful action documented in a claim note that moved the claim towards resolution. A claim note containing at least one meaningful action is considered to be a Substantive Action claim note
A claim note with no meaningful action is labeled as a Routine Activity note
Comparing claim handlers' SARA metrics provides dynamic insight into claim handler proficiency
Access without Implementation
ClaimMeasure operates in an independent environment and is fully complementary to all claim systems
Compare it to the way numbers are exported from systems and loaded into a spreadsheet for analysis. In the same way, sentences are exported, processed and loaded into ClaimMeasure
Results are available without systems implementation
ClaimMeasure - The Old vs The New
ClaimMeasure: A Paradigm Shift in Claim Audits
- ClaimMeasure is a tool for objectively measuring claim activities and claim handler performance
- SDRefinery AI reads and interprets every sentence written in ever claim note in every claim file
- Operational metrics are created to score both handlers and claims against the norms for any given population of claims
Claim Audits - The Old Way
Claim audits have been around since 1347!
The conventional process
- Select a sample of claim files
- Multiple people (with varying levels of experience) read and review the claim files
- Results from individual reviewers are aggregated through various means to form a conclusion
- The overall results are presented to management
- Management and reviewers argue about whether the sample was representative of the population
Technology - The New Way
Using SDRefinery’s AI creates enormous advantages
- Every sentence of every claim file is read
- Every claim file is read consistently
- The aggregate results for the population are created without bias
- Issues, problems and opportunities are identified for the entire population of claims
- Strengths and weakness of individual claim handlers are quickly identified
Which ClaimMeasure is Right for You?
ClaimMeasure Workers Comp is a jointly developed and owned product
of SDRefinery AI and Milliman