Settlement Adjudication Triaging FNOL / FROI
Claims Duration
Case / Loss Reserving Subrogation
Litigation Propensity
Claims Severity / Jumper Claims
Optimizing Claims
In this increasingly digital and complex world, claims departments can no longer rely simply
on individual experience and professional judgment. Today, tools such as AI and predictive
analytics, to augment and accelerate business decision-making have become essential. In
fact, a recent Workers' Compensation (WC) survey by Mitchell International, found that 70%
of participants believe that either telemedicine or predictive analytics will have the biggest
impact on the WC industry in the next 5 to 10 years.
Predictive claims processing or claims analytics is the process to analyze both structured
and unstructured data at all stages in the claims cycle to make the right decision, at the
right time for the right party. Rather than analyzing one case at a time – based on only the
current information available – analytics gives you added perspective by allowing you to view
this one claim "in context" – by comparing it with previous claims settlements in your
database.
Simply building claims predictive models is not enough. The real return on investment
comes when the models are fully embedded into the claims management solutions to
augment their claims professional's knowledge with real-time insights to make better
informed business decisions.
F i g u r e 1 – F i v e P r e d i c t i v e M o d e l s t o A u g m e n t t h e C l a i m s L i f e c y c l e
OPTIMIZING CLAIMS | 3
