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Best Practices/Case
Studies
Innovation First Notice could simply pick up the phone, take down the
caller’s information, and send it over to you. But we
don’t. We know that for our services to yield you the
greatest return, we have to do a lot more. Like integrate
with your systems. Intelligently path claims to different
units in your organization. Escalate or refer, on the spot.
And many more actions we refer to as “best practices.”
We’ve collected just a sample of these practices below
and included details of how our customers are putting them
to use right now. Above, you can find more detailed case studies,
highlighting clients’ special programs and the returns
they’re realizing through Innovation First Notice.
Account Hierarchies
Large self-insureds and third-party administrators (TPAs)
with multiple clients need flexible claim/incident intake
services to meet the unique reporting needs of various business
units and organizational levels. Through ClaimCapture’s
Designer tool, Innovation First Notice can create a virtually unlimited
number of loss reporting processes to capture and distribute
first notice of loss (FNOL) data according to the insured’s
division, subsidiary, office, department or however else your
organization or accounts are segmented. One First Notice client
has over 50,000 accounts representing over 190,000 risk locations,
each with its own unique corporate structure that includes
our customization at up to eight levels of hierarchy. We receive
a nightly feed from this client that updates contact information,
changes branch assignments and adds or deletes risk locations.
It’s all part of our standard service.
Adjuster Assignment
Claims adjusters lie at the heart of the claims management
process. Few claims can be successfully settled without their
intervention. Innovation First Notice understands this and realizes that
the sooner an adjuster receives a claim, the sooner that claim
can be closed. That’s why we assign claims to adjusters
during first notice of loss. One of our clients leverages
ClaimCapture’s rules-based engine and lets the loss
location, loss type, adjuster availability—sent to First
Notice on a daily basis—and whether or not an injury
occurred drive which adjuster is assigned. From this process,
we select and electronically notify the right
type of adjuster (fast track or standard) at the appropriate
branch office so that claims processing begins immediately.
Claim Number Assignment
A claim number is a critical piece of information for both
a policyholder and an insurance carrier. It’s the one
constant that reassures the insured that the claim is being
processed and simultaneously lets adjusters track all activities.
For this reason, best-practices clients have Innovation First Notice
assign claim numbers at first report according to their business
rules. Our claim assignment process can be as sophisticated
as your organization is. For one client, we assign a different
set of claim numbers for each of its 21 branch offices. While
the first part of the claim number reflects the branch office
code and year of claim, a numeric counter that varies from
branch to branch generates the second part. Thanks to this
procedure, claims are handled more quickly and settled sooner.
Custom Call Flows
Every insurance carrier, TPA or self-insured relies on receiving
specific pieces of information in order to efficiently process
a claim. Yet none of these organizations wants to overburden
the party responsible for submitting a claim, whether it be
a policyholder, risk manager or agent, by asking too many
questions during the reporting process. Innovation First Notice’s
intake platform, ClaimCapture, strikes the right balance every
time. Its rules-based engine dynamically generates questions
based on policy/coverage information we store and the answers
to previously asked questions. The result is an extremely
accurate and efficient intake experience. One client has six
main call flows, each driven by ten different types of coverage
and each with unique call scripting. First Notice has a library
of over 2,200 questions (“building blocks,” if
you will) from which we can design custom, dynamically generated
call flows, plus we create new questions all the time.
Employee Eligibility
Reporting a worker’s compensation claim from within
a large organization can be a complex process. Managers who
phone in these claims know the specifics of the injury, but
often don’t have at their fingertips details like job
codes or location codes. Innovation First Notice simplifies the reporting
process by accessing employee eligibility data received directly
from human resource information systems. Several clients send
us employee data feeds so that by searching on employee name,
social security number or employee number, we can retrieve
and pre-fill important details about the employee, the employer
and the employment status of the claimant. This enables worker’s
compensation claims to be filed quickly, accurately and completely
the first time.
Escalations
Worried that if you outsource you won’t receive sensitive
information in time? Not to fear with Innovation First Notice.
Although we typically distribute call information through
EDI, email or fax, you can design your program so that the
incidents or occurrences that are priorities for you become
priorities for us. Our rules-based engine removes all subjectivity
and allows you to pre-determine what you’d like us to
escalate. Our call center supervisors immediately respond
by following your instructions and personally notifying you
of special events 24 hours a day, 7 days a week. We’ll
try your home phone, your cell phone or your pager—or
we’ll try them all. The result is that no time is lost
between the moment we learn about an incident and the time
you hear about it.
Intelligent Routings
It’s one thing to accurately capture the right data
when a loss is reported. But if this information doesn’t
reach the right recipient at the right time, its value is
severely diminished. Innovation First Notice understands this and lets
clients create customized routing plans to send FNOL data
via any combination of EDI, XML, fax, email and U.S. mail
to any mix of destinations, including risk managers, adjusters,
agents, branch offices, insureds, claims management systems,
DRP participants and more. Clients also leverage our ability
to trigger transmissions based on their business rules so
that destinations only receive FNOL data if the claim meets
specified criteria. All this is can be easily modified to
meet the dynamic needs of clients.
Policy Loads
Having up-to-date policy data on-hand during a first report
is key to Innovation First Notice’s ability to generate high
quality loss reports. Whether your company uses an industry-leading
policy maintenance system or a home-grown legacy mainframe,
First Notice can connect with you. To build more basic
policy
loads, we rely on ACORD AL3, ACORD XML and ASCII standards.
But we’re also quite adept at developing customized
load programs to interface with policy system extracts
of
any kind. And to keep your data fresh, you can send us adds/changes/deletes
as often as you’d like. Clients send us their updates,
some as often as every fifteen minutes, via FTP, IVANS,
email
or SNA/RJE. Each night we receive over 1.2 GB of new data.
Reports
Every business relies accurate, up-to-the-minute data to
make informed decisions. But not all business focus on the
same metrics. ClaimCapture’s flexible reporting module
was designed with this in mind. It enables clients to create,
design and configure management reports in ways that facilitate
action. One client in particular harnessed this flexibility,
requesting reports that categorize and monitor distinct types
of events ranging from restroom incidents and product defects
to robberies and tooth-chipping injuries. Innovation First Notice responded
with a series of custom reports, disseminated on a regular
basis, that have since become critical to our client’s
ongoing operations.
Vendor Referrals
When callers report claims, they often need help returning
their damaged car or property to pre-loss condition. Or they
may be trying to locate other necessary services like doctors,
rental cars or towing. Innovation First Notice performs vendor referrals
to help carriers manage their loss expenses and to connect
callers with services in times of need. Each client has a
unique program: the business rules that trigger referrals;
the scripting we use to introduce referrals; the vendors we
offer (from your proprietary list or from First Notice’s
network); and the order in which we offer the vendors. Because
we offer vendor referrals at the most opportune time—when
a claim is first reported—we’ve had tremendous
success helping carriers control costs while delighting policyholders.
One client, in fact, has Innovation First Notice refer its policyholders
to four types of networks: car rental; auto body repair; general
contracting repair; and emergency water mitigation.
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