An automatically better approach

NEXT-GENERATION SERVICE: The Beacon Mutual claims and information technology teams have created a tool that helps resolves medical claims faster and more accurately, largely by bypassing the human element. / PBN PHOTO/RUPERT WHITELEY
NEXT-GENERATION SERVICE: The Beacon Mutual claims and information technology teams have created a tool that helps resolves medical claims faster and more accurately, largely by bypassing the human element. / PBN PHOTO/RUPERT WHITELEY

PROFESSIONAL

SERVICES

Innovation is often the result of one theory being creatively applied as a solution to another kind of problem.

Such is the case at Beacon Mutual Insurance Co. in Warwick, which specializes in workers’ compensation, with its new medical-only auto-adjudication claims system.

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Those injured on the job that have medical-only claims – in other words, they are injured and need treatment but don’t require time off from work to heal – can file claims and receive payment with a rules-based adjusting system online that requires no human touch.

These kinds of instances, which make up 70 percent of Beacon’s claims business, are cut and dry, said Tim Benson, vice president of claims.

“Where our only obligation is to pay medical bills, the claim is reported, paid automatically, automatically reserved, auto-paid electronically and auto closed,” Benson said, adding that almost 70 percent of Beacon’s medical-only claims are now paid using this online process.

“This system was inspired by a technical, creative solution to a problem we faced internally,” said Brian J. Spero, Beacon’s chief operating officer and general counsel, with medical-only claims high in volume but low in risk and volatility. “It’s a novel approach to claims adjusting.”

This concept was previously used only on the underwriting side, not on the claims side of insurance, according to Beacon, which employs about 175 people.

The two agents who previously handled these medical-only claims calls were put in another area of the company. For those customers who still prefer speaking with a human, they can certainly do so, said Spero.

Contributing to the system’s win-win success is the fact that Vice President of Information Systems Rajani Mahadevan and her team were able to get the system up and running in nine months.

And the industry has taken notice. The Insurance Accounting & Systems and Ward Group gave Beacon Mutual Insurance a Technology Innovation Award.

“It wouldn’t surprise me if other [agencies] followed suit,” said Benson of the new claims process. •

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