How Tech Can Help Case Managers in Claims Management

Lately, with all the nervous chatter about AI and technology taking over the world – and specifically, jobs in the insurance industry – let’s pause and note two basic points that are both true:  

  • Technological applications are fantastic at automation, and if programmed well, they are capable of mimicking human interactions. 
  • Technology cannot replace the high-touch experience. That is, it cannot replace the care and empathy demonstrated by a case manager who is helping an employee solve a problem.  

Top 3 Areas Where Case Managers Excel

When employees are experiencing a crisis in the absence/leave arena, they want to interact with an actual human being. If you are a case manager or responsible for the case management function at your company, you know that case managers:  

  1. Shine at handling complex employee issues. When employees are worried about leave, talking to an automated system or responding to a chatbot is the last thing they want to do. In fact, technology can make the issue worse, because employees will perceive the company is treating them like a file instead of a human who needs personalized attention. Case managers who listen to employees’ concerns and help resolve their issues are the not-so-secret sauce to a company’s positive reputation and lasting success.
  2. Skillfully navigate the health care universe. From conversing with medical professionals to reviewing documentation, case managers are a critical resource for employees, especially those facing terminal illness or chronic conditions.
  3. Deliver claims denials with compassion. No one wants to hear that their claim is denied, but having a conversation with an empathetic case manager is far preferable than challenging a chatbot. Skilled case managers provide employees with the reasons behind the denial and suggest alternative solutions where possible.

Technology Gives Case Managers What They Need Most: Time

Time is the most important asset a case manager has. A typical case manager may have 35-40 employees in their portfolio. That means the case manager can only allot one hour each week to each client. For difficult claims, one hour is simply not enough time to provide exceptional service.  

Companies that value a high-touch experience for their customers’ employees will harness technology to automate repetitive tasks, including:  

  • Leave and benefit determination: Advanced leave software systems equipped with rules engines can swiftly assess an employee’s eligibility for various leaves and benefits. This immediate information enables case managers to respond promptly and accurately to employee inquiries. 
  • Eligibility calculations: With the right data inputs, technology can quickly work out an employee’s eligibility for specific plans. 
  • Leave balance and payment calculations: As leave laws increase and change, addressing them simultaneously becomes even more complex. , Automated calculations ensure precision in leave balances and payments, mitigating the risk of human error. 
  • Fast-track simple case approvals: Technology can efficiently make approval determinations for uncomplicated cases, such as standard medical procedures with established guidelines. Think appendectomies, knee surgeries, etc. 
  • Automated reminders: Routine reminders about paperwork deadlines and return-to-work expectations can be automated, saving case managers valuable time.

Human Touch and Technology Define the Future of Absence Management

By implementing technology to streamline processes and increase efficiency, companies allow case managers to provide personalized support to employees when they are seeking guidance during challenging life events. The automation of routine tasks ensures that case managers can devote their undivided attention to what truly matters – the employees’ well-being and peace of mind during disability and essential leaves of absence. 

Want to learn more? Watch our webinar, “Making the Human Touch Matter: Automation in Claims.” 

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