The Successful Disability Claims Audit

Devery Johnson, Senior Business Consultant, FINEOS

While every claims professional is diligent, the word “audit” has a way of instilling fear in the hearts of men!  But it needn’t, and having tools available to assist in achieving a successful audit is worth its weight in gold!  The following are some areas where, despite my best abilities, and those of my staff, would sometimes be found in an audit, and now FINEOS has created some powerful devices to help ensure that these areas would no longer be a concern.

Early response to the claim notification

While all claims personnel make every effort to respond to that first notification of a claim, within the established guidelines, sometimes they do get missed. Even more importantly, having the documentation to support that you have responded in a timely manner is paramount.

How Can FINEOS Help?

We have developed an automatic process, which, upon creation of the claim, automatically sends out the notification response letter. This relieves the claims professional of the task, and ensures that every notification is handled as required. The timeframe and content can be configured to meet the needs of each individual company.

COLA increases

Many policies, group and individual, have provisions that necessitate increasing the benefit on an annual basis. Previously, claims professionals would develop their own tools to remind them to manually adjust the disability benefit to account for this; however, being life, occasionally these may be missed, resulting in potential penalties.

How Can FINEOS Help?

The application has built-in COLA functionality, which allows companies to establish COLA parameters, and once set, the application automatically applies the increase, thus eliminating the need for a claim professional to set those manual reminders.

Change of Definition

Most companies that deal with a change of definition have rules in place regarding activities which should take place prior to the change. These vary from company to company, but there is consistency within an organization. Largely, this is left to the claim professional to ensure that these activities are set in motion.

How Can FINEOS Help?

By establishing the processes required by an organization, the appropriate tasks will be automatically initiated, and if by chance these are overlooked by the Claim Owner, their supervisor can be alerted to safeguard that the appropriate actions have been launched within the established timeframes.

While we’re all human, and as such, imperfect creatures, having some automation behind you to help alleviate those imperfections is never a bad thing!

You may also be interested in