Canadian Underwriter
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Member Benefit: Online Claims Management


September 30, 2010   by Marcel Arsenault


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Internet-enabled technologies are driving new efficiencies and possibilities in every business sector. Claims management is not excluded from this trend; in fact, these new technologies are an ideal fit for a 24/7 industry that largely operates with a workforce on the road. Widespread adoption of online claims processing is inevitable. If long-term business viability is in the plans, a business will need to consider the competitive impact of increased efficiency, accessibility and compatibility offered by Internet-enabled claims management.

The Canadian Independent Adjusters’ Association (CIAA) has recognized this and has responded by entering into a partnership with Nova Scotia-based KLJ Computer Solutions (KLJ). Together they aim to offer CIAA members simply acquired technology that will support members’ need to succeed in a highly competitive market. The strategic partnership, engineered by the CIAA executive, provides member firms of any size with an opportunity to participate in this new affinity program at an affordable cost. This technology is the online claims management system, Venue. Details of the affinity program are available on the CIAA’s website ( http://ciaa-adjusters.ca).

Value to clients

1. Timeliness. In an occupation where so many daily activities are tied to deadlines, timeliness is everything. Online claims management systems respond to this need by allowing users to configure custom diaries and email alerts for deadlines associated with activities, such as:

• reporting file progress to clients and regulatory bodies;

• generating internal progress reports and financial reports;

• interim billing;

• first contacts;

• pending expiration dates on policies;

• limitation periods for responding to legal documents; and

• submitting time sensitive claim documents like a proof of loss.

It is increasingly important that information be accessible and deliverable in real-time. KLJ has addressed this issue by incorporating automation and user-configurable alerts into its Venue Claims Management System. These alerts can be sent by email to multiple parties simultaneously or viewed in easy-to-follow electronic reports that can be printed and shared. This can be done from anywhere, anytime.

2. Accuracy. With information accuracy being so crucial to claims handling organizations and their clients, electronic claims management systems offer a high level of precision. Powerful time and expense tracking management, client account details, billing rate management and other meticulous data tracking systems must be in place to accurately process the data, resulting in predictable service to clients.

3. Accountability. Insurers look for accountability from their claims handlers in everything they do. Likewise, users of claims management systems look for accountability from their vendors in everything their claims management system does. Some of the features that allow claims handlers to uphold the highest standard of accountability to their clients include time and expense tracking, document management, diary management, workflow, account instruction, appointment/calendars, task managers and a comprehensive client billing system. Integral to the service is responsive, reliable backup support. Online claims management vendors must deliver reliable, effective and, most importantly, responsive customer support. In the online world, vendors have custody of adjusting firms’ management systems and data. Access to predictable service is a business imperative. With that in mind, vendors also have the expertise and infrastructure to best maintain those systems. The burden of maintaining computer hardware and software infrastructure in-house is most often untenable, and certainly unreliable if not supported by dedicated IT staff.

4. Accessibility and security. Claims operations are increasingly dealing with their clients seeking online access to their files. There is also an increasing demand for the ability to accommodate a mobile workforce. Users are able to access their files anywhere there is an Internet connec- tion, made possible through rigorous assigning of roles that limits access only to parts of the database for which they are authorized. Most jurisdictions require that businesses keep their clients’ data secure in accordance with applicable privacy laws. Venue has a comprehensive security subsystem that manages access rights based on policies established by the claims organization.

5. Flexibility. Every claims organization has unique procedures driven by clients or that support a competitive advantage in the market. This requires a high degree of flexibility in setting up a claims management system, especially in relation to specific workflow, documentation, communications and billing. Venue offers configurable tools like the event or action manager, diaries, notes and document management that can be customized to comply with the needs of your client.

For business value

6. Efficiency. In an industry where there is more work than time, a claims management system with effective tools and appropriate automation can help you plough through your tasks more quickly, more accurately and on-time. A well-designed claims management system will eliminate the need for double entry in different areas of a file, or whenever a form or letter associated with a file must be generated. It will also centralize all aspects of the business operations such as job assignment, tracking, billing, payments, etc.

7. Performance monitoring. Part of running a successful business requires measuring and monitoring the performance of the most valuable resource — staff. The claims management system represents a repository of performance data that will help keep tabs on key indicators pertaining to claims handling (executing diary activities, closing files, interim billing, meeting billed hours expectations, etc.). This information is invaluable to enable better control of the workforce, problems can be seen and prevented before clients are affected. The result is higher quality of service, which will translate into more assignments.

8. Document preparation and management. One thing that there is no shortage of in the claims management industry is forms, letters, reports and invoices. Paperwork is a necessary evil. An electronic claims management system will automate document preparation and management by merging data from a file directly into a claim-related form, letter, invoice or report, saving the time of duplicating that data in the document. Effective claims management systems will also be able to store documents electronically and conveniently in relation to their associated files. Various formats of documents can be stored (photographs, text, video, PDF, spreadsheet, etc.). With many offices aiming to become paperless, being able to generate forms and send them electronically is a huge benefit. In Venue, emails, attachments and documents are saved with directly associated files at the click of a button.

9. Business intelligence. While it is not necessary for a claims management operation to have a secret spy division, intelligence gathering is an important activity if long-term viability is in the plans. A well-built, consistent and comprehensive data set that contains virtually all data associated with a business is a goldmine. A claims management system will be able to generate comprehensive reports with this data so that owners and management can get a better understanding of their business, identify opportunities and detect deficiencies that need to be addressed quickly.

10. Profitability. At the end of the day, in order for an online claims management system to add value to an organization, it must provide cost savings through efficiencies in administration, technology avoided, reduced capital expenditures, and higher r
evenue potential. Greg Merrithew, owner of Arctic West, reports that Venue has increased his operation’s efficiency by 25 per cent. In fact, Merrithew is so confident in Venue, that during the CIAA’s recent Annual Conference, he sat down at KLJ’s booth and started demonstrating Venue to other CIAA members. CIAA and KLJ hope to bring this type of efficiency and increased profitability to all of CIAA members.

Venue offers independent adjusting firms a competitive advantage by enhancing current business practices through streamlining tasks and using automation. Venue restructures processes in a way that effectively reduces man-hours and saves network resources by eliminating data redundancy. Users of Venue can interact and check the status of a claim, a diary, invoice or task from any given part of the value chain, and they can do it from anywhere there is an Internet connection. All of this makes a strategic partnership between KLJ Computer Solutions and the CIAA a great addition to the affinity programs available to CIAA members.

Marcel Arsenault is in charge of sales and marketing at KLJ Computer Solutions Inc.