The workers’ compensation industry has been striving to streamline and automate the claims process for years. Imagine a day when a first report of injury can be dictated into a mobile phone, the audio file sent to an insurance company. The claim’s file could be auto-populated with data from that file. Missing information could trigger a text to the injured worker’s phone, so additional data could be collected. When the medical bill is submitted from the treating physician’s office, it could auto-populate additional screens in the system. Artificial intelligence (AI) would recognize it’s a medical-only claim, pay the bill, and close the claim—all of this occurring with the straight-through processing the industry has longed for.
One of the things that’s holding us back from this picture of automation is the fact that many organizations are clinging to outdated technology. Legacy claims systems can often be 10 years or older. These systems are built on archaic infrastructure, while today’s latest platforms have the potential to get us to that futuristic scenario above.
What’s Code Got to Do with Claims?
Organizations with legacy claims systems are frozen in time. Their systems are difficult to modify because they’ve been developed with rigid programming languages. To make changes, programmers or IT experts are needed to develop code. And when significant changes are made, it can be challenging for organizations to then upgrade to newer versions of the software. After a couple years, they can easily get behind on releases.
Since workers’ comp is highly regulated, organizations face new mandates, which claims staff have to adhere to. Regulations vary by jurisdiction, and national organizations have to manage claims differently in the various states they operate in.
As we’ve seen with COVID-19, speed and agility were required to adapt. Organizations quickly had to switch to remote work, which required changes to be made in a matter of days. In these types of situations, organizations can’t wait for busy IT professionals, nor can they endure the time it takes to code a lengthy project.
Of course, change is nothing new. But the pace of change has accelerated, and organizations need to be equipped with the right technology to keep pace. They need faster access to data, and with a shortage of experienced claims professionals, they also want to leverage intelligent automation to handle routine tasks and guide junior staff through complicated processes.
Low-Code / No-Code Platforms: A New & Growing Phenomena
Today, newer platforms make it possible to modify claims systems on the fly—with little to no code—hence, their moniker: low-code / no-code platforms. They provide carriers and claims organizations with tremendous potential to have the ability to turn on a dime.
That’s the key reason low-code / no-code platforms are growing in popularity. Gartner (an IT analyst firm) predicts that by 2024, low-code application development will be responsible for more than 65% of application development activity, and that 75% of enterprises will be using low-code development tools.
Low-code / no-code development is done on cloud platforms that provide users with a graphical user interface and “drag and drop” capabilities to achieve configuration. In essence, it’s a “clicks not code” approach.
The Rise of Citizen Developers
A claims system built on a low-code / no-code platform is delivered with a significant amount of business logic built-in. An off-the-shelf version offers robust functionality that can be used out of the box. Security, likewise, is embedded in the platform. At the same time, the basic interface and user environment is intuitive and easy to learn.
From there, modifying the system or adding new functionality is so easy that everyday business users can do it—with a little training. As a result, Gartner has forecast that these platforms are leading to the rise of “citizen developers.”
Instead of programming code, citizen developers could leverage their claims-handling experience to configure additional logic to drive processes, workflow, and AI. Putting power in the hands of business users means carriers and claims organizations can execute necessary system changes faster than ever before. This is because users can make modifications without having to rely on busy IT staff. Of course, these systems come equipped with guardrails and controls, so users can’t mess up the core solution, but they are empowered to configure other critical processes.
Using a low-code / no-code platform, citizen developers can configure these types of claims-handling capabilities without an IT assist:
- Screens & Fields. Low-code / no-code platforms are highly extensible. Claims professionals or system administrators, acting as citizen developers, can easily add new screens and data fields, or they can change field names or move fields around.
- Business Intelligence. In the past, when a claims department needed a different type of report, an IT expert would typically have to run a query. Now, low-code / no-code platforms provide native dashboards that are functional and interactive. Users can “point and click” to view active claims or loss reserves by location or job function. They can drill down to see all the records contributing to a trend in a chart or graph. And they can just as easily change the views on their dash.
- Smart Automation. Assigning a new claim to adjusters is a common task that would benefit from a “smart” assist. Whereas in the past, complex business rules had to be programmed, now AI can be applied to a “new claims” queue. When a new injury is reported, the claims system leverages AI to make an assignment recommendations based on current adjuster caseload as well as experience in handling that claim’s level of severity.
- There’s a Bot for That. One third-party administrator we spoke to said claims professionals were spending about 20% of their time responding to requests for information, such as checking on the status of an invoice payment. Now, users can quickly set up a chatbot to automate these types of time-consuming or labor-intensive processes. Then when claims adjusters receive similar emails or calls, they can direct vendors to that chatbot, so they can quickly look up the information on their own. This saves time. And similar bots and apps can be deployed to automate other administrative tasks.
- Easy Integration. Recently, leaders of another organization explained that they were using Twilio as a messaging tool across the company. As a result, it was important to integrate this tool with any new claims solution. The beauty of low-code / no-code platforms is they come with hundreds of predefined connectors to industry tools—whether it’s Twilio or Slack, Outlook or SAP. Not only that, but workflow can be defined and automated across the connected systems.
- Straight-through Processing Becomes a Reality. The industry has been talking about straight-through processing (STP) of claims for as long as I’ve been in claims. In the past, there might have been business rules that could be customized to automate certain processes, but low-code / no-code platforms will take us further along the STP journey. Business users can configure rules themselves, doing it faster and easier with the visual interface and “point and click” configuration. And they can also incorporate AI into these processes, so the system can learn, making processes even more streamlined in the future.
Crossing the Coding Chasm
Early adopters are embracing the benefits of low-code / no-code platforms. They see the potential to not only modernize claims but also make processes more adaptable to market and regulatory changes.
We’ve covered many of the advantages of these platforms, but chief among them is control. As we’ve discussed, claims professionals can rise up and become citizen developers. With some training, they’ll have the power to automate processes on their own, without relying on IT. They can define new ways of engaging with stakeholders. They can design screens, workflows, and chatbots. These capabilities will help them do their jobs more effectively and efficiently, but it also prepares the organization for the future. Knowledge from the most experienced claims adjusters can become embedded in intelligent processes for posterity. Finally, data analytics and AI can provide insights to further strengthen loss control. We’ve touched on that topic here, but we’ll delve further into it next week.
About Brian Mack
Brian Mack is the co-founder and CRO at Spear Technologies. He has more than 25 years of experience in insurance solutions and a track record of bringing innovation to the workers’ compensation and broader property and casualty market. He has helped many claims and insurance organizations meet their business objectives with a strategic approach to technology, often encompassing mobile capabilities, cloud hosting, business intelligence, and AI. He also strives to build strategic alliances with other industry-leading solution providers to offer a best-of-breed approach.
About Spear Technologies
Spear Technologies aims to provide property and casualty insurance companies with an enterprise claims management system for the future. Developed on the Microsoft Power Platform, SpearClaims delivers unparalleled control, speed, and results. By leveraging this top-rated low-code/now-code development platform, Spear Technologies empowers companies with the ability to easily and quickly configure and tailor SpearClaims to meet their unique needs. SpearClaims’ architecture provides the capabilities for using built-in AI and automation tools to extend capabilities for competitive differentiation and results.