ClaimIQ has introduced a component for its claim software.SubroIQ is intended to provide adjusters and recovery specialistswith information and analysis for identifying subrogationopportunities.

For many insurance companies, the money paid to settle claimstypically is the largest item on the balance sheet, comprisingroughly 60 to 70 percent of net premiums written. According to theNational Association of Subrogation Professionals, many of thesecosts can be recovered from liable third parties throughsubrogation, and automobile carriers are missing about 40 percentof the subrogation opportunities in their book of business.

“By better managing the subrogation process, claim organizationscan be measured not by the resources they consume, but by theprofit they create,” said Tom Baird, ClaimIQ's president and CEO.“SubroIQ gives adjusters and recovery specialists the tools,information and predictive analysis they need to help increase therate of subrogation claim identification and recovery.”

SubroIQ offers adjusters recommendations with descriptions ofthe reasoning behind them. The program also integrates simply withexisting systems.

For more information, contact the company at 415-498-2400,www.claimiq.com.

Sedgwick Cuts Claims Processing Time

Based in Nashville, Tenn., Sedgwick CMS (Claims ManagementServices) is a third-party administrator handling workers'compensation, disability claims, and some general and autoliability claims. It has about 4,000 employees and 50-some offices,not counting the employees on site at customer offices.

Sedgwick wanted to create a paperless workers' compensationclaims processing system that would improve efficiency,consistency, and quality. The company decided to do a pilot testwith MedRisk's CLAIMExpert service in a small office it has in DesMoines, Iowa. The results were met with approval, and Sedgwick nowplans to convert all its operations by the end of 2006.

Efficiency – Sedgwick has professionalexaminers who analyze and investigate claims, and their time wasbeing eaten up by administrative, routine duties. The TPA wanted totake the administrative function off their professionals' backs andgive them information when they needed it, but only the specificinformation they wanted. CLAIMExpert's automatic electronic routingaccomplishes just this. In the past, a case manager might receive adocument that only the adjuster needed, and had to spend timeresending it to the correct person.

Sedgwick also wanted to increase claim processing speed, andeliminating paper was a major first step. In the past, people hadto open envelopes, read documents, determine where they should go,and send them not only to internal personnel, but also to one ormore vendor partners. Often, that involved making copies thenmailing or using overnight services to send them to external vendorpartners. Time delays are big problems in workers' comp whereindemnity payments come into play because companies can bepenalized for failing to act within a given time frame.

With CLAIMExpert, the electronic document moves through a seriesof questions. If information is missing, the system automaticallyreturns the invoice to the provider and requests the missingdata.

The service can automatically approve straight-forward invoicesand weed out non-compensable invoices, too. If the document meetsthe business rules test, it can be processed without going througha human.

Consistency and Quality — The business rules built intoCLAIMExpert always use the same criteria to evaluate an invoice orother documents unlike humans, who may judge similar claimsituations differently.

One immediate time and cost-saver is taking the mail room andfile room out of all the Sedgwick's offices. Paper (and electronic)mail goes to MedRisk, who handles the scanning, indexing, etc.(Eventually losing the mail and file rooms will mean leasing lessspace and reduce FTEs). Plus, they have to keep documents for 10-20years sometimes and have a warehouse, but it would take a lot oftime to retrieve a document. Now, any security-approved user can goonline and look at documents in the claims processed throughCLAIMExpert.