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Applying automated systems to claims. Companies should strategically apply any predictive models, warning flags and business rules to claims. (Photo: Shutterstock)

Workers’ compensation insurers across the country are leveraging data analytics, medical expertise and root cause analysis (RCA) to implement innovative ways to identify the right claim, using the right resource at the right time. The success of these efforts can vary drastically, from predictive models that fail to deliver as expected, all the way to data-inspired processes that significantly reduce costs and are built into claims protocols.

Here are some thoughts on avoiding false positives and a look at how workers’ compensation insurers can leverage data to help prevent adverse developments, often referred to as “jumper” or “developmental” claims. When used successfully, policyholders benefit from lower insurance premiums while their employees receive better and more timely care after an accident, helping to avoid unnecessary surgeries, treatment delays and excessive prescriptions.

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