Smarter Claim Processing

CGI Adjusters Inc. has now implemented SMART technology, which allows clients and vendors real-time access to claims data. Now, more than 100 CGI Adjusters offices across are connected to the portal and it is full steam ahead. What will this mean for clients and vendors?

MAKING THE SMART MOVE

The world is increasingly counting on electronic technology to assist in meeting demands for increased efficiency, customer service and higher productivity. The insurance industry is no different. In implementing SMART technology, CGI Adjusters Inc. intended to take advantage of some internal benefits of using the technology, as well as offering the benefits of the new technology to its clients.

Traditionally, clients gave independent adjusters assignments by means of phone, fax or email. Adjusters then submitted reports to keep the client up to date on activity as the claim progressed. The adjusters’ reports were usually couriered; more recently, they have been emailed. These means of sending the reports created certain inefficiencies. For example, there was always a lag between the time an adjuster did something and the time the client received a report about the adjuster’s activities. Also, there were additional costs associated with photocopying, faxing or couriering a report.

Today with SMART, CGI Adjusters Inc.’s clients can now get real-time updates on all claims activities 24 hours a day, 7 days a week. In addition to providing the timely sharing of information, SMART technology decreases the volume of phone activity, since more information can be retrieved without the necessity for phone calls. By reducing the amount of staff time and money spent on phoning, faxing, photocopying and courier activity, adjusters could focus instead on better service to the customer and a higher level of productivity.

WHO CAN VIEW CLAIMS ON SMART?

As discussed, CGI Adjuster Inc.’s clients can view real-time data and communicate with the parties involved in the claim. Vendors can also, in a limited way, access claim information. Such access only allows vendors to see information that is pertinent to them; they will not have total access to all activities that were performed on the file, so there is no concern about privacy violations. Vendors will be able to receive work assignments through SMART technology. They will be able to load their reports, pictures and estimates into the technology with a date- and time-stamped note that confirms when the activity was executed. As with the client, the vendor is also capable of sending messages to the file handler. The days of vendors and adjusters playing the frustrating phone tag are over.

CGI Adjuster Inc.’s accident benefits branch in Ontario has benefited immensely from the use of this vendor feature. The timeline for medicals reports is quite strict, as outlined in the legislation. Previously these documents would have to be faxed, photocopied and mailed out to the medical facility. Quite frequently, this would have been done multiple times during the life of a claim. Now, using the new technology, medical documents can be scanned into the SMART claim file. This allows the firm doing the medical to view the pertinent documents. This one-step referral process ensures the timely setting of appointments and reduces any delays.

Once the medical has been completed, the firm drops the medical report in SMART. This action is date- and time-stamped; it also sends a message to the adjuster that the report is in the file. Branch director Tammy Norn believes this communications tool significantly reduces the amount of time and money previously invested in the independent medical process, because it has limited the number of photocopies, faxes, couriers and administrative charges. In addition, the process saves time, which is important because of the legislative requirement for tight timelines.

The special accounts branch of CGIAI also reaps benefits from the technology change. This branch deals with many self-insured clients, who are constantly interacting with adjusters in the branch. These clients do not have a system of their own, but they are now able to view all activities through the SMART technology. In addition, these clients are documenting their authorization to settle a claim or giving instructions in the journal portion of the system. This process has greatly reduced the faxing, emailing and voicemail between the two parties. All activity in the claims process. The report is date- and time-stamped, so the branch manager can easily monitor activities and gauge the timeliness of responses.

Branch director Wendy Lebskin says her clients are enthused by the technology and find it very easy to use. She has found it a novel experience to audit a file in which an adjuster, risk manager and vendor have recorded all of their activities. Usually, the manager views the activities from one side of the process. Given the additional perspectives, auditing the file can be more effective in determining areas for improvement, because any bottlenecks or stumbling blocks can be more easily identified.

Another advantage CGIAI clients have recognized is the ability to enter the technology from anywhere the Internet can be accessed. For example, one risk manager with whom CGIAI works is out of his office for weeks at a time. He says he has enjoyed the opportunity to access the system from his hotel room and get real-time updates on all his files without being in his office. He can also communicate with the adjuster without having to leave a voicemail or play phone tag as he travels from city to city. He said he most appreciates this benefit upon his return to the office, where he no longer faces a backlog of information to review.

In addition to moving towards a totally electronic file, CGIAI is hoping that, through the use of SMART technology, adjusters will have to take fewer phone calls. This will make adjusters more efficient; it will also allow adjusters more time to take calls from the people who need the adjuster the most – the insured.

ADDITIONAL FEATURES

CGIAI wants to give adjusters the capability to input information and pictures into the system directly from the onsite location of a claim-related incident. This might be done, for example, through the use of the smart phone. In this scenario, an adjuster might be out of the office and receive an emergency claim. He or she could attend the scene, download any pictures and details, and immediately the client would have some information on the claim.

This kind of technology is Web-based, so it can integrate easily with our clients’ systems. It can also integrate with the systems of other valuable partners that can supply tools to assist in the claims handling process.

As CGIAI continues to use the new SMART technology, it will monitor results and evaluate its processes. The company will continue to enhance the technology, so more benefits can be recognized. The goal will always be a higher level of service and quality.