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Who Owns and Capitalizes on Your Claims Data?

When HR, Employee Benefit, or Risk Management leaders contract with insurance companies and third party claims administrators for coverage or claims management services, who owns and takes advantage of the data produced and generated by resulting claims from their workforce? Do leaders of employee benefits or risk managers ever consider this area in the contracting phase? Should they?

Ultimately, claims will be generated by an organization’s people – across life & health, disability, workers’ compensation, general and auto liability, etc. And, the leaders responsible for employee benefits and P&C/risk management, including CFO’s, will want to understand their claims costs and trends. So, the data is yours and the opportunities to use it are vast.

While it may seem that you are at the mercy of your insurer/TPA, you need not be. You should not have to depend solely on their reports, which could be biased for a variety of reasons. Independent assessment of your data can provide a cohesive and continuous source of reporting and analytics, especially when you opt to change insurers or TPAs. Existing report output can be continued, since data from your new insurer/TPA, while different, can be translated to coincide with previous data and current output. New reports from your data can be designed which highlight trends not previously realized. Seamless opportunities exist with business intelligence (BI) companies specializing in people data, which can provide this independent type of reporting.

Firms providing BI services not only provide an independent source for reporting, but also have capabilities that can integrate data from multiple insurers/TPAs on your behalf. Attempting to understand claims, cost and trends independently by vendor is like try to build a car with only tires or with only an engine. While the tires seem disconnected from the engine, and provide a completely different purpose, you won’t have a fully functioning car without connecting the various, seemingly disconnected pieces. In the same way, you won’t get a full picture of your organization’s claims experience until your data is integrated and analyzed together. So, it is imperative that the insurers/TPAs that you contract with make your data available for analysis upon your request.

The insights gained from understanding the true picture of your claims data will vary by company but some key insights will be similar. Are you aware of the characteristics associated with the employees incurring the majority of your claim costs across all benefits and have you adjusted your benefit plans accordingly? What percent of your users of FMLA ultimately migrate to long-term benefits such as workers’ compensation and long term disability? These types of trends and realities should be readily on your horizon so that you’re able to make cost saving decisions based on your claims data generated by your employees, with which you have unrestricted access.

The C-Suite correlates fiscal accountability of benefits with those responsible; HR, Employee Benefit and Risk Management leaders. That responsibility substantiates the leader’s ability to determine to whom and with whom their data can be shared and analyzed.

Management functions in HR and Finance want to access, manage and be able to analyze any claim data generated by their people. Consequently, as a ‘data governance’ policy the ownership and access to that detail data (protected for confidentiality, of course, and in compliance with HIPAA, GLB and any other Federal or State privacy acts) should be addressed in contracts with these providers and vendors. In this age of data and analytics, otherwise, how can leaders ever expect to better understand their own people data if vendors will not give you access to the data that “your” people generate?

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