Automation to build trust and improve WC claim outcomes

Barnes-Cook, Meredith (crop)

Written by - Meredith Barnes-Cook, Global Head of Insurance at Ushur

This blog post was originally published in the July 2nd, 2021 edition of P&C 360

Insurance is a service industry, and the customer’s claim experience can drive their decision to renew or change carriers, including for workers’ compensation. The customer is entrusting their insurance carrier to both take care of their injured employee and protect their company from financial harm. The challenge is that each worker’s compensation claim is both unique and multi-dimensional. A claims adjuster can sometimes feel like they are expected to be a juggler or even a magician to always keep all the goals in view.

Service is the foundation of the claim process. Insurance carriers have core services to provide a consistent brand experience to all. But some customers may purchase additional special services, tailored to their unique claims handling needs. When a colleague recently asked me what’s most important to successfully manage a WC claim, some self-reflection was in order since the answer “Everything!” wasn’t all that helpful.

Compliance is both paramount and complicated when it comes to WC claims. Workers’ compensation in the United States is governed by state-specific regulations that vary across a myriad of dimensions, from the timing of the first indemnity benefit payment to injured worker communication. I won’t even try to describe the variability and quantity of WC forms each different state requires.

Expense management is important for WC claims handling. Back in my day, we focused more on the indemnity expense versus medical spending, as we worked tirelessly to guide the injured employee to return to work. Medical expenses are now front and center with cost increases outpacing inflation. Litigation also contributes to WC claim expenses and does so not only when a dispute arises. When an injured worker obtains legal representation, the WC claims adjuster is barred from any direct communication and can no longer work with them on their return-to-work plan. Litigated WC claims cost 4 times more and can take twice as long to resolve with almost triple the number of lost time days.


How does email routing automation improve customer service?

Customers expect to manage 85% of their relationships with business without interacting with a human.

- Gartner Customer 360 Summit

66% of customers will try a company's self-service channels before engaging with an agent - regardless of age

- Microsoft Dynamics 365: State of global customer service report


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About Ushur

Ushur delivers the world’s first AI-powered Customer Experience Automation™ platform that has been purpose-built, from the ground up, to intelligently automate entire customer journeys, end to end. Designed to deliver delightful, hyper-personalized customer experiences through rapid issue resolution and unified, omnichannel engagement, Ushur is the first-of-its-kind system of intelligence. It combines Conversational Automation and Knowledge Work Automation in a No-Code, Cloud-native, SaaS platform to digitally transform every step of the complete enterprise customer experience – from Micro-engagements™ to entire customer journeys.

Backed by leading investors including Third Point Ventures, 8VC, Pentland Ventures, Aflac Ventures and Iron Pillar, Ushur’s Customer Experience Automation™ solutions are currently in production at some of the leading insurance providers across the globe including Irish Life, Unum, Aetna, Cigna and Tower Insurance.

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