How ACM creates a streamlined claims process to close claims faster & easier

In an earlier blogpost we talked in broad brush strokes about the benefits of ACM’s proprietary claims platform. Today we’re diving deeper into the benefits of our claims system and how it provides a streamlined claims process.

How does ACM’s proprietary claim platform differentiate us from other third-party claims service providers? First, the system is completely integrated with all our ancillary services. Its sophisticated role-based technology helps us capture data for performance metrics based off any field in the claims platform. Second, it allows us to easily create customized reports on the fly. ACM further uses this role-based technology to notify different parties at various intervals about transactions that occur in the system. This technology not only provides a streamlined claims process but is also a safeguard to circumvent human error.

Technological oversight

ACM’s claims system captures all client special handling requirements while providing clients with statistics on a global basis, down to a specific retail location.

Timely assignment of claims

ACM offers 24/7 reporting of claims via phone, fax or web. New claims are entered into the system and assigned a sequential claim number specific to each client. Each claim is triaged by the manager who assigns the loss to a claim adjuster with the requisite expertise. Within twenty-four hours of receipt of the claim, the claims adjuster will contact all relevant parties – client representative, the claimant (if not represented by counsel) and any witnesses. Diary follow-up with all parties is mandatory until all contacts have been completed ensuring a thorough investigation.

Diary system

ACM’s claims platform produces a combination of electronic generated and manual diaries based on each client’s specific service instructions. The ACM claims adjuster, supervisor and/or manager can supplement the electronic diary system with a manual diary to address specific claim requirements.

Automated processes

ACM internal procedures provide automated functions including claim import, claim assignment, alerts, reports and letters for various notices through the life of the claim. We can customize these functions to meet our client’s unique needs.

Benefit calculations

When a WC weekly benefits is entered, our software calculates the rate by jurisdiction and the number of days for benefit payments. An auto payment function allows ACM to issue biweekly payments for a specified duration.

System generated checks

Claims personnel work exclusively within the platform and are not involved in the issuance of checks. A user entering a payment cannot print a check. All payments entered into ACM’s system must be approved by a supervisor or manager before being processed. The issuance of checks is handled by the ACM Accounting Department. A user who can print a check does not have the ability to enter a payment. All checks centrally print in the Carlsbad office’s locked check printing room. Checks are mailed out directly by the ACM Claims Accounting staff. All check information is easy to view in the system to include when the check has cleared and a copy (front and back) of the check.

Claim file notes

ACM personnel working a claim document their activity into the system claim file notes. The notepad fields are completely customizable. Automation allows our team members to link notes to create a subsequent action. For instance: The adjuster can insert a notepad which can then trigger an email/notification/diary/referral to a colleague or an external party.

System generated diaries and correspondence

ACM’s claims platform produces a combination of electronic generated and manual diaries based on each client’s specific service instructions. All correspondence in the system can be generated manually or can be customized to auto-fill information from the claim database directly into pre-formatted letters specific to each client’s needs.

System generated reserving

The system’s available automated reserving function allows our clients to establish a standard opening reserve for a particular claim type, such as a Medical Only WC reserve, of $700 upon inception of the claim.

Attachments

All mail is imported as an attachment into the platform, with each document categorized and titled for consistency. Based on word recognition software, the contents of the attachments can trigger automated actions. For instance, when a wage statement document is received and attached to the claim file, the system triggers an alert at 10 days if there is no evidence that a note has been inserted that calculates the new wages.

Data feeds

ACM can provide both import/export data feeds of transactions and claim details at any interval requested for any field we capture in our system. For instance, policy data could be imported daily, file attachment could be imported weekly, and notes monthly. We can accommodate feeds in a variety of ways including FTP, Web Services and API.

Everything is customizable in this streamlined claims process.

Additionally, ACM can import a client’s historical data feeds (data gathered prior to contracting with ACM).

Performance scorecard

Adjuster performance is measured in a monthly scorecard distributed to each adjuster and manager. The performance scorecard and metrics vary by client. ACM’s standard dashboard is available in our proprietary system to every user. It can be run by each adjuster to self-check their performance at any given moment.

From 24/7 claims reporting abilities, to an adjuster call within 24 hours, to notes, data and report sharing for all involved in the claim, whether it’s ACM’s team or yours, ACM’s goal is to create a streamlined claims process, helping you close claims more quickly and efficiently.