The Art of Science: Balancing the Human Touch and Technology in the Claims Process

Insurance is a commodity that many people hope they never have to use, but it provides peace of mind when they really need it. Filing a claim for a disability leave or cash benefits due to an injury or illness needs to be as easy and empathetic as possible. That’s the experience employers want for their workers.

 

Ongoing advances in claims technology are bringing more speed and timely support to the process. Automation of certain routine tasks, like calculating length of time off work, payments and pay schedules, or requesting information from medical providers, means that an insurance company’s claims teams can spend more time with the person who filed the claim.

 

“The optimal claims experience is when humans and technology work together,” says Megan Holstein, head of absence management for Group Benefits at The Hartford. “That blend of automation, personalization and human interaction should be there throughout the employee’s journey.”

 

That journey often begins with a major life milestone – planned or unplanned - such as the birth of a child or an accidental injury. Having the right support of human intervention and technology at the exact moment of need can make all the difference for that individual. If employers outsource the administration of leave and income protection benefits, such as short-term and long-term disability insurance, it’s important that they understand how and why it all comes together.

 

With automation and predictive analytics, a worker’s disability claim can often be verified and approved the same day it’s filed or when an extension is requested. Holstein explains that the technology can comb through thousands of claims for similarities such as age, gender, occupation and medical condition. It also considers how long the individual may need the benefits. With all that data going into the equation, employees could find out their eligibility status within a few minutes. The prompt approval starts the benefit payments and helps alleviate stress.

 

Maternity leaves have historically accounted for 25% of short-term disability claims in the U.S.¹ These are generally straightforward claims with quick approvals, barring any complication. But when they overlap with the following federal, state and company-sponsored leaves, they can be an administrative tangle for an employer and confusing for the worker taking leave:

 

“Technology today can help untangle that process for both the employee and employer,” Holstein says. “It streamlines administration by identifying all the leaves, benefits and job protection for which an employee is eligible.”

 

For example, some leave claims systems automatically set up an FMLA leave when a new mother files a short-term disability claim. And if her doctor says the return-to-work date should be later than originally approved, the system can automatically extend the leave.

 

Mental health continues to be a concern in the workplace, but many people aren’t comfortable talking about it at work. The Hartford’s 2022 Future of Benefits Survey showed that while the majority of employers (82%) say they have an open and inclusive environment that fosters dialogue about mental health, only 48% of workers agree.

 

A mental health condition can be an underlying reason that slows recovery for someone out on a disability leave. While it may be an invisible chronic condition, such as anxiety, technology can help pick up on symptoms and bring in additional support the employee needs to recover.

 

Claims systems can automatically review written conversations and identify when people need support. The system picks up phrases such as “I can’t sleep,” “I’m worried” or other statements that indicate difficulty coping or anxiety. This will prompt claims analysts to bring in behavioral health professionals for compassionate support, goal setting, relaxation practices, coping skills and more. Think of it as proactive technology triage that can trigger one-on-one support.

 

One of the biggest challenges for employees can come well before they even need to file a claim. It’s understanding what those benefits mean to them, when to use them and how to use them.

 

“People are focused on their jobs, not insurance,” says Laura Marzi, benefits expert and head of marketing for Group Benefits at The Hartford. “It’s extremely important to make the benefits they select relatable. Clearly and simply explain how the benefit connects to their everyday lives.”

 

Traditionally, workers are alerted to available benefits while onboarding or at open enrollment time. Marzi says benefits education should be year-round. Company newsletters, emails, social media, blogs, carrier websites and webinars can provide a variety of benefit touchpoints throughout the year.

 

“The insurance industry is constantly innovating with technology, and our claims professionals help deliver an empathetic experience,” Marzi says. “The third prong is education. People will get the most out of their benefits the more they understand them.”

 

Help empower employees to make informed benefits decisions and protect their future today.