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Transforming how we manage claims

An update on the change from our current structure to an “end-to-end” model

posted March 12, 2018

We've made several key decisions to reposition our claims division's ability to provide quality claim management and customer care, and ultimately, to create the best outcomes for Oregon workers and employers.

Key decision #1: geography
The claims division structure will continue to focus on geography to realize all of the benefits that geographic knowledge brings to our customers and teams.

Our claims presence and ability to recruit in Portland continue to be valuable assets. The northern region remains our largest and fastest-growing area. We'll move a portion of our northern regional accounts to Portland, allowing for more efficient travel and easier connections for our customers and agents.

To support these two priorities, we'll integrate our service center customers into their respective geographic units by creating service center claims teams in our northern, central, and southern regions to serve small businesses.

We'll also create two units to serve all of our northern region customers (both regional and service center business): one in Salem and one in Portland.

Our critical claims unit will remain a unique and separate unit.

Key decision #2: claim complexity
As a division, we'll focus on the complexity of the claim rather than the specialties of compensability and disabling. This means our work will include evaluating how we move to an "end-to-end" claim management model.

Our customers will experience handoffs when the complexity of a claim warrants a different level of expertise (rather than because of an internal process).

Assignment by complexity will also allow us to assign work to adjusters and other roles based on the experience level of our employees, creating better outcomes.

What this means to our agents and our policyholders
We'll implement these changes gradually and through small pilot groups so we can learn, adjust, and support both our employees and customers through the change.

What you'll notice now, or in the very near future:

  • New claims will not be automatically assigned to a compensability adjuster. Instead, they may be assigned to a certified examiner with an expertise in that type of claim.
  • Accepted claims will not be automatically reassigned to a disabling adjuster. Instead, a handoff in a claim will occur when the complexity level requires a different type or level of experience.

What we're learning
We recognize that no score replaces our knowledge and expertise. Because of this, and especially as we begin this process, we'll be reviewing claims all the time to determine if escalation and reassignment is required.

From saif.com

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