Transforming Legacy Claims Solutions

The workers’ compensation industry has been striving to streamline and automate the claims process for years. Imagine a day when a first report of injury can be dictated into a mobile phone, the audio file sent to an insurance company. The claim’s file could be auto-populated with data from that file. Missing information could trigger a text to the injured worker’s phone, so additional data could be collected. When the medical bill is submitted from the treating physician’s office, it could auto-populate additional screens in the system. Artificial intelligence (AI) would recognize it’s a medical-only claim, pay the bill, and close the claim—all of this occurring with the straight-through processing the industry has longed for.

One of the things that’s holding us back from this picture of automation is the fact that many organizations are clinging to outdated technology. Legacy claims systems can often be 10 years or older. These systems are built on archaic infrastructure, while today’s latest platforms have the potential to get us to that futuristic scenario above.

What’s Code Got to Do with Claims?

Organizations with legacy claims systems are frozen in time. Their systems are difficult to modify because they’ve been developed with rigid programming languages. To make changes, programmers or IT experts are needed to develop code. And when significant changes are made, it can be challenging for organizations to then upgrade to newer versions of the software. After a couple years, they can easily get behind on releases.

Since workers’ comp is highly regulated, organizations face new mandates, which claims staff have to adhere to. Regulations vary by jurisdiction, and national organizations have to manage claims differently in the various states they operate in.

Of course, change is nothing new. But the pace of change has accelerated, and organizations need to be equipped with the right technology to keep pace. They need faster access to data, and with a shortage of experienced claims professionals, they also want to leverage intelligent automation to handle routine tasks and guide junior staff through complicated processes.

Low-Code / No-Code Platforms: A New & Growing Phenomena

Today, newer platforms make it possible to modify claims systems on the fly—with little to no code—hence, their moniker: low-code / no-code platforms. They provide carriers and claims organizations with tremendous potential to have the ability to turn on a dime. That’s the key reason low-code / no-code platforms are growing in popularity.

By 2024, low-code application development will be responsible for more than 65% of application development activity, and that 75% of enterprises will be using low-code development tools.

Gartner Research

Low-code / no-code development is done on cloud platforms that provide users with a graphical user interface and “drag and drop” capabilities to achieve configuration. In essence, it’s a “clicks not code” approach.

The Rise of Citizen Developers

A claims system built on a low-code / no-code platform is delivered with a significant amount of business logic built-in. An off-the-shelf version offers robust functionality that can be used out of the box. Security, likewise, is embedded in the platform. At the same time, the basic interface and user environment is intuitive and easy to learn.

From there, modifying the system or adding new functionality is so easy that everyday business users can do it—with a little training. As a result, Gartner has forecast that these platforms are leading to the rise of “citizen developers.”

Instead of programming code, citizen developers could leverage their claims-handling experience to configure additional logic to drive processes, workflow, and AI. Putting power in the hands of business users means carriers and claims organizations can execute necessary system changes faster than ever before. This is because users can make modifications without having to rely on busy IT staff. Of course, these systems come equipped with guardrails and controls, so users can’t mess up the core solution, but they are empowered to configure other critical processes.

Learn More about Low-Code / No-Code

To learn more about how low-code / no-code platforms are changing the claims and risk management landscape watch our on-demand RiskTech Webinar Series – “Low-code/No-Code Technology Transforming Legacy Claims and Risk Management Solutions” sponsored by Spear Technologies.

In this webinar you will learn about these transformative platforms and the benefits that they can bring to your organization. We will discuss how these solutions can support your unique business needs and workflows and allow you to take charge of your transformation.  

Founder of Redhand Advisors, Patrick O’Neill discusses these developments with Jose Tribuzio and Brian Mack, co-founders of Spear Technologies.  Spear is the first P&C software provider to leverage the Microsoft Power Platform, a leading low-code/no-code platform. Jose and Brian are industry veterans and bring a wealth of experience and knowledge to the discussion.