Extending personalized support to every injured worker

Industry
Insurance
Risk Management

Use-Case
Claims Case Management
Provider CRM

Products and Services
Eccentex ServiceJourney
Eccentex Professional Services
Genesys Cloud

Organization Size
Multinational Corporation (5,200+ employees)

A large third-party administrator streamlines medical management on worker compensation claims – leading to better outcomes, higher satisfaction and lower litigation rates.

Challange and vision:

A modern proactive care approach

The company is a large global insurance service provider and leader in workers compensation claims. Every year, they help tens of thousands of injured workers get the care they need while helping their employers mitigate risks.

Workers comp claims can be complex requiring coordination between the injured worker, employer, clinical providers, nurses, adjusters, and lawyers. Ad-hoc tasks like scheduling appointments, requesting medical records and preparing for next steps required too many manual actions by overqualified staff.

They wanted to extend the highest level of care to every injured worker, not just the most complex cases. They launched the “Clinical Concierge” pilot program proving that empathetic, high-touch engagement and oversight can be done cost effectively at scale and does lead to a win-win for all parties involved.

To make this service cost-effective for all their clients, they needed to optimize the entire claims workflow – from automating personalized engagement to orchestrating work across people, bots and other core systems.

Launching this improved service at a large scale required a modern platform with the flexibility to accommodate their and their customer’s unique needs.

How Eccentex helped:

Uniting human judgement with technology

They chose Eccentex ServiceJourney to deliver an omnichannel case management and CRM solution that would rapidly streamline workers compensation claims. Together we delivered a…

• Unified claims workflows, tasks, SLAs and operational management onto a single platform accessible by all staff.
• Improved productivity by automating manual tasks, routing routine tasks to offshore teams and integrating with their core systems.
• Deployed a comprehensive real-time view of the claims process across all touchpoints, participants and tasks.
• Integrated with their Genesys Cloud CX contact center – providing context-aware conversation routing and screen-popping claim data.
• Improved the case assignment process that balances employee utilization with job satisfaction.
• Automated personalized engagement with every injured worker at every key moment – empowering staff to resolve problems early.
• Standardized referrals, forms, and communications – reducing mistakes and manual work.
• Launched a “Provider CRM” to continuously improve their provider network and match workers with highest rated clinical provider.

Results:

Best-in-class tools to streamline every step of the WORKER’S journey

With Eccentex ServiceJourney, this large claims handler revolutionized the industry by providing the highest level of care for all injured workers.

This solution helped them achieve a 20% reduction in claim cost and 60% reduction in litigation rates, while seeing a user satisfaction score of 9.4 out of 10.

ServiceJourney’s low-code technology will allow them to continuously evolve their solution, launch new products and respond to changing regulations.