risk management: workers’ compensation

Employers frequently view workers’ compensation and disability costs as significant uncontrollable business expenses. Many have neither the internal expertise, nor the time to proactively address the issues. KBA believes and has proven that these costs can be managed, contained and reduced through defined loss prevention and loss control programs partnered with our assistance. Some of the services we provide to our clients are highlighted in the following segments.

Assessments

• Establish compliance metrics to ensure proper recording and reporting
• Assess your insurer/tpa’s performance by auditing a random sampling of claim files to ensure that service expectations and special handling instructions are adhered to by the vendor
• Establish RFP criteria and assist with the proposal review and selection process
• Review and report on the claims management and administrative infrastructure
• Perform cost/benefit analysis of claims administration options, including self administration
• Evaluate risk control programs (e.g., return to work, safety, managed care) and make recommendations for enhancements

Claim Reviews

• Review complex claims in order to assess claim resolution strategies and mitigate costs
• Examine claim files to assess your internal processes and programs to improve efficiencies and outcomes working together with your insurer/tpa
• Conduct reviews to identify recovery/subrogation opportunities
• Audit experience modification factors for retroactive adjustments and to identify cost drivers
• Conduct reserve analyses for funding purposes and actuarial studies
• Participate at quarterly claim reviews with client and insurer/tpa.

Program Development and Management

• Review current policies and procedures and make recommendations for enhancements
• Establish appropriate insurer/tpa claim service guidelines and develop standards of performance/best practices
• Coordinate all aspects of the claims reporting and claims management process
• Identify and establish communication expectations for preferred health care providers to assure best level of care
• Facilitate a return to work policy and integration with FMLA, ADA and total absence management
• Provide on-site claims and risk management services
• Coordinate disability and injury management
• Design and implement an in-house claims administration department