Detect and manage high-severity workers’ comp claims through predictive analytics

Accurately determining workers’ compensation claim severity early is key to controlling claim costs. wcNavigator® uses predictive analytics to help adjusters and claims managers accurately identify claim severity as early as day one.

wcNavigator identifies high-severity workers’ comp claims 40 days sooner than unaided adjusters.

Early severity detection can reduce workers’ compensation claim costs

Detecting workers’ comp claim severity early can improve outcomes because it allows adjusters to start managing costs sooner. But the signs of claim severity can be hidden deep within injury reports, medication lists, and treatment plans. That’s why wcNavigator uses powerful predictive analytics that draw upon both company and industry data.

The solution can accurately predict 88 percent of high-severity claims within the first 30 days.

What can you do if a claim scores high for severity?

  • Examine treatment plan to see if high-cost procedures are warranted
  • Involve home office examiner, peer review, or an independent medical examiner  
  • Give case to senior claims staff and involve claims manager  

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Faster Severity Detection Vital to Better Workers’ Compensation Claim Outcomes

The warning signs of severity can be discovered as early as day one, enabling cases to be managed better—to the benefit of claimants and insurers.

wcNavigator provides:

  • continual rescoring as new information is received so you can make informed decisions from first report of injury through claims resolution
  • rank-ordered severity score drivers that provide insights into the reasons behind the severity score
  • the ability to integrate prescription and medical data directly from your PBM and MBR providers
  • pharmacy alerts that notify case managers and adjusters when severity-driving prescriptions are filled

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wcNavigator ROI = 35:1

By indicating which cases will spiral into complex, costly claims, wcNavigator can yield a 35:1 return on investment.

The best workers’ comp claims solutions stem from an interdisciplinary team

Our team of nurses, lawyers, adjusters, and insurance claims executives lend their decades of experience to our staff of top data scientists to develop powerful predictive claim models. This ensures that wcNavigator delivers advanced analytics designed by claims people for claims people, providing you the insights you need in a manner that can easily fit into claims workflows.

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Access to case matching for better claims management

You can now access Case in Point case matching through wcNavigator. This feature shows where a claim may be headed by matching it with your similar adjudicated claims. With guidance on expected cycle time and medical and settlement costs, you can make better claim decisions and improve consistency.

For more Verisk workers’ compensation compliance solutions, check out:

wcPrism®

A comprehensive suite of tools to simplify workers’ compensation data reporting

wcAnalyzer™

Provides states and insurers with the means to turn untapped data into actionable insights

wcCapture™

A workers’ compensation data collection system for states

Medicare Future Allocations

Medicare Set-Asides and cost mitigation

For more Verisk claims solutions, check out:

Liability Navigator®

Section 111 Reporting

Lien Services

ISO ClaimSearch®