Streamlined medical assessments for efficient claims management — our learnings

Introduction

Medical assessments are essential for settling complex personal injury claims. Even as AI continues to advance, medical assessments are still crucial in the claims process. However, for many insurers, this process involves high costs, risks, dependencies, and is generally time-consuming and unstructured.

Background

With over a decade of experience managing a network of hundreds of medical advisors and collaborating with almost every insurer in the Nordics, we understand the value of a streamlined medical assessment process and its impact on claims management.

Challenges in medical assessments

Evaluating a personal injury claim requires a deep understanding of the injury. This involves correlating an accident with the injuries and assessing the long-term disability caused by the injury. It's a complex, time-consuming task, and mistakes can be costly for both the insurer and the claimant.

Despite their medical knowledge and AI support, claims handlers are not doctors. This is where medical assessments come in. Typically, a claims handler requests a medical advisor to review the claim and write an assessment supporting their decision.

The traditional process

Requesting medical assessments is often complicated and manual. It might look like this:

• The claims handler emails a known medical advisor but receives an out-of-office reply.
• They try another advisor but encounter bias issues.
• After several attempts, they find an available and unbiased advisor, but the lack of structured requests means starting from scratch each time.
• Extensive back-and-forth communication follows before the assessment is completed.

This process is time-consuming, prone to errors, and poses significant security risks when sharing sensitive information over emails.

The solution: Mavera DSS

Mavera DSS automates and structures communication between claims handlers and medical advisors. The system automatically assigns claims to the most suitable and available medical advisor, streamlines the process, and leverages AI to accelerate assessments by up to 10x.

Key Features:

• Document sharing
• Chat and messages
• Bias verification
• Second opinions
• Requests for clarification
• Additional motivation in an assessment

All documentation is encrypted and protected, preventing unauthorized access or printing of sensitive information.

“Since using Mavera DSS, we have cut the average number of case touches (number of times a case is opened for a new action) by 50%. Shorter handling times, more satisfied customers, and internal efficiency gains is an obvious triple win,"

says Oskar Norman, claims manager at Sensor Försäkring.

Managing your medical advisor network

A comprehensive network of medical advisors is essential for accurate decisions and fair evaluations. The network should cover every medical discipline and have multiple doctors in common fields to manage seasonal peaks and second opinions.

Get instant assessments from licensed medical advisors from every discipline in Mavera DSS – sign up for our network

Challenges without a management system

Without a dedicated system like Mavera DSS, managing a network of medical advisors can be daunting. Typically, a medical manager is responsible for recruiting, onboarding, evaluating, and managing time reporting and payments for advisors. These tasks are often handled using extensive Excel files or general contact management systems, which are error-prone, add unnecessary complexity, and hinder efficient collaboration.

How Mavera DSS solves network management challenges

Mavera DSS provides a unified platform that simplifies the management of medical advisors.

The system offers:

• Efficient recruitment and onboarding: Streamline the recruitment and onboarding process with centralized data management.
• Performance tracking: Monitor advisor performance, including frequency of clarification requests, missed deadlines, and assessment durations.
• Self-Service portal: Medical advisors can update their details, manage their workload, and report time, reducing manual administration.
• Comprehensive oversight: Medical managers get a complete overview of operations, enabling proactive management and efficient collaboration.

Solving the challenges of managing a network of medical advisors with Mavera DSS brings significant business benefits. A unified and efficient system reduces administrative costs, minimizes errors, and improves decision-making quality.

“You are assigned a case within a reasonable timeframe. The digital platform is very simple, user-friendly, and supportive, so you can focus 100% of your attention and time on the case. Immediate access to all relevant files, medical questions, and your assessment only requires one click to submit. Interaction with other claims adjusters also works very well. Highly recommended.”

Marianne Nygaard-Wulff, medical advisor, Specialist Physician in Orthopedics, Ph.D

Summary

Lacking a structured way to obtain medical assessments adds unnecessary complexity to an already challenging process. Mavera DSS transforms medical assessments into a support tool rather than a problem, replacing manual processes with an automated and efficient workflow. This leads to claims being handled more accurately and promptly, resulting in better outcomes for both insurers and claimants.

Streamlined. Structured. Secure.

This enhances insurance companies' operational efficiency, improves customer experience, and creates a competitive advantage.

We'd love to show you how it all works and share our experience of how other insurance companies have benefited. Contact us today for a personalized demo and see firsthand how Mavera DSS can transform your claims process.

Want to learn more?

In this webinar, we go through how to turn medical advice into an industry-leading advantage.

• How to streamline communication with medical advisors
• How to collect structured data from medical assessments
• Common compliance issues you should be aware of
• Best practices for managing a medical advisor network