What is a predictive scoring model?

A predictive scoring model uses data mining techniques to predict likelihood of return to work in a given timeframe.

Its predictions are given as scores from 1 to 10. The higher a score a claimant receives, the greater the likelihood of return to work.

What do you mean by claim scoring?

Claim scoring is a tool to help disability claim experts in their day-to-day work. Claim scoring provides a fast, objective, consistent way of ranking the quality of each disability claim.

Claims are scored from one to ten. The higher the score, the greater the likelihood of return to work. The scores are calibrated: a score of 1 indicates a 0-10% likelihood of RTW, 2 indicates 11-20%, and so on.

Why should we score our disability claims?

Claims experts are confronted daily by a myriad of claims that they must work through one by one, evaluating and ranking as they go. Claim scoring eliminates a significant amount of this work.

Claim scoring provides an accurate, objective starting point for each new claim. Claims experts and clinical staff can use the scores – and the time freed up by expedited evaluation – to help focus their efforts where they will be most productive.

Is claim scoring of any benefit to experienced claims people?

Yes. In fact, we find that the benefits of claims scoring are best realized in sophisticated claims departments.

Claim scoring, because it precisely and objectively ranks each disability claim, can be used by claims managers to optimize the allocation of resources, and to decide which claimants will benefit most from the various case management options available.

Our practices are unique. How do we know the scoring model will work for our company?

Every Claim Analytics scoring model is tailored to the client – built from the client’s own claims database. Its scores predict recovery based on that client’s unique claim practices.

We test each model upon completion, using a set of historic data that is new to the model.

In the chart below, a typical example of one such testing, note that actual results closely track the model’s predictions. Example: In the dataset below, actual aggregate recovery for 6′s was 57% – closely matched by the model’s predicted aggregate recovery for 6′s: 50-60%.

How many claims are required to build a statistically robust scoring model?

A statistically robust scoring model can be built with as few as 500 historical claims.

Will the implementation of claim scoring tie up staff in new learning or new operational activities?

No. The Claim Analytics model is built and maintained offsite. Our clients will attest to the fact that the process is non-intrusive to their operations.

Scoring of new claims is only a matter of sending data on a weekly or monthly basis.

What are the systems and data requirements for building the model?

There are no systems requirements, as the model is built and run offsite. Scores are sent via an Excel file.

There are also no specific data requirements. Each model is tailored to the claims data that a client can readily provide. A suggested list of data fields can be found here.

Is the service expensive and will the benefits offset the cost?

The Claim Analytics service is all about saving money. The benefits of implementing the system far exceed the cost of the services.

Significant financial benefits are realized in two areas:

1. Expense savings, through optimized use of rehab, medical and investigation services
2. Improved claims experience.

Is there a trial period?

Yes.

We are so confident in the value of our claim scoring system that we build the model for our clients at our own cost, and then allow a trial period of six months at 50% of our normal monthly charge. There is no obligation to the client to continue after the trial period.

How can a model developed by actuaries help disability claims people in their work?

Every scoring model is based upon, and ‘learns’ from, a company’s own historical claims database. By identifying complex patterns and relationships within that database, the model is able to provide information (the scores) that can be used as a decision-making tool in the claims management process.