Gallagher Bassett-Claiming the Future: How Innovation at Gallagher Bassett is Delivering Superior Outcomes

Follow Gallagher Bassett on :

Mike Hessling, Chief Client Officer and Russ Pass, CIO & EVP of Product Development, Gallagher BassettMike Hessling, Chief Client Officer and Russ Pass, CIO & EVP of Product Development In the chain of events that immediately follow an ‘incident’—assessment of casualty and/ or damage, registering a claim notification, confirming the type of insurance cover, all the way up to the resolution of a claim— the field of claims processing is a complex web of decision points. Most often than not, it demands that insurers navigate through regulatory requirements, providing all the documents such as police reports of road accidents, medical reports in case of injury and payment invoices. These needs are varied, for whether it is health, disability, or cost outcomes, or even unique service priorities of the clients, the bottom line rests on achieving the best, industry leading claim outcomes. “Gallagher Bassett is a risk and claims management company, committed to innovation, employing cutting edge practices and technologies to deliver that very solution through the best possible way of handling claims for our clients. It is our mission, to get there and deliver that result on our clients’ behalf, no matter the complexity,” says Russ Pass, CIO and EVP of Product Development.

"Gallagher Bassett is committed to innovation, employing cutting edge practices and technologies to deliver the best way of handling claims"

Founded in 1962, Gallagher Bassett (GB) is a premier provider of global provider of risk and claims management services dedicated to exceptional customer service and demonstrably superior outcomes. The purpose of GB's over 6,000 claims professionals is to help people, teams and companies face unexpected loss and uncertain futures with confidence by providing expertise, innovation and quality, wrapped in a unique culture that delivers the best results. Gallagher Bassett is a member of the Gallagher family of companies, based in Rolling Meadows, Illinois.

There are a number of different approaches to resolve claims, but GB focuses on those decisions that lead to the best outcomes for the claimant and client.

With so many different claim options out there, it is important to identify and focus on the specific type of claim, a capacity that GB specializes in. As Gallagher's CEO and Chairman, Pat Gallagher mentions, “insurance is the oxygen of business.” Everything that a business does, and in every area that it operates, there is risk, and in the event of an adverse turn, claims are/maybe created. That includes everything from a fender bender, to workplace injuries, natural disasters, and so forth, all of which imply that it is important to get specific type of claims that are being addressed, when trying to identify technology trends in claims processing that have the greatest impact.

Custom Claims Management Expertise

GB is very capable of handling all kinds of claims, but are second to none, when it comes to high severity claims where good decision making is really front and center, which is what makes the difference between a positive outcome and an average or below average result. The distinction there, for instance, is that in their line of business, it isn't all about maximally automating the simple claims, to deliver the lowest cost claims services. So their focus is on the high severity claims, “specifically the ones that matter the most.” For such high risk claims, the most relevant technology trends are around the use of AI and data science, ML and predictive modeling to help professionals make the best possible decisions at the critical points that direct a claim in the optimal direction.

GB draws not only on the clients’ own expertise, but on the knowledge and their own experience, which is something that AI, Data Science, ML and the vast claim handling history enables the company to do

This draws not only on the clients’ own expertise, but on the knowledge and the experience of GB, that is something that AI, Data Science, ML and the vast claim handling history enables the company to do. These novel technologies are also helpful in claims prevention.

GB heavily utilizes mobile, smartphone based solutions, which enables them to facilitate and keep the channels of communication open, to ensure continuous and up to the minute information exchange. Their absorption of the content includes everything from audio and video recordings of the locations (as they pertain to the claim) and evidence of the actual incidents as they occur, to staying in touch with the claimants on the outcomes of the latest doctor's appointment or court appearance.

Identifying Flaws in the Process

Carriers and claims management companies, now more than ever are functioning as integration hubs, rather than an agent for streamlining the claims process. For carriers who have in part or completely outsourced their claim handling operations, integration into their technology ecosystems is the next phase of their evolution. In the risk management business, companies who are not in the insurance field such as manufacturers or healthcare organizations, GB brings to the table, all their necessary insurance related technology. But with carriers, the company needs to fit into a much broader ecosystem that includes underwriting systems, agency management systems, actuarial tools, so serving as an integration hub is one of their highest priorities. They do that through web services, APIs, sophisticated data transfer software, which enables them to communicate and exchange information with carriers, risk management companies, or other third parties, in ways that are easiest for them.

One other challenge in the claims processing space is a tremendous lack of standardization in practices and data capture, due to the fact that insurance is regulated at the state rather than the federal level. As standards continue to advance, and as states that are propagating some of this legislation and regulation, merging or moving into the direction of more common standards the integration becomes easier. Developments in those areas are a good thing, and GB is an indispensable part of their clients' business. The company is helping protect brands and businesses from a liability perspective and in restoring lives and property through the clients’ use of their solutions.

Better Solutions through Innovation and Communication

In order to drive beneficial claim outcomes, it is important for GB that their solutions, helping them drive the better real-time decisions, and be able to help drive those claims to a positive conclusion. They have deployed decision support tools in order to identify when to intervene on a claim with the appropriate clinical management. Making sure that the client is appropriately representing the financial status of a claim, GB lends value to their customers by identifying the other actors involved in a claim, such as doctors and defense counsel, to determine who provides the best overall service in those respective areas of the claim fulfillment process. Aligning with the priorities of clients and their businesses is how GB is able to tailor their services to make sure that they do meet the business objectives of those companies.

From a solution perspective, GB is tightly integrated with their clients in how claims are reported, and send information on their underlying employee base or customers they are interacting with. As a result, the more the client can be tightly linked to GB, the more successful they will become at fulfilling their promise to clients.

“We begin with prevention, and recognize that the best claim is the one that never occurs,” as they say at GB.

GB’s PC365 product offering, gives claimants and clients access to medical knowledge immediately at the point of need. In some cases, there will be a question as to whether an injury is serious enough to become a claim, or to have a bandage. GB provides immediate medical data resources, to minimize the severity of the injury itself, and help the claimant identify what is required in the event of the incident. They are also proficient in getting the right team, on every claim, with a clear roster of the best providers in each field, including people who are resolution managers, claim adjusters, primary physicians, and top notch 3rd party service providers for everything from pharmaceutical benefit management to utilization reviews.

GB monitors the trajectory of the claim and the medical treatment, with their medical treatment quality index, which looks at all the different procedures that are performed to ensure a claimant's return to health and compares them against evidence based medicine best practices. This gives GB the power to track if the claim is proceeding as it should, and to intervene if not. This can be through, pharmacist reviews on scripts, medical procedures by consulting physicians, and a number of ways to intervene, to ensure that claims are on track. The relationship that they form with the claimant is augmented with their integration through web and mobile tools. Speaking on the culture of innovation at GB, Mike Hessling, Chief Client Officer at GB has this to say “We are an outward facing organization, in that we are not solely focused internally, but are always looking for the best ideas in the marketplace. Our process involves a lot of rapid experimentation, and piloting of ideas, which is essential to being successful innovators.”

For a Better Future in Claims Processing

With clients that are operating in countries such as the UK and Australia the company today is extending its reach to multinational clients. GB has opportunities for specialized claims management in other countries, which are not only open to GB’s capabilities but are highly innovative in their own ideas about claims management, resulting in a synergistic partnership. As the solution provider builds more exposure to these varied global partners—interested in more than just claims management—the key role that regulation plays in these sector would make for even better incentive for them to work together at a measured pace, which is a critical area of focus to GB. From a technology perspective, AI and ML, the company has good investments in these areas. “We are exploring the applications of IoT, wearables and newer such tech for injury prevention, and they also see drones as promising in some cases,” adds Pass.

Newer technologies, tokenization of data, redaction and auto redaction of information, even in images, this is becoming more technical and ever more visceral in a space like New York, California, and the EU. GB is aware of the growing development of those technologies in these areas and how it becomes ever more prescriptive about the types of information that can be shared and the circumstances under which it can be shared. The company is looking to build bots to automate the process, drones to get into property and disaster work. They are making significant investments to build capabilities specific to the need of carriers, which also benefit their risk management clients, widening their field of expertise to a larger marketplace.

- Pamela Morgan
    June 04, 2019