Situation

A large software company with thousands of employees needed a third-party administrator (TPA) that could provide consistent, high-quality customer service for all of their facilities. After becoming frustrated by inconsistent customer service received from multiple TPAs, the client decided to look for a single risk management provider who offered dependable claims services in several states. As a self-insured employer whose injured workers take an active role in their workers’ compensation benefits, they also required knowledgeable claims adjusters who could educate claimants and provide prompt, concise communications.

Action

The client selected Avizent to manage its workers’ compensation claims nationwide. Since then, the Avizent team has taken an aggressive approach with their claims to reduce return-to-work time for injured employees and control costs for the client. Avizent’s dedicated claims adjusters take ownership of any issues or questions that arise on a claim, research the details, and provide thorough information for the employer, injured worker and providers.

For medical only claims, Avizent’s claim staff plays an important role in helping claimants meet deadlines, keep appointments on schedule, and works diligently with providers to obtain work releases for claimants. As a part of its managed care services, Avizent works with a dedicated vocational counselor who assists with all of the client’s long-term disability cases. The counselor is familiar with the client’s human resources team, and understands the value of prompt turnaround and its impact on return-to-work time. Avizent’s claims adjusters often take on the added responsibility of educating the physicians on the wide range of limited, part-time and/or full-time, light duty positions available with the client.

Results

Avizent’s efforts have produced substantial savings through its claims management and medical managed care services. During a five-year period, Avizent saved the client nearly $2.6 million in bill review and Preferred Provider Organization (PPO) network services. When compared to the client’s workers’ compensation costs, the savings represent a 21-to-1 return on their investment. The specific areas where the client experienced the most savings include radiology treatments, hospital fees and doctor visits. The client saved an average of 46% on these types of medical services during the same five-year period.

By monitoring medical treatment schedules and working closely with providers, Avizent has also reduced costs related to time loss exposure on many claims. Timely, thorough responses provided by Avizent’s expert claims staff have helped keep all parties involved on track, so injured workers can get back on the job sooner.

The client is pleased with Avizent’s consistent, high level of customer service. They have worked with Avizent for more than a decade and value Avizent’s experienced staff, centralized claims intake process, and RMIS technology. In addition, after reviewing Avizent’s technology capabilities, the client selected VISUAL Risk Solutions, Avizent’s software subsidiary, to work with them to develop a customized risk management system.