The Stockwell Firm adjustercom publishes your thoughts and ideas...


Other Claims News
The Comp Examiner Directory
The Liability Adjuster Directory
Service Provider Directory
Post a Job
View Jobs
View Resumes
Contact Us

Adjusters Friend


Place Your Banner Here With A Click - FraudFromInsideAndOutsideTheCourtroom


Welcome Guest! | Login | Register with adjustercom

News Main Page

Email a Friend Email A Friend

More News

May 25, 2023
California's DIR Division of Workers' Compensation Issues Notice of Public Hearing on June 26, 2023 for Proposed Evidence-Based Updates to the Medical Treatment Utilization Schedule

May 18, 2023
California Division of Workers' Compensation (DWC) Posts Additional Adjustments to Official Medical Fee Schedule (Hospital Outpatient Departments/Ambulatory Surgical Centers)

May 12, 2023
Calif Division of Workers' Compensation Issues Notice of 15-Day Public Comment Period for QME Process Regulations

May 3, 2023
California Division of Workers' Compensation Posts Adjustments to Official Medical Fee Schedule (Hospital Outpatient Departments/Ambulatory Surgical Centers)

Benchmarking Study for Workers' Compensation Releases Ninth Annual Report Examining Operational Transformation Amongst High-Performing Claims Organizations
By Rising Medical Solutions LLC - September 1, 2022

As modern workplaces continue to evolve in light of the COVID-19 pandemic, so too must workers' compensation claims organizations in order to achieve optimal outcomes. Yet, standing in the way are deeply entrenched challenges that more than 3,300 claims leaders and frontline professionals have brought to the forefront in previous Workers' Compensation Benchmarking Study research.

"Eight years of data show—to succeed in the face of core claims challenges—organizations need to transform legacy processes, mindsets, semantics, and ingrained cultural practices. Specifically, our data shows that those claims organizations with superior outcomes are also those who are further along in this transformation process," said Rachel Fikes, chief experience officer and study program director at Rising Medical Solutions. "With this in mind, our latest research brought together claims leaders from diverse organizations to dig deeper into exactly how they are evolving to outpace their peers."

The ninth annual study draws upon first-person, focus group research for its latest report, with over 30 industry executives gathering this past December to examine what real-world strategies organizations are using to overcome the foremost barriers to claims management mastery. Participant companies represented a national cross-section of self-insured employers, regional and national carriers, state funds, and third party administrators.

With claims, clinical, and medical management perspectives, the research exercise generated expert guidance payers can use to drive success by: (1) surmounting the repeatedly ranked top obstacles to achieving desired claims outcomes, (2) moving from tactical to strategic, cultural change in the execution of employee-centric claims models, and (3) operationalizing social determinants of health (SDOH) best practices.

Focus group research topics were chosen based on prior study data and the resulting report contains three (3) concise lists of potent recommendations, including key claims strategies to:

  • Improve return-to-work options, drive incentives across stakeholders, and engage injured employees
  • Equip frontline professionals with optimal interventions, while addressing the stigma of psychosocial issues and mental health conditions
  • Overhaul communication practices to increase employee trust and reduce litigation
  • Redesign claims best practices to include an end-to-end, cultural focus on the employee-centric model
  • Utilize frontline claims professionals in employee-centric model design, implementation, and training to create ownership and accountability
  • Improve outcomes based on a total worker health model, including training on SDOH risk factors that go beyond the walls of the workplace, such as housing instability or food insecurity
  • Leverage community resources and social interventions for injured employees with potential health disparities

As in prior years, the new 2021 Report is available to all industry stakeholders without cost or obligation as a contribution to the workers' compensation industry. It may be requested here.

About the Workers' Compensation Benchmarking Study

The Workers' Compensation Benchmarking Study is a national research program examining the complex forces impacting claims management in workers' compensation today. The study's mission is to advance claims management in the industry by providing both quantitative and qualitative data. Through survey research with claims leaders and practitioners nationwide, the program generates actionable intelligence for claims organizations to evaluate priorities, challenges, and strategies amongst their peers. Conceived and directed by Rising Medical Solutions, the ongoing program is a collaboration of industry executives representing diverse organizational perspectives, including the Study's Principal Researcher and Advisory Council:

  • Denise Zoe Algire, Director of Risk Initiatives & National Medical Director | Albertsons Companies
  • Melissa Burke, PharmD, VP, Head of Claims Integrated Solutions | AmTrust Financial Services
  • Dr. Tyrone Spears, Chief, Workers' Compensation Division | City of Los Angeles
  • Ben Tebo, JD, VP | Creative Risk Solutions
  • Sharon Scott, VP, Medical Programs | ESIS
  • Freddy Mistry, AVP, US Claims Operations | Gallagher Bassett
  • Helen Weber, AVP, Head of Medical Strategy | The Hanover Insurance Group, Inc.
  • Adam Seidner MD, MPH, Chief Medical Officer | The Hartford
  • Victoria Kennedy, VP, Workers' Compensation | Linea Solutions
  • Scott Emery, Senior Director, Claims | Markel
  • Thomas Wiese, VP, Claims | The MEMIC Group
  • Michele Fairclough, Medical Services Director | Montana State Fund
  • Molly Flanagan, AVP, Workers' Compensation Claims | Nationwide
  • Marcos Iglesias MD, VP, Chief Medical Director | Travelers
  • Linda Butler, Director, Claims Management | Walt Disney World Resort
  • Brian Trick, Director of Claim Services | Wegmans Food Markets, Inc.
  • Thomas Stark, VP, Underwriting | Zenith Insurance Company

About Rising Medical Solutions

Rising Medical Solutions is a national managed care firm that provides medical cost containment and medical care management services to the workers' compensation, auto, liability, and group health markets. Rising also directs and publishes the annual Workers' Compensation Benchmarking Study, a national research program examining the complex forces impacting claims management in workers' compensation today.

SOURCE: Rising Medical Solutions LLC, Rachel Fikes, with editor and journalist Lonce Lamonte, adjustercom magazine,


 Hot Jobs

writer - news stories

News Writer -- claims news, workers' compensation and liability, property, casualty
Western States (basically California but can include the near West)

writer - People stories

Nurse / Medical Professional
Medical Bill Reviewer
CostFirst Corp
View All Jobs

IEA - Insurance Education Association

Build Your Brand

The Comp Examiner Directory

    Copyright 2023 | Privacy Policy | Feedback |  

Web site engine's code is Copyright © 2003 by PHP-Nuke. All Rights Reserved. PHP-Nuke is Free Software released under the GNU/GPL license.