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  #1  
Old 01-09-2018, 02:41 PM
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Default WC Triage Models

I'm looking to educate myself on the topic. Anyone have recommendations for papers or maybe past CAS meeting presentations that would fit the bill? Please feel free to share opinions/experiences with building or deploying them as well.
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Old 01-09-2018, 03:25 PM
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Have you heard of IoP? It's internet of people. Each worker has nanobots, which are connected to the insurer via the Internet, injected into them that monitor state information at a times. As soon as an accident occurs, the nanobots will be able to detect them, quantify the severity, and assign the case to the appropriate adjuster and health care facility with automatic FNOL.

Save 15% or more on your WC insurance by switching to nanobots!
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Old 01-09-2018, 03:51 PM
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There are a variety of ways to do it. It really depends on what you are trying to triage and how that fits in with the claims handling structure of your organization.

For example some triaging decisions can be generalised as: "If the claim (fits criteria), then (perform action with claim) ."

You would build a predictive model for the criteria and then specify the logic on what actions need to be taken if the model makes a certain prediction.

One simple example would be, if the claim is over 500k then you should send it to Joe Bob. The model can be a gamma severity model that sends everything that it predicts to be over 500k to Joe Bob. A logistic model would also be a possibility.

Other examples are to route claims by how long they will take to settle or how likely they are to be fraudulent.

More complex triage models can be a combination of smaller models that make a variety of decisions within the claims handling process.
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Old 01-11-2018, 12:55 PM
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this concept can be applied to anything, no? e.g. med mal?

Is it only for claims handling?
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Old 01-11-2018, 01:08 PM
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this concept can be applied to anything, no? e.g. med mal?

Is it only for claims handling?
I think you can use the same model form, but the variables will differ by line of business and so would the actions taken (Med Mal may have a different claims organization structure than WC).

There are other applications. For example, if you are using a severity model as the basis for triaging, you can also use it to price policies. Although, I think the severity model can be more refined on the claims side since you aren't burdened by regulation.

Triaging can also be used for underwriting - routing a submission to the underwriter who is most likely to bind the policy, or placing priority on submissions that are most likely to bind.
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Old 01-11-2018, 02:51 PM
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I gave a presentation on Claims Analytics at last year's Spring meeting that had 3 slides on the topic. You can triage with a single model, but you might do better by approaching the problem from several different directions. Talk to the subject matter experts (ie, claim department leadership and adjusters) for ideas.
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