MetLife processes more than 26,000 long-term disability (LTD) claims each year. Assigning the appropriate likely claim progression (LCP) to a new claim is a complex and time-consuming task. Claims specialists must validate medical information and relevant data, including an assessment of return-to-work (RTW) potential, to make a decision. Before applying advanced analytics, this process took about 36 days to complete.
Recognizing that the process needed to be streamlined, the MetLife LTD team explored ways to shorten the LCP decision time for each claim and improve claim payment accuracy. The team coordinated resources across various disciplines in the company, including data analytics, to reimagine the process and build out workflows utilizing available technology and analytics.
The MetLife data analytics team designed and implemented a solution that included multiple machine learning models and dashboard applications. The dashboards provide a platform for collecting inputs from claims specialists, tracking machine learning model performance, monitoring claim decision efficiency, and providing feedback for model refinement. The models support key decision points in the LCP process:
- The LCP segmentation model predicts the LCP for a new claim shortly after the required data is received.
- The RTW model provides a score based on the status of the claim when it was approved. Claims specialists leverage the model-generated score to expedite management of the claim.
- The authority limit model makes the escalation process more efficient and accurate, minimizing decision-making errors by claims specialists.
The analytics solution enables the MetLife LTD team to greatly improve efficiency and claim results. The LCP segmentation model has delivered an 80% match between the LCP predicted by the model and the LCP assigned by a claims specialist. The average time needed to make a claim decision has decreased by 15%, and the rate of claimants returning to work has increased by nearly 10%. The new analytics-driven claims process has improved the accuracy of LTD claim payments. This analytics solution produced millions of dollars of business benefit in 2018, and more is expected in 2019.