Read this article about MetLife, one of our finalists, in the category Best Achievement in Operational Excellence to deliver Digital Transformation, selected by the independent judging panel, for the 2019 Business Transformation & Operational Excellence Industry Awards program. Click here to read articles on other finalists.

MetLife’s digital strategy aims to unlock the potential created by the shifting landscape of the digital age, where customers are highly empowered. The company is in the midst of a multi-year transformational effort to enhance claims processes through new digital solutions that increase efficiency and simplify the employee and customer experiences.

When a claimant comes to us to report a disability claim, it is a vulnerable time in their lives, so it’s imperative that their experience is an easy one. Through a value stream analysis of our U.S. Short Term Disability (STD) operation, we realized we had a significant opportunity to radically improve the claimant experience.

Given that we initially approve approximately 90% of all STD claims received, we initiated a program to analyze claims in real time at intake, and automate the decision-making process for eligible claims. Enabled by a robust engine of analytical models, a cross-functional team across MetLife developed an innovative solution that segments and analyzes all claims received, with eligible claims being automatically adjudicated in real time:

• Claim segmentation and assignment analytics, which combine segmentation results with resource capacity and skill requirements to assign the claim to the optimal specialist. This includes predicting involvement of specialized teams such as clinical or return-to-work specialists 
• Likely claim progression analytics that identify the most appropriate path for the claim, including if the claim is likely to bridge from STD to a long-term disability (LTD) claim
• Automatic adjudication analytics which drive the automated decision for eligible and appropriate claims

It’s important to note that all claims are run through the analytics engine, including claims which do not qualify for automatic adjudication.

This was an extremely complex transformation program that required strong collaboration and execution from a cross-functional team involving many groups within the company. Given that no group insurance competitor has been successful at developing a solution like this, it required the execution team to be creative, innovative and adaptive as they learned from their experiences throughout the project. The team started with small-scale proof of concept (POC) implementations for each of the analytics components, testing the logic and ability to deliver the right outcomes via the models. As they mined more data to refine the analytics, they expanded the POCs while also integrating the new workflows, analytical models and processes into the existing complex IT infrastructure.

Since its inception, we have automatically adjudicated approximately 46% of addressable STD claims.  We will be refining the existing solution and building new capabilities to target automatic adjudication for greater than 50% of STD claims by the end of 2019. Compared to claims that are not auto-adjudicated, we are seeing approximately 90% improvement in decision turnaround time and an average of five fewer calls per claim.