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Claims Managers Discuss Measuring Success

Defining success for the claims department is a major challenge, and Claims Practice Group members are trying different techniques. This was one topic in a wide-ranging discussion at a recent conference call that also touched on the best carriers in handling claims and carrier download challenges.

Following are some of the comments on measuring success:

  • “We focus on customer satisfaction with claims service. However, we can only impact results to a certain extent. We don’t own the files and we can’t drive closure rates in the same way that a claims adjuster can.”
  • “We struggle with comparing individuals within the team. They have different clients, and different clients have different needs. It’s a ‘gut’ check. You can’t measure performance as you can with an account manager.”
  • “We try to measure the timeliness component as far as deliverable information goes.”
  • “Our budget is allocated to sales, and our claims department is considered to be part of the sales process.”
  • “We’ve toyed with measuring the experience modification rate on the workers comp side. But even then you have variables, and it is hard to find something useful to compare.”
  • “We are hoping that some of the new Epic reports will give us better measurements.”
  • “We try to send out surveys while the claims experience is still fresh.”
  • “How do you factor in a situation where there was a denial, but the client is unhappy with the carrier and not with you? What can we do to create a different experience next time?”

Members also discussed the following topics.

Carrier Downloads

Carrier downloads can be challenging. “If you are moving into carrier downloads, fine-turn the process with one carrier before you add another one.”

Carrier Advisory Councils

Serving on carrier advisory councils is “hugely” beneficial. One member agency has representatives on The Hartford and Travelers national councils, Liberty and Zurich regional advisory councils and the California State Compensation Insurance Fund.

“It’s much like the RiskProNet group. You’re getting together with 10 to 15 others claims managers and it becomes a strong networking community. You learn about new programs early on and this helps to facilitate communications. Claims representatives are often left out of new programs.”

CIAB also is a good way to get involved with a strong claims group. The association has a big voice in Washington.”

Claims-Handling Practices

Travelers got top marks for handling claims. They are “easy to work with.” Travelers also “understands the client-agent relationship and how to leverage that. If they have bad news, the Travelers adjustors will let us know. They’ll give us an opportunity to review a denial in advance so we can see it before a letter goes out to the client. It gives us a chance to see where they are with the claim. If they’re right and we agree, we can help explain the denial to the client. Some carriers just send out denials. We find out about it from the client and have to play catch-up.”

“We’re trying to get adjustors at all carriers to give us a heads-up if they are about to deny a claim. About 50 percent of them do.” Another RPNI member, however, reported limited in success in getting advance notice of denials.

AIG has been historically problematic in paying claims, one member said. Major issues have been in California and on the East Coast, one member said, although “I don’t know why.”

Benchmarking Surveys

MarshBerry is a source for benchmarking surveys, although no one was aware of a specific program for claims departments.

Outsourcing

Outsourcing is a solution for handling unexpected growth or tasks, two members said. They reported success with using ReSourcePro and Patra Corp. “We work with ReSourcePro for data-entry tasks that are important but no fun to do.” ReSourcePro has been able to handle extra work with no advance notice.

 

 

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