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Category Archives: SPOT on Ops

  1. Encounters of the Best Kind Can Create The Strongest Claims Organizations July 20, 2010

    Posted in Best Practices, Customer Service, SPOT on Issues, SPOT on Ops.

    Companies cannot define their core “brand” through brute marketing and advertising. Rather, customers define what that brand is in their individual interactions with the company. Those interactions can either be transactions or encounters. Encounters make the relationship stronger while transactions result in a worse relationship or one that stays the same. This is no different in the claims professional’s world. How can claims professionals create encounters, and avoid transactions, in their interactions with their customers?

    No comments
  2. 5 Questions To Ask Property Adjusters Before Making That Partnership July 9, 2010

    Posted in Due Diligence, SPOT on Ops.

    Selecting the right partner for your property adjustment needs can be absolutely crucial to meeting stake-holder needs across the claims process. Making the wrong decision up-front can create countless problems down the road.

    At a high level, claims executives might look for synergy, good philosophical fit, and a proven track record. But what about day-to-day operational considerations? What should be included in your detailed market evaluations, your informational meetings with potential vendors, or even your RFI and RFP for property adjustment services?

    Learn how to not not shortchange the process by not asking the right questions in Taylor Smith’s posting of 5 questions to ask property adjusters before making the partnership.

    2 comments
  3. “What’s The Point” Claims Process And How To Avoid Them July 6, 2010

    Posted in My SPOT, SPOT on Ops.

    Being able to truly focus on what’s important is a path to success. Claims organizations are notorious for multiple process and procedures. Many of these procedures are truly necessary and are required to maintain controls, prevent fraud or comply with a multitude of regulations facing the insurance industry. Nonetheless, doing something for the sake of doing it is no way to be an efficient organization. Today we speak about asking “what’s the point” before proceeding with new projects or exploring existing process.

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  4. The Importance Of The Pre Bind Claims Review In The Reinsurance Context June 29, 2010

    Posted in Claims Auditing, Due Diligence, SPOT on Ops.

    Reinsurance companies faced with a new submission often review loss runs and other financial data to determine the effectiveness of an account. However, numbers only tell half the story and in order to get a complete picture of a cedent’s submission, it is important to have an understanding of the claims department. What is the company’s reserve philosophy? What kind of systems do they have in place? How are claims staff measured? Conducting a comprehensive pre-bind review is an important step to help minimize the risk.

    In this post, the Claims SPOT explores the importance of the Pre-Bind review in the Reinsurance context.

    2 comments
  5. Allstate SVP of Claims Discusses The Customer And Claims At The ACE Conference June 24, 2010

    Posted in SPOT on Ops.

    An interesting keynote speech given by Allstate head of claims at America’s Claim Event in Las Vegas. Michael Roche discussed Allstate’s push to improve customer service through both improved technology and initiatives. We discuss a few interesting lessons learned that can be considered by claims operations to improve customer experiences.

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  6. You Can’t Wait Till The Last Minute To Improve You Operation – Planning Starts Now! June 22, 2010

    Posted in SPOT on Ops.

    In a a great analogy about the rapid growth of lily pads in a pond, we discuss the need to start strategic planning to solve problems before they become to hard to deal with. Like most industries, adopting and changing with the times can be a difficult proposition. It takes time to think of issues, come up with solutions and implement the changes. Insurance companies have added legal, compliance and regulatory concerns to say nothing of complex (sometimes outdated) information technology systems. Regardless, it’s not too late to address issues such as a social media or mobile strategy. We give two suggestions of recent trends that should be explored by claims organizations over then next few years.

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  7. The Modern Claims File – 5 Considerations When Selecting A Records Retrieval Partner June 14, 2010

    Posted in Claims Technology, Litigation Management, SPOT on Costs, SPOT on Ops.

    The growth of national records retrieval partners, and the availability of sophisticated web-based record delivery platforms, means new options for claims executives looking to improve their operations. Turning over the routine tasks associated with retrieving records in the claims process to an expert company can mean more time available for what claims professionals, staff counsel and outside law firms do best — analyzing and resolving claims. It can also mean faster retrieval and lower case cycle times. And, depending upon how the records are presented, it can dramatically reduce the time required to index, sort and derive real analytical value from the records themselves. Five key ideas for what to consider in selecting a records retrieval partner are discussed.

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  8. The Legacy Claims System Facelift – 5 Issues To Consider When Looking At New Systems June 7, 2010

    Posted in Claims Technology, SPOT on Ops.

    While historically the replacement of a claims system could seem like a 18-month root canal, new technologies and new approaches have made it possible to significantly reduce implementation times. While this can make a decision to change systems more appealing, the evaluation of new claims systems still presents a myriad of options. Pages and pages of feature-sets offer tremendous advancement, but can seem confusing and even overwhelming.

    So with all these options available, what are some key items to consider as you look at the marketplace? Taylor Smith gives 5 items to consider when selecting a new claims system for you organization.

    1 comment
  9. Medicare Secondary Payer Allows Direct Data Entry For Small Reporters Of Claims June 2, 2010

    Posted in Medicare Secondary Payer, SPOT on Ops.

    A new change to the Medicare Secondary Payer reporting will allow those entities with a small number of reports the ability to key in individual claims. This will alleviate the need to create, test and manage a data feed. While not without limitations, the news should help those smaller reporting entities that had been struggling with the onerous requirements. The method is limited to those reports that have less than 500 reportable events in a year. Read more about the changes in today’s post.

    1 comment
  10. 5 Items To Consider When Evaluating An Electronic-Invoicing System For Your Outside Law Firms May 26, 2010

    Posted in Litigation Management, SPOT on Costs, SPOT on Ops.

    Estimates vary, but by most accounts roughly 30% of P & C claims organizations have put some kind of e-billing platform in place. Now, as prices have decreased and law firm utilization expanded, these solutions are easily accessible by claims organizations of all sizes, including those with very low legal expenditures. In Taylor Smith’s last post, 10 Keys To Managing Court Reporting Costs, he wrote about the benefits claims organizations are experiencing when implementing a national court reporting program. He now tackles several key concepts to consider when implementing an e-billing system to improve the management of legal invoices.

    Take a look and let us know what you think.

    1 comment
  11. Does Hiring More Staff Improve Claims? How To Know When The Time Is Right May 3, 2010

    Posted in SPOT on Ops.

    Deciding when to hire new staff is always a difficult question to answer. It’s even harder in a tough economy. In this week’s post I explore what to consider before hiring. Developing a staffing model and exploring internal metrics should be done before making a decision. But how do you create a staffing model? I suggest a few methods for developing a staffing model that makes sense. Before you bring on more staff review your staffing model, see if there any trends affecting file loads and take a quick look inward at your operation. Once these assessments are completed, you will be in a better position to know if hiring is the right decision.

    1 comment
  12. 6 Essential Elements To Explore When Choosing A Third Party Administrator April 27, 2010

    Posted in Due Diligence, SPOT on Ops.

    A Third Party Administrator (TPA) is often the best way to handle claims for an organization. Many self-insured and captives choose to outsource their claims instead of creating their own internal operation. Whether to get expertise in a particular areas, or not wanting to invest in the infrastructure to build a claims department, using a TPA can be a smart business decision. So what make a good TPA and what should you look for? In order to find out you must conduct a comprehensive due diligence of the TPA you are about to hire. This is especially the case when that TPA will be holding and managing your claim dollars. Besides understanding the financial strength and capabilities of the TPA, it is also important to know whether they will be able to meet your data needs, provide consistent claims handling, and work to lower costs where they can.

    In this weeks post I address 6 essential elements, and questions, that should be explored as part of any due diligence when selecting a TPA

    4 comments
  13. New Claims Technologies To Help Companies Drive Revenue And Differentiate Themselves April 12, 2010

    Posted in Claims Technology.

    New Study By The Gartner Group Shows 10 Technologies With The Greatest Impact For The Property/ Casualty Industry To Drive Revenue. In this post I comment on 4 solutions that can have a dramatic impact on claims and improve bottom lines. Failing to adopt new technology will put companies at a competitive disadvantage. Every company should look to evaluate their current systems and offerings and create a strategic plan to keep up-to-date with software and solutions. Staying ahead of the curve is a sure way to help drive costs down and stand out from those who don’t.

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  14. Medicare Secondary Payer Enhancement Act Being Introduced in Congress Could Address Many Concerns of Section 111 Reporting March 23, 2010

    Posted in Medicare Secondary Payer, SPOT on Ops.

    Dealing with MSP Can Feel Like Walking Into a Maze The Medicare Secondary Payer Enhancement Act of 2010 (HR 4796) is a new piece of bi-partisan legislation introduced on March 9, 2010. It is designed to streamline Medicare Secondary Payer reporting and provide some finality for insurers required to reimburse Medicare for “conditional payments” of […]

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  15. Considering Forming a Captive? Maximize Your Claims Benefits In 3 Steps March 10, 2010

    Posted in SPOT on Ops.

    The Benefits Of Forming A Captive Are Great – IF – You Set It Up And Manage It Correctly The use of captives as an alternative means for managing risk is growing rapidly  (read a nice overview of captives at the Captive Counsel Law Group). Changes in laws, increasing tax benefits and control over assets […]

    1 comment
  16. 7 Considerations When Drafting Claims Guidelines March 1, 2010

    Posted in Best Practices, Compliance, SPOT on Issues, SPOT on Ops.

    Claims departments employ professionals that want to do a good job for policy holders as well as the company, and claims guidelines should help foster those goals. Before drafting guidelines there are a few things that should be considered and we, along with our fellow blogger Phil Loree, suggest 7 things a company should consider when drafting claims guidelines.

    5 comments
  17. Thinking Outside The Box: Litigation management program initiatives can substantially lower costs February 25, 2010

    Posted in Litigation Management, SPOT on Costs.

    Managing litigation is an easy way to save extra expense costs on claims files. A strong litigation management program designed to help foster improved communication, and streamline defense of insureds, benefits all parties involved. As I wrote about the cost savings benefits of out-of-the-box claims handling, using new and forward thinking strategies for litigation management is an excellent way to save money. Using specialized vendors, claim handlers can further control legal costs as well as enhance their defense.

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  18. 3 Essential Report Types That Insurance Executives Should Use To Analyze Their Claims February 23, 2010

    Posted in SPOT on Ops.

    Today’s modern claims systems have a wealth of knowledge about every aspect of claims operations. With the right reports it should be easy to get a basic snapshot of how effective your claims are being managed, and how well your business is doing. With all that information where is one to start? What are the key metrics that should be reviewed by claims and business executives to better understand their operations? We give three specific report types that claims executives should review on a regular basis to get a valuable snapshot of their organization.

    1 comment
  19. Important Update: Medicare Secondary Payer changes production date to January 1, 2011 February 18, 2010

    Posted in Medicare Secondary Payer, SPOT on Issues, SPOT on Ops.

    The Centers for Medicare/Medicaid Services (CMS) have announced the following: CMS advises all NGHP RREs that the date for first production NGHP Input Files is changed from April 1, 2010 to January 1, 2011, effective immediately. Read the complete announcement at the CMS website in “What’s New.” This is clearly a welcome change and one […]

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  20. 5 Claims issues cited for non-compliance on market conduct exams & 3 tools to avoid them February 15, 2010

    Posted in Best Practices, Compliance, SPOT on Issues, SPOT on Ops.

    Insurance Market Conduct examinations are a regular part of the insurance business. Besides the stress of the exam itself, being cited for violations can result in costly fines. Regardless, many citations can be avoided. Every year, insurance compliance solutions provider Walters Kluwer releases its annual study of top ten reasons insurance companies are found to […]

    3 comments
  21. Blizzard Warning in the East! Can your claims department keep running if the office closes? February 10, 2010

    Posted in SPOT on Ops.

    The East Coast snow storm is a great reminder to be prepared for disasters and other reasons why your office would have to close. Do you have the plans in place to manage the next event? Does your claims system give you the ability to manage claims remotely? Can you manage claims remotely for an extended period of time?

    2 comments
  22. Warning – Medicare Secondary Payer (MSP): Government sends strong message and goes after non-compliance February 3, 2010

    Posted in Medicare Secondary Payer, SPOT on Ops.

    If you are an insurance company or self-insured, and make payments on liability or workers’ compensation claims, be aware that the Federal Government has filed a lawsuit signaling their intent to be aggressive in seeking reimbursement. As reported in Business Insurance, this “case breaks new ground because CMS simultaneously named insurers, settlement beneficiaries and plaintiffs attorneys all in one lawsuit.” This case should alert all that if you make a payment on an injury claim, and fail to let the Government know about money they should be collecting, they will come after you.

    2 comments
  23. Failing to properly document files can be costly – It cost one insurance agency $5.83 Million February 1, 2010

    Posted in Best Practices, Commentary, SPOT on Ops.

    Files should speak for themselves. A recent California decision is yet another example of what can happen if you don’t document your files and maintain procedures. In this case – it cost $5.83 million.

    No comments
  24. Better claim reports can help improve producer/carrier communications (take our poll) January 29, 2010

    Posted in Customer Service, SPOT on Ops.

    Improved producer carrier relationships can be a competitive advantage to help increase profitability in tough economic times. According to the survey, a key differentiator for carriers to attract more business from their producers is in the areas of claims handling and technology. Most modern claims systems can create automated customized reports. Producers should be able to ask for specific reports and have them electronically scheduled for delivery. Better reporting will go a long way to improving relationships, and can only help increase profitability and enhance service to the policy holders.

    No comments
  25. Are claim departments’ process and systems ready for the new “Freelance Nation” worker? January 26, 2010

    Posted in SPOT on Ops.

    Can claim departments handle the change in the American workforce. The insurance industry has struggled in recent years to attract and retain new talent, especially in claims organizations. In an effort to continually provide the best talent, as well as provide the best customer service, more of the “Freelance Nation” will need to be employed. To do this, claim organizations will need to employ strong procedures and up-to-date technology to ensure optimal performance from this more fragmented workforce. Are they ready?

    2 comments