Skip to content


Tag Archives: Claims Handling

  1. 3 Claims Department Musts That Will Let The CEO Sleep Soundly March 23, 2015

    Posted in Best Practices, SPOT on Issues.

    There are many elements to a well run claims department. As with many areas of business it comes down to people, process and technology. Good people will drive the success of any department and working with defined efficient processes, as well as technology tools that support the organization, are basic core requirements to any well run department. Specifically what people, processes and technology make up a good claims department is a subject for another day. Regardless every claims department should be using metrics, performing audits and have a business continuity plan in place as a minimum. Take our survey too and let’s see what companies are doing on these three.

    1 comment
  2. 4 Keys to Managing a Successful Outsourced Claims Operation October 30, 2013

    Posted in Best Practices, Compliance, Due Diligence, SPOT on Issues.

    All things being equal there are many fine TPAs in the market that will provide wonderful service to your insureds in a cost effective and comprehensive manner. Initially you think you have chosen a good one. However, as time goes on you realize you are not exactly getting what you expected from your TPA. So what happened?

    It matters little what your reasons for outsourcing were. Bottom line is if you didn’t take certain steps to properly select and manage a TPA you are likely to end up with problems. The partnership you form with your TPA will be fruitful if you take key steps to select and manage them in a way designed to foster long term success.

    Learn how in our latest post!

    No comments
  3. Claim Files Are Evaluated Using A Form Of Root Cause Analysis So Why Not Do The Same When Evaluating The Department? March 5, 2013

    Posted in SPOT on Ops.

    Similar to a claim file analysis, operational problems require an assessment as to what happened, how it happened, how could it have been prevented, who was at fault, what’s it going to cost to fix the claim and are there any lessons learned. For example, let’s say payments are being delayed resulting in fines being assessed against the department. If one looks at the fines as a claim one would want to determine what caused the fine? how did it happen? and how can it be corrected? An analysis of the “claim” needs to take place prior to making any decisions. Why not use these smae claim evaluation techniques to understand the operation? In our latest post we give a suggestion for doing just that.

    No comments
  4. How Would Albert Einstein Approach Claims January 3, 2013

    Posted in Best Practices, SPOT on Ops.

    Who knew Albert Einstein was a claims professional? OK maybe he did more important things in this world but some of his most memorable quotes could certainly apply to a claims organization. “Nothing happens until someone does something” as he has been quoted so make it happen and readt our latest post.

    2 comments
  5. 7 Steps To Effective Problem Solving For Every Claims Professional August 2, 2011

    Posted in Best Practices, SPOT on Issues.

    Let’s face it solving problems in claims is a core reality to what we do. From the second a claim hits your desk until the minute it leaves it there are a series of problems that need to be solved. Should this claim even be accepted? Was there any liability? What experts should I hire? How much is it worth? What are my next steps? At every turn there is another problem that needs to be solved. As you probably have experienced, some people are very good problem solvers and others are not. In claims, however, there is no escaping the need to solve a variety of issues on a daily basis. Don’t fret if you don’t consider yourself a good problem solver as it turns out there is help for you. In our latest post we discuss 7 effective step to problem solving.

    1 comment
  6. Claims And The Investigative Journalist And Learning From All The President’s Men November 9, 2010

    Posted in Best Practices, SPOT on Issues.

    Investigating a claim is like being an investigative journalist. Using the story of Bob Woodward and Carl Bernstein and All the President’s Men, see how there is a relationship between investigative reporting and claims. In today’s post we also remind claim professionals how technology has truly made certain aspects of claims bette. Regardless, it is important not to forget what is most important in claims – the knowledge and skill of the claims professional’s ability to analyze fact and come to a reasoned and supported conclusion.

    1 comment
  7. Why Extending More Claims Authority Means Extending More Responsibility September 10, 2010

    Posted in Best Practices, SPOT on Issues.

    Extending additional authority to a number of claim handlers can have a dramatic affect on the department’s total incurred. Make sure claim handlers understand the impact, both good and bad, to the company. Deciding when, and how much authority to extend will always depend on the line of business, and experience of the claims professional. Giving more authority also means extending more responsibility to the junior claims professional to make greater financial decisions for the company.

    In today’s post we discuss the authority-responsibility correlation and the importance of ensuring claims authority is extended only when responsibilities associated with that authority are understood.

    No comments
  8. 3 Suggestions To Beat The Summer Slow Down In Claims (If You Do Slow Down) August 3, 2010

    Posted in Best Practices, SPOT on Issues.

    It’s summer time and the living is easy!

    Take advantage of the summer slow down and make changes, clean things up and improve your operation. In the latest post from the Claims SPOT see three suggestions for ways to use your summer effectively. One for the manager, one for the claims handler and one for the claims executive, suggestions to use the slow down to improve your operation. Take a look and suggest others – we would love to hear from you.

    2 comments
  9. Why Can’t We All Get Along? Making The Agent A Partner In The Claims Process July 27, 2010

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

    Creating a strategic advantage through improved agent carrier relations

    The relationship between claim adjusters and agents can be an adversarial one. Each side often finds itself correcting issues created by the other side. Agents may set the wrong coverage expectation for a customer, leaving the adjuster to deliver the bad news. Adjusters may get overloaded and not return phone calls in a timely manner, resulting in a complaint to the agent’s office. In the worst case scenario, adjusters and agents may badmouth each other to customers, putting customers in the middle. Clearly, agencies have a role to play in the claim process. Enabling agents and their staff to perform their role efficiently with empathy and professionalism can benefit customers, agents, and the claims department. Read more this week from Melissa Loew.

    2 comments
  10. In Claims Don’t Let The Process “Thing” Get In The Way Of Doing The “Right” Thing July 19, 2010

    Posted in Best Practices, SPOT on Issues.

    Making a check in the process won’t ensure the matter is done right. I have written, and am a big proponent of, the importance of good process as a way to ensure good results. Putting a proper process in place is a road-map to help move claims to a prompt fair resolution. Nonetheless, doing and focusing on the process without making sure the outcome is sound is doing things right without doing the right thing. It’s so easy in claims to focus on the process and not use the process as a means to the end

    2 comments
  11. Change Hats With Someone And Free Your Mind To Make Your Claims Operation Better June 9, 2010

    Posted in Best Practices, SPOT on Issues.

    Don’t limit what you can imagine by what you know – look to others to help improve your claims department.

    In Trading Places: A Smart Way to Change Your Mind, Harvard Business Review contributor, Bill Taylor discusses the “power of a whole new mindset about innovation.” The article goes into what happened when two CEO’s switched companies for a day and the learning that came from the new perspectives they had. The Claims SPOT discusses how having claims adjusters switch roles with different disciplines can be a new way to expand their skills. Having managers sit with other business divisions, such as underwriting or actuarial, can be a great way to get a better understanding of the entire insurance process outside of claims. And lastly, looking outside of claims and insurance altogether to change hats and free your mind to new ways to make your operation better.

    2 comments
  12. Commentary – Expect Gulf Oil Slick Claims To Be Extensive And Impact Multiple Lines Of Business June 5, 2010

    Posted in Commentary, My SPOT.

    We still do not truly understand the entire impact from a claims perspective of the tragedy that has unfolded as a result of the Deepwater Horizon rig accident in the Gulf of Mexico. Losses are being estimated in the $30-$40 billion range with only a fraction of that number covered by insurance. What has recently been reported, however, is an increase in premiums for offshore energy coverages. What is next? No one really knows. The Claims SPOT comments on the some of the issues facing the industry.

    2 comments
  13. The Claims Writing Workshop: Write How You Speak! Just Leave Out The Color Commentary June 1, 2010

    Posted in Claims Writing Workshop, SPOT on Issues.

    From our new contributor Dr. Gary Blake, we learn about writing and claims. Dr. Blake is a Port Washington, NY-based writing consultant who presents claims writing webinars and seminars throughout the United States. In his first post on The Claims SPOT, Dr. Blake discusses writing the way you speak without the color commentary. As he states, “write using the model of speech’s simplicity, directness, and warmth. Just don’t mirror speech’s unplanned distraction and tendency to ramble. “

    1 comment
  14. How Do You Effectively Manage A TPA? Speak Up And Be Active! May 20, 2010

    Posted in Best Practices.

    Tweet Become The Squeaky Wheel To Actively Manage TPA Outcomes As claim practitioners, most of us are familiar with what to look for when we shop for a third-party claim administrator (“TPA”).  One recent discussion on this blog cited such elements as claims systems, data reporting capabilities, and quality control (6 Essential Elements When To […]

    3 comments
  15. The 5 Essential Components of Defense Attorney Reports That Can Improve Claims Costs and Outcomes March 14, 2010

    Posted in Commentary, My SPOT, SPOT on Costs.

    Why are Attorney Evaluation Reports sometimes so light? I was recently conducting an audit of claim files and had the opportunity to review a significant number of Attorney Evaluation reports from a variety of law firms. Like many other things in life, some were better than others. What seemed to be most glaringly consistent was the inability of counsel to truly provide an assessment of exposure and what the case is worth. Every counsel evaluation report should contain 5 basic components that I outline and attorneys should be required to provide their actual valuable opinion. [More…]

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

    Posted in SPOT on Ops.

    Tweet 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 […]

    1 comment
  17. 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
  18. Improve bottom-line outcomes on claims by thinking outside-the-box! February 9, 2010

    Posted in Best Practices, SPOT on Issues.

    Tweet Claim handling is just as much an art as it is a science. Synthesizing facts and investigating losses requires, not only following process and procedures, but also the ability to look at new ways of solving established problems. Following best practices is of course an effective way to achieve consistently good claims results. Regardless, […]

    1 comment
  19. 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
  20. 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
  21. A checklist of the 8 critical issues to be concerned about when self-managing claims January 25, 2010

    Posted in SPOT on Ops.

    You self-insure, but how well do you manage claims? Companies make decisions to self-insure their risks for a variety of reasons from financing to claims control. Regardless of the reason, when handling claims in-house it is important to manage those claims in an organized manner to protect company assets. Insurance and reinsurance companies use loss experience to determine what to charge for coverage as well as how much coverage is needed

    1 comment