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Tag Archives: Claims Operations

  1. 3 Types Of Claims Metrics Every Department Should Be Looking At February 12, 2016

    Posted in Claims Technology, SPOT on Ops.

    Good news! – claims departments are now flooded with great data.

    Seems like great news doesn’t it. It is great news, or can be, if you’re using the data to help improve the operations, lower cost or predict the future. However, many firms aren’t using the data they have to provide valuable information for the operation. With the advent of more modern claim technology there has been a push to input more and more information about claims.

    1 comment
  2. 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
  3. Part 3 on Leadership: Challenges and Assistance in Leading Change March 25, 2014

    Posted in Strategic Planning.

    In Leadership: The Change Process In Claims Requires A Different Approach, I put forth the position that changing a claims organization needs a new brand of leadership skill that does not usually exist in the traditional claims organization. In Part 2 on Leadership: Developing a Strategic Transformation Team, I addressed how to break from existing management process to achieve effective strategic results. In the final installment, I discuss how challenges around leading change make it beneficial to bring in strategic support to help achieve the desired success.

    No comments
  4. Part 2 on Leadership: Developing a Strategic Transformation Team March 17, 2014

    Posted in Strategic Planning.

    Breaking from the linear approach to management is the key to leading Strategic Transformation. A standard organization will have a head of claims and then a variety of department heads to manage each line of business. Depending on the company there may be additional senior managers to handle various operational aspects of the group, which may include support staff, call center, technology and data analytics. Under this method, projects get initiated and managed within the same linear organizational framework. The result of this approach is a development process built in a silo that limits input and understanding of possible interdependencies that may exist outside the framework. In this post we will explore further how a strategic transformation team is formed and can be effective.

    No comments
  5. Leadership: The Change Process In Claims Requires A Different Approach March 10, 2014

    Posted in Strategic Planning.

    Successful organizations are always changing and adopting to improve their operations, lower costs and increase efficiencies. Claims departments are no different and have been under pressure to transform their operations and live by the mantra of doing more with less. Good claims organizations continuously evolve and adapt to ensure they add value to the overall business. Regardless, changing to meet the challenges of the marketplace is often fraught with problems and difficulties. Many initiatives fail to get off the ground or fail in the implementation process. Change can be very successful and if managed and led correctly. To change effectively there must be a strategic approach and a change in how these initiatives are led.

    No comments
  6. Claims Challenge: It’s Time for a Change – Are You In? January 14, 2014

    Posted in Commentary, My SPOT, Strategic Planning.

    Here’s a challenge! Let’s redesign the claims industry. Yes innovation has improved the world of claims over the past few decades to make claims more efficient. As recent catastrophe’s have shown, the industry is much better at responding to losses than in years past. Regardless, claims functions in an assembly line approach. This has of course been a huge improvement and like manufacturing has helped to produce a better more consistent product. Today’s world allows us to collaborate more so my challenge is to tap into your collective experience and come up with even better ideas. What do you think?

    No comments
  7. 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
  8. 3 Ideas To Prepare For The Completely Unexpected: The “Sandy Contingency” November 28, 2012

    Posted in SPOT on Issues, SPOT on Ops.

    Preparing for the unexpected is always the core of any disaster recovery plan. Regardless, the Sandy “Super Storm” created a series of events that few truly every contemplated. It was a scenario that strained many businesses and exposed a number of weaknesses in disaster recovery planning. Unlike prior events, Sandy left a wide are in surrounding a major metropolitan city without power, fuel and public transportation for long periods of time. It’s time to rethink plans that don’t take into account a Sandy Contingency. Tell us what type of planning you have done too and share those ideas with others looking to learn from this tragedy.

    1 comment
  9. 2 Preventative Steps To Help Avoid Claims Crisis Before They Become Emergencies June 11, 2012

    Posted in Best Practices, Commentary.

    Seth Godin in his wonderful blog recently wrote about Emergency room doctors in organizations. These are the people that are really good at and are rewarded for stopping bleeding. Seth is questioning where all the strategic thinking to prevent those emergencies in the first place? In claims we tend to hire and support that emergency room doctor mindset. Despite this, we can avoid becoming emergency rooms and be more proactive strategic organizations. In our latest post we explore possible solutions to be less reactive.

    2 comments
  10. Insanity: Claim’s Departments Can’t Expect Different Results Without Changing Their Organizations May 9, 2012

    Posted in Commentary, My SPOT.

    Maybe I care too much about our industry or am just frustrated by the lack of attention to quality claims handling, but this is annoying. Why should claims make up half of the most frequent market conduct issues for the Property & Casualty industry as listed by Wolters Kluwer for the 5th straight year? As part of their review they track and analyze the results from state market conduct examinations. As with their prior studies, claims issues continue to dominate the list of state concerns. In my latest post I analyze the last 5 years of the Wolters study and find an upsetting trend – nothing is changing. This is a challenge to claims organizations to improve! Check it out.

    7 comments
  11. What Would Steve Jobs Do In A Claims Organization? March 15, 2012

    Posted in Best Practices, Claims Technology, SPOT on Ops.

    So what would Steve Jobs say about our claims industry? Well, having heard about his reputation I think I will leave what he would say out of this post. Regardless, I think Mr. Jobs would see an industry with tremendous opportunities to innovate and improve the way they deliver and manage claims services. In our most recent post, we explore a claims world in as it may be in the world of a master of product design and marketing.

    No comments
  12. There Is No Such Thing As A Pro Forma Signature On A Document – If You Sign It You Own It October 6, 2010

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

    Doing things for the sake of doing things can have significant adverse consequences for an organization. It is important to realize that one day you may have to answer for every action you take on a claim file. The concept of how doing a pro forma task can come back to bite you is being highlighted as a yet another fallout of the mortgage crisis. Tens of thousands of foreclosures are being halted because of a process in place where an individual just signed hundreds of documents without ensuring the information contained on the documents were correct.

    Clearly, doing something for the sake of doing something can really have negative consequences for the organization. In our latest post we offer questions to ask when signing documents. Controls are important, however, if they are not adding value they should be reviewed.

    1 comment
  13. Increasing Claims Satisfaction Doesn’t Mean Increasing Staff July 21, 2010

    Posted in Customer Service, SPOT on Ops.

    Is it possible to increase claim satisfaction and decrease cost at the same time? Many claim representatives say no. Some view that satisfaction is driven by the ratio of adjusters to claims – having more people to handle claims means higher satisfaction, although also higher loss adjustment expense. Some believe that higher settlement amounts result in higher satisfaction and higher loss costs.

    As the Claims SPOT welcomes new contributing author, Melissa Loew, see how customer satisfaction can be addressed in tight staffing markets.

    5 comments
  14. Is Your Caims Department Becoming A Bus Company? May 12, 2010

    Posted in Commentary.

    Claims departments can get into ruts and begin to act like bus companies. As Seth Godin, business author, recently wrote in his blog – “We all have a vision of the typical bus company, slowly moving people from place to place, going through the motions and showing a lot of fatigue.” In this weeks post, I point to some ways claims department can avoid the bus company mentality and figure ways to stay fresh and motivated.

    No comments
  15. 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
  16. 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
  17. 2 Cost-Cutting Solutions To Get Work Done Without Overloading Claims Handlers March 31, 2010

    Posted in SPOT on Costs.

    Too Many Tasks, And Hiring New Staff Is Not An Option? (Part One of Two) Not every company can afford to hire dedicated teams to focus on cost-saving initiatives such as subrogation or Anti-Fraud. Sometimes there is simply not enough work to justify a full-time position internally. Regardless, failing to focus on cost-saving programs can […]

    1 comment
  18. 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
  19. 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.

    No comments
  20. Absence of procedures to notify reinsurance is a basis for bad faith February 17, 2010

    Posted in Bad Faith, Best Practices, SPOT on Issues.

    Recently I was discussing bad faith and notice procedures with attorney Phil Loree Jr., an expert on reinsurance and arbitration issues and author of the the Loree Reinsurance and Arbitration Forum blog.  I thought this was a timely conversation as it reinforced the concepts regarding procedures and the potential risks when they are not in […]

    6 comments
  21. 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 […]

    2 comments
  22. 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
  23. 5 expense reduction opportunities insurance CEOs should not overlook January 27, 2010

    Posted in SPOT on Costs.

    Increased profits come from efficient claims operations: Take a look at that annual reports of the top performing insurance companies and you will see a similar message from their CEO’s. Expense management and efficiency is a principal driver of profitability.In a tight market do less with more without sacrificing quality and significantly customer service is the edge needed to be a top performer. The claims department is the perfect place to lower costs and improve the customer experience at the same time. Here are 5 key areas that should be looked at for cost savings.

    No comments
  24. 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
  25. With old claims systems come old claims processes – You can’t change one without the other! January 21, 2010

    Posted in Claims Technology, SPOT on Costs.

    So you need a new claims system You know the darn thing doesn’t work or do what you want it to do so what’s next? You can’t just go out and buy a new system without understanding what your current process looks like. Over the years you have adopted your operation to your existing technology.  […]

    2 comments