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Category Archives: Best Practices

  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!

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  3. Kindergarten Management: Getting Back to the Basics June 10, 2013

    Posted in Best Practices.

    Everything we know in life started back in kindergarten. Kindergarten is where we learned to socialize in groups, lived by rules, played well with others, managed time, took turns asking questions and listened to authority. Success and creativity were rewarded and failures became further learning experiences. The more I thought about this recently the more I realized that kindergarten is a perfect example of a well-functioning organization and management.

    We can lean a lot by going back to kindergarten. Bear with me take a look how this would apply in a claims department.

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  4. 3 Things Good Claims Professionals Won’t Do January 24, 2013

    Posted in Best Practices.

    I have audited a lot of claim files over the years and one consistently good claims professionals manage their claim files following best practices. And when looking at these files there are certain patterns that develop. Good claims professionals don’t fail to document, assume things they don’t know and always stick to the basics. Our latest post gives three examples of things NOT to do to become a good claims professional.

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  5. 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
  6. The 5 Core Leadership Traits Of A Well Managed Claim File October 8, 2012

    Posted in Best Practices.

    Leadership is a topic that we tend to think about as it relates to an individual leading a group. In claims we are always faced with leaders that manage us and help, hopefully, to get the best out of us. But leadership does not mean that you have to have a group of people that follow. There are 5 core traits a good leaders show. In our latest post we connect those five traits to 5 traits a good claims file, when handled well, will show.

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  7. A Claims Tale Of Three Little Managers And Their Review Programs June 20, 2012

    Posted in Best Practices, Claims Auditing, Compliance, SPOT on Issues.

    We have all head the story of the 3 little pigs but have you heard of the 3 claims managers? The Manager of Straw, the Manager of Sticks and the Manager of Bricks are all motivated to do the right thing but they go about it in very different ways. One had no program in place to review their operation, one had a basic process in place and one used a detailed program to review claims. Read on this story and see how problems occur and are managed differently.

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  8. 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
  9. 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.

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  10. Why Don’t Claims Organizations Track Claims Through The Process The Way UPS Tracks A Package? December 28, 2011

    Posted in Bad Faith, Best Practices, Claims Technology, Commentary, SPOT on Costs, SPOT on Ops.

    Today as a customer you can track your packages from the moment they leave the store to the second they arrive at your door. During that time you can see where they are in the process. Truly amazing. Why can’t claims organizations do the same thing? How much better would a claim be if we could track it through the system in the same way UPS can track a package. Something to think about when reading the latest from theClaimsSPOT.

    2 comments
  11. 2 Problems To Prevent Before They Get Out Of Control: The Lily Pads Revisited December 7, 2011

    Posted in Best Practices.

    Waiting to the last minute can be a costly venture. In out latest post we tell the story of the farmer who waited to clear those innocent lily pads from his pond. He kept going on to what he thought were more important things. Unfortunately he waited to long and the lily pads took over the pond and cost him a lot more to clear. We all have lily pads we don’t want to clear from our desks. It’s time to look for them and clear them off before they strangle the life out of your pond….I know a little poetic but read on and you will get the idea.

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  12. 2 Company Types And Their Approach To Claim Audits: The Have To’s And The Wants To’s  November 9, 2011

    Posted in Best Practices, Claims Auditing.

    Companies can choose to audit because they have to or choose to audit because they want to. Companies that want to audit are destined to provide better customer service, happier employees, and improved results. Our latest post asks the question: Which company are you?

    1 comment
  13. 6 Ways To Conquer Procrastination – A Primer For The Claims Professional August 17, 2011

    Posted in Best Practices, SPOT on Issues.

    Continuing with more insight from the Business Insider War Room, our most recent post deals with ways to fight procrastination. One of the hardest things to do sometimes is avoid distractions and focus on the work. Claims can be exceptionally exciting but at times can be rather repetitive. Working to deal with those times of procrastination in a positive way will help you become a better claims person. Take a look at these ideas and let us hear from you about others.

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  14. 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
  15. “Summer’s Here And I’m For That” With 2 Ideas To Improve Your Claims Operations July 11, 2011

    Posted in Best Practices, SPOT on Issues.

    It’s another summer and it can be a slow time for many. Don’t waste the opportunity of a slow time period to improve your operation. In our latest post, we suggest 2 ways to make your claims organization better. First we write about developing a better claim review process and create a value added claims auditing process that goes beyond crossing the “T”. Second, conduct a worklow audit and you will find hours of wasted time for those working even the most basic tools such as Excel or Outlook.

    1 comment
  16. 3 Ways to Make Your Claim Notes Better May 11, 2011

    Posted in Best Practices, SPOT on Issues.

    Recently I have been spending a lot of time auditing claim files. It’s really a great exercise to review files, and an important part of well-run claims organization. One thing that continues to amaze me is the number of files that have poor documentation. Writing good claim file notes are an important part of handling a claim file. Claim notes record the history of what is going on in addition to the reasoning behind claims decisions. Good claim notes tell a story.

    In our latest post we discuss three suggestions to make claim notes better.

    4 comments
  17. Continuing Education Is The Path To An Improved Claims Operation April 19, 2011

    Posted in Best Practices, SPOT on Issues.

    We at the Claims SPOT are committed to promoting continuing education within our industry. As part of that commitment we have teamed with the Americas Claims Event as a media sponsor to promote the conference. Expanding claims knowledge is a critical part of any successful operation and at the ACE Conference you will learn new trends from the best and the brightest in the industry.

    1 comment
  18. Claim Reviews Empower Better Decisions By Putting Critical Information In Hand March 30, 2011

    Posted in Best Practices, Claims Auditing, Compliance, Due Diligence, SPOT on Ops.

    Insurance is as much about having the right information at the right time as anything. Whether it’s an underwriting choice to price a risk correctly or a claim decision as to when to a play a claim, having the best data available can make or break an organization. Despite this fact, many organizations fail to take advantage of tools and rights available to them prior to making critical business decisions. Claim reviews are empowering tools to help make better decisions. Staying ahead of the competition and managing risk is a key component of any any successful organization. The claims review allow decision makers to have the most available data to make better decisions. In this weeks post we discuss 8 reason when they should be done and speak to going beyond the claim files to fully understand the substance behind the numbers.

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  19. Claims And A Half Plate Of Vegetables – Teachings From The New Dietary Guidelines February 3, 2011

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

    Recently the government changed the way the public should look at nutrition through simplified messages like “eat less.” Simplicity and looking at the obvious in an easy to understand way is a tool that would go a long way to helping the claims professionals be better at what they do. Being understandable and actionable can only be a good thing in claims. In our latest post, we discuss how trying to use visual cues when handling a claim or looking at the claims process can benefit today’s professionals. We are a visual society – time to shift some of those visual cues to claims.

    2 comments
  20. Looking Back On 2010 And Forward To 2011 In The World Of Claims December 31, 2010

    Posted in Best Practices, Claims Technology, Commentary, My SPOT, SPOT on Issues, SPOT on Ops.

    The year began with continued economic concerns, a poor job market and no recovery in sight. It has come to a close with a booming stock market, improved job numbers and a better outlook for 2011. Looking back on the year in claims and looking ahead to the future of claims is always a fun exercise this time of year so here we go! The Claims SPOT adds to the debate about the past and the future.

    Thanks for reading and have a happy and healthy holiday season and New Year!

    2 comments
  21. 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
  22. 3 Perspectives On The Use Of Social Media In The Claims Investigation Process October 25, 2010

    Posted in Best Practices, SPOT on Issues.

    Social medial sites like LinkedIn, Foresquare and Facebook are becoming a regular common experience in today’s world. With increased use is information that regular people put online that is available for review and scrutiny. In today’s post we discuss the use of these sites in the investigation of claims from the perspectives of attorneys, claims professionals and investigators. Summarizing a recent discussion on the Insurance Professionals group of linkedIn, it provides and interesting perspective on how these sites are very much being used in the claims process today.

    2 comments
  23. 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
  24. What are your towing and transport processes costing you? September 14, 2010

    Posted in Best Practices, Claims Technology, Customer Service, SPOT on Costs, SPOT on Issues.

    Claims organizations have long recognize the power of vendor networks. Direct Repair Programs are an easy example. New technology and new providers allow those same benefits to be applied to vehicle transport management, where a primary goal is to reduce vehicle storage costs. In fact vehicle storage costs can be a major component when evaluating the overall costs of non-drivable vehicles. This article highlights what to look for in evaluating your current process and how you can hone in with almost pin-point accuracy on this previously less-managed area of cost expenditure.

    1 comment
  25. 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.

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