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Category Archives: SPOT on Ops

  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. Breaking Those Competing Commitments To Change January 23, 2015

    Posted in SPOT on Ops.

    In life change happens and people adapt. In business change happens and people react. Those who are resistant to change are usually easy to spot and equally as easy to manage and therefore rarely derail a change initiative. However, it is the person that generally supports change and outwardly appears to be working for the implementation of a new initiative that can sometimes harbor a “competing commitment” that can have a more deleterious impact on the success of a new initiative.

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  3. 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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  4. 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.

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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. 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
  7. Claims Predictive Modeling: Using The Numbers To Improve Operations And A Change Worth Exploring August 22, 2012

    Posted in Claims Technology, SPOT on Issues.

    Claims Predictive Modeling (CPM) is one of the big buzz words in the industry. After a few decades of improving claims technology systems and creating vast databases of claims information, CPM is an attempt to use that information more effectively. In our latest post we discuss CPM and what it means to make changes to adopt this new metric.

    1 comment
  8. 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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  9. Everybody Wants to Make Improvements In Claims But No One Actually Makes It Happen June 15, 2012

    Posted in Claims Technology, Commentary.

    There is so much that needs to be done in the world of claims. Operations need fixing, technology needs improving and a futures need to be defined. For some reason however, we are all really good at talking about it and not so good about doing anything about it. The industry needs to take action. Claims departments need to think creatively and “out-of-the-box” if we are going to attract new talent to the industry. This also means acting and not just talking about acting.

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  10. 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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  11. 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
  12. 5 Must Haves To Consider When Implementing a New Claims System June 21, 2011

    Posted in Claims Technology, SPOT on Ops.

    Implementing a new claims system can be fraught with issues and concerns. It is important to understand the people aspect both before and after a system is put into place. At the end of the day the system must support people and those people should be involved in the process way before you go live. This week we learn 5 suggestions to assist in the implementing a claims system learned from Paul Tuhy, Global Head of Claims for XL Insurance who recently spoke about technology at the most recent Americas Claims Event in New Orleans.

    1 comment
  13. 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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  14. 5 Business Basics Every Claims Person Should Live By February 14, 2011

    Posted in Customer Service, SPOT on Ops.

    Ideas from successful business can be adopted in claims very easily if one takes the time to look. As we all know, claims folks have little time to look and that is where I hope the Claims SPOT can help. Sometimes claims organizations get so involved in the day-to-day that they have little time do the basics. However, concentrating on doing the write thing from a business perspective is the best way to succeed in claims. Expanding on Donna Flagg’s recent article Five Things They Don’t Teach You In Business School, we explore how those five things apply in the claims world. It’s common sense time in our most recent post.

    5 comments
  15. 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
  16. 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
  17. Getting Creative And Reducing Claim Costs Without Sacrificing Quality – Part II December 22, 2010

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

    Last month, Suzanne Ganier discussed the building blocks needed to reduce claim and litigation costs, while still maintaining a strong focus on quality. Those building blocks included:

    * collecting current data about your claims and litigation
    * evaluating the claim and litigation work itself
    * settling on a carrier claim and litigation handling philosophy

    In her follow up, Suzanne discusses how these building blocks create a foundation on which to build new processes and procedures that will reduce your claim and litigation costs, and maybe even decrease you volume as well. I refer this building process as looking at What I Have, What I Want, and What I See.

    3 comments
  18. Here We Go Again! CMS Postpones Deadline For P&C Mandatory Reporting Until January 1, 2012 December 14, 2010

    Posted in Medicare Secondary Payer, SPOT on Ops.

    For the second time the government has postponed the mandatory reporting requirements for carriers. The complex nature of reporting and several unanswered questions surrounding implementation and enforcement seems to have prompted the change. The costs associated to comply as well as the risk for improper or failure to comply has resulted in a new insurance product to protect those entities from liability due breakdowns in the reporting procedures. Learn more in the latest from the Claims SPOT.

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  19. Time to Get Creative – Reducing Claim Costs without Sacrificing Quality (or your sanity) November 22, 2010

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

    In an environment of increased pressure to reduce costs and close claims, bright ideas can help to reduce legal costs while still ensuring great service. In this article, litigation expert Suzanne Ganier speaks about the importance of understanding what you know and what you don’t, analyzing the strengths and weaknesses of those involved in the litigation process, and aligning those analyses with your organization’s philosophies. The result can be a litigation management process that reduces overall claim costs and preserves your sanity.

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  20. 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
  21. 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
  22. 3 Ways To Help Defense Counsel Help You Make Claims Management More Efficient September 3, 2010

    Posted in Best Practices, Litigation Management, SPOT on Ops.

    We all talk about collaboration with counsel as a means to get better results at a lower costs. But getting what you want is not so easy. How about trying to get what you truly need to get your job done. In our latest post, we discuss three suggestions for helping counsel help you get better results. No attorney is going to say that they don’t want to make a claims professional’s job easier, so help them to help you. Start by telling them what you do, ask for what you want, and then make sure they do it. Take a look at the latest – from the Claims SPOT.

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  23. Quick SPOT: 6 Security Tips To Keep Portable Technology Safe For Claims August 27, 2010

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

    If you are like me you keep everything on your laptop and cell phone. Numbers, corporate information, claims data, and even some of the dreaded non-private personal information of others. Claims data is filled with information that if lost or stolen could be detrimental to both the company and the individual. Many companies today issue corporate cell phones and blackberry devices as well as laptop computes in place of desktops. It’s a modern world and we are all expected to be connected. Partial work at home arrangements also mean this information is traveling from location to location which can increase the risk that things may be lost or stolen.

    Take a look at these suggestions to help keep your claim information safe and secure in the latest post from the Claims SPOT.

    1 comment
  24. 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
  25. 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