Tag Archives: Claims Staff

3 Ideas To Prepare For The Completely Unexpected: The “Sandy Contingency”

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Time to revisit those disaster plans!

As much as one can prepare the reality is you never believe the worst will happen until it actually happens.  The tragedy of 9-11 was my first hands-on experience in dealing with initiating a disaster recovery plan.  Despite being with a well established multinational insurance company with plenty of documented protocols for dealing with disasters, there were still lessons learned.

Unfortunately it seems that we have to suffer a disaster before we take the steps necessary to truly prepare for them.  The Sandy “Super Storm” has been the latest disaster to expose weaknesses in existing plans – assuming of course you had a plan to begin with.

The “Sandy Contingency”

I have termed having to prepare for the completely unexpected event such as Sandy as preparing for a “Sandy Contingency.”

Back in February 2010 I wrote in Blizzard Warning in the East! Can your claims department keep running if the office closes? about preparing your office in case of disaster.  Clearly the recent events of “Super-storm Sandy” made me revisit the subject. Unlike other events, the Sandy storm really brought the worst possible scenarios together in one event.  Buildings flooded, transportation went down, gas shortages grew, and several areas suffered extended power outages that lasted for weeks. While coastline areas are still dealing with the storm, and will be for months and years, many of the business areas are finally getting back to normal.

The insurance industry, like many, faced challenges from a business operations perspective. While companies instituted there well managed disaster recovery plans, the widespread nature to a major metropolitan area exposed weaknesses in these plans.  Insurance companies extensively prepared to manage an influx of claims, knowing how to deploy resources to disaster areas and trained to initiate those plans.

Large insurance companies with multiple claims office locations across the country could deal with local offices that were impacted. However, smaller carriers with local operations may have prepared well on how deploy adjusters to the disaster areas, but they likely did not expect to have problems with their claims offices 20 miles from the coast.

Other entities that one would have expected would have been prepared for a large storm also found how unprepared they actually were when faced with the Sandy Contingency.  A major hospital in New York lack of preparedness forced mass evacuations of critically ill patients and created a ripple affect to surrounding medical facilities forced to take in an influx of patients. (see Sandy Exposed Hospitals’ Lack of Disaster Preparedness).

So what was learned? Sandy exposed the unexpected

The Sandy Contingency will dictate the need for a new approach to disaster planning. Often times the disaster plan deals with a single event that causes a disruption in an area for a relatively short period of time or one location for a long period of time. Sandy showed us a disruption in a large area for a long period of time. This was further complicated by the fact that almost no one dealt with a 1 in a 500 year scenario in an place such as the New York Metropolitan area.

The three things that stood out to me the most that I would never have thought were going to happen were:

  1. Extensive power outages lasting more than a week.  It took almost a week to restore power to half of Manhattan and even longer to areas within a 100 miles of the city. This widespread power outage meant that business with back up locations within that area were still unable to get running.  The “we have great technology and our employees can work from home” plan proved to be useless in many instances as there was no ability to work from home without power or Internet connections.
  2. Transportation disruptions went beyond some minor inconvenience.  Public transit disruptions and gas shortages lasted weeks and made it extremely difficult to get employees back into the office or to remote locations. The impact on such a wide area exposed holes in many contingency plans. The restoration of power and services alleviated some of these issues and allowed people to work from home, however, the difference wasn’t felt for at least a 10 days. Did businesses really expect to have a complete office down for 3 days? 5 days? 10 days?
  3. Flooding in places that you would never expect.  I am not sure many business in lower Manhattan expected extensive flooding to inundate basement facilities and significantly damage electrical service at the building.  Some buildings lost not only electrical equipment but their entire HVAC plant. Some of those office are still closed and will be for months. And while lower Manhattan should have expected the possibility of basement flooding, I don’t think anyone thought how extensive it would be.

So how can we improve our planning?

Here are 3 suggestions to consider when preparing for the Sandy Contingency

  1. Think about crazy possibilities.  It’s time to put away the “that won’t happen here” mentality and figure all bets are off the table. Assume tornadoes in a non-tornado prone area, earthquakes in a non-seismic area, and flooding in places you never thought of. If Sandy showed me anything it was that holding to ideas that it can’t happen here is a dangerous way to plan.  I know some of the planning around the doomsday event may seem silly, but it’s worth having the discussion and some form of plan.  Does that mean we plan for alien’s attacking the Earth? Maybe not, but using some of the crazy Hollywood movie plots may not be an absurd way to think of possible scenarios.
  2. Is your back up area really far enough away?  100 miles was not going to help get your business up and running in short order if your office was in Lower Manhattan and your back up office was across the river.  When you factor in the regional power outages neither was the “work at home” a viable solution. Redundancy plans have to consider the possibility of moving people greater distances in the short term. That may mean factoring in office space and lodging for a few key team members in a location in excess of 100 miles.
  3. Practice. Practice does make perfect. Practice also will allow you to test even crazier events to see what problems might come up. A few years back I participated in a Government test regarding preparedness to handle a pandemic virus.  Each day we received a new set of events (i.e. transportation shut down, martial law imposed, hospitals shutting down) that we were asked to deal with and discuss how we were to handle our operation. Even with a well honed plan we were found some weaknesses and areas to improve.  Mock disasters are a great way to perfect your plans and expose your weaknesses.

I am not naive to think we will never have to deal with a another Sandy Contingency again.  Whether you believe in climate change or not, we seem to be suffering from 100 year events every 5-10 years. We have to break from the
that can’t happen here” thinking and prepare for a wider set of potential circumstance. The more we prepare for the unexpected the better chance we have of limiting the effects.

What lessons did you learn from Sandy?

 

Why Extending More Claims Authority Means Extending More Responsibility

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How much authority is too much authority?

Extending authority to claims personnel is always a difficult exercise. 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.

Any small increase in authority can really add up. For example, if you extend an additional $10,000 in authority to a claims professional who gets 10 new claims a week you are giving them the responsibility over an additional $5.2 million per year.  Do that for ten claims professionals, and that group can commit an additional $52 million per year to the company.

The inverse claim volume and value relationship

It is fairly well common in the industry that there is an inverse relationship between claim volume and the claim value.  A common example would 80% of the total incurred is found in 20% of the claim volume.  This would also mean the 80% of the claim volume is managing 20% of the incurred. Regardless of the exact split, this would mean that most of the claim volume is being handled by junior claims professionals.

In most companies the top valued matters are very well reviewed and examined. Those claims have to move up through the authority chain, and are seen by managers, specialists and executives, and in almost all occasions, are well worked up.  The lower value claims, however, are usually assessed and moved quickly with less scrutiny and review by senior managers.  Many claims of lesser value speak for themselves, and do no not require the work up or intense scrutiny that is needed in a multimillion dollar loss.

The lower level claims are the training ground for the industry and allow a claim professional to walk before they run with a more significant matter. Despite their individual value, the lower level claims add up. How much authority to extend is often an arbitrary matter determined by the level of the examiner. A junior examiner gets $10,000 and senior examiner $50,000 and so on. However, extending authority should be an exercise on how much responsibility the particular claims professional can handle.

The example above shows that even a moderate increase in authority can significantly affect the company’s financial outcome.  When authorities are left too low, however, there is more pressure on management and a greater risk non-value added duplicative work.  Claim professionals will have to prepare additional internal reports, consult more with attorneys and set up and attend meetings even to get a nominal increase. This creates an operational burden as well as higher costs.

So what is the big deal about extending more authority?

The authority goes up and so does the spending

Back in the day I was at a company that had a relatively new book of business that had not developed. Because of this, management made a decision to restrict the amount of authority extended to claim handlers and managers. As the book aged, as was expected, there was an increase in the number of larger claims. With authority levels relatively low, there was a delay in raising reserves and moving files. To alleviate any backlog, authority levels were increased for claim handlers as well as the threshold to present claims to senior management. The process worked and claim reserves were increasing when they needed to and files were moving to resolution. All seemed to be a success until a deeper look at the numbers told us a different story.

A close look at the numbers several months later revealed an interesting trend.  Average payments made within manager’s higher authority level were no different when compared to the pre-authority increase. This was a good sign that, at that level, there was a consistency as to how claims were being resolved. Unfortunately, the results were not as consistent at the lower levels. With an increase in authority came an increase in the average claims being paid out.  Lower level claim handlers were resolving more claims, and were doing it at higher level. While the study could have looked deeper at the total costs to see if this resulted in lower expenses due to quicker resolutions, what was clear was that with more authority came a willingness to spend more.

Where was the failure? Was it management extending too much authority? Was it the claim handler trying to resolve cases faster to move files off their pending? Did giving the ability to get a case resolved, without having to write up and present it, give too much responsibility to the claim handlers?

No matter the exact reason for the numbers, lessons could be learned and the one that stood out for me was don’t extend authority without extending responsibility.

What it means to extend authority with responsibility

Responsibility and authority are two different things and you cannot extend one without the other. With increased authority comes increased responsibility. In other words, as you extend more reserve or settlement authority to more junior employee it is important that they understand the increased responsibility that comes with it. They are becoming “keepers” of a larger part of the pie, and if they can manage that responsibility, then extending authority is appropriate. Blanket increases in reserve authority by a claims professional’s title, or years of experience, is not the best way to determine whether they will have the understanding of the responsibility behind that authority.

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. Interview your claim professional before the increase is extended and see how much they truly understand about the responsibility more authority will bring.  Ask them how they plan to protect the company assets while remaining compliant with fair claims practices. Reserves that need to go up, and claims that need to be settled, still need to happen, but it should happen when the claim professional understands what an increase in authority means. When this convergence of authority, understanding and responsibility occurs, then the increase in authority is warranted.

Spend the extra time ensuring there is an understanding of the responsibility of increased authority and you will create better claims professionals.

What steps do you take when extending authority?

Promote Creative Thinking To Get The Most Out Of Your Claims Staff

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So how do you train the next leaders in claims? How about challenging their creativity!

If you do not know about TED, I strongly recommend you take a look. To quote them directly:

TED is a small nonprofit devoted to Ideas Worth Spreading. It started out (in 1984) as a conference bringing together people from three worlds: Technology, Entertainment, Design. Since then its scope has become ever broader.

I recently watched the clip below from the TED archives and was so fascinated by the concepts I just had to relate them to claims.  Good workers are sometimes all that claims departments look for and, given the nature of claims these days, it is not a bad thing. There is so much to do and so little time to do it and good workers, however you define them, are great to have. But how often are creative thinkers found and rewarded?

I am a big proponent of new ways of looking at claims and trying to get people to think out of the box (see Change Hats With Someone And Free Your Mind To Make Your Claims Operation Better and Is your claims department becoming a bus company?). With increases in technology, more claims specialization and the constant pressures on staffing, the ability to freely think, analyze and resolve claims creatively is being challenged.

Sir Ken Robinson is considered a “Creativity Expert” and led the British government’s 1998 advisory committee on creative and cultural education, a massive inquiry into the significance of creativity in the educational system and the economy, and was knighted in 2003 for his achievements. He has most recently published a book, The Element: How Finding Your Passion Changes Everything, which is a deep look at human creativity and education.

Good workers but not creative thinkers

Take a look at the video below with Sir Ken. He is truly and a dynamic speaker and the will engage you quickly.  In this clip, Sir Ken asks why don’t we get the best out of people? He argues that it’s because we’ve been educated to become good workers, rather than creative thinkers. Do you recognize that employee in your organization?

Two suggestions to help promote creativity

So how do you promote creativity? How do you get the claims staff to try new ideas? It is difficult to encourage creativity when claims have to be regimented and everything is being monitored and standardized. Regardless, there are ways to attack the creative mind to open up new ways to manage claims.

  1. Challenge staff to be more creative when looking at problems. When facing a difficult situation try and put together an old fashioned brain-storming session to allow free flowing ideas no matter how crazy. The idea here is to promote creativity and come up with new ways to solve problems.
  2. Another way to try and teach creativity is to tell war stories. Have a war story lunch and see who has resolved a claim in the most creative way. I am sure you will be surprised at how creative people are and retelling those stories will help stir the imaginations of others.

How do you think creativity plays a role in claims? What have you done to encourage free thinking?

Increasing Claims Satisfaction Doesn’t Mean Increasing Staff

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Looking At The End of the Rainbow For Your Claims Satisfaction Pot Of Gold?

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.

There is some truth to these views.  If having more people means that estimates are completed earlier, calls are answered instead of going to voicemail, and checks are issued faster, then satisfaction will likely increase.  If the higher settlement amount meets, but not necessarily exceeds, previously set expectations, higher satisfaction may result.

Drivers of Customer Satisfaction In Claims

But is hiring more people or paying higher settlements required to increase satisfaction?  Let’s look at some of the key drivers of claim satisfaction from the JD Powers survey:

  • Expressing genuine concern
  • Ensuring customer is at ease with the claims process
  • Giving customers a time line and meeting it
  • Providing flexible appraisal appointments
  • Answering all customer questions
  • Managing expectations regarding the settlement
  • Returning phone calls
  • Sharing information between representatives
  • Providing proactive updates
  • Avoiding negotiated settlements

Communication and Reducing Cycle Times Are Keys

Communication and cycle time are the key themes among these attributes.  Reduced cycle time generally results in lower costs for most industries.  And, there are many ways to improve communication in the claim process that can also reduce cost.  Take, for example, claim status.  In many companies the process goes something like this:

  1. Customer calls agent to inquire about claim status
  2. Agent calls claim adjuster because he or she can’t access that information in the system
  3. Agent calls customer

This is a simplified process that doesn’t reflect the phone tag that usually occurs.  Still, a minimum of three calls are required to answer a question that might have been answered on the first call.  Better yet, if the information were available online, no calls would have been required, saving agency and claim adjuster time as well as telephony costs.

There are many other examples of ways to reduce cost and improve customer satisfaction at the same time:

  • Automated email or voice updates on claim status to minimize inquiry calls
  • Expanded capacity in drive-in claim centers to reduce usage of field adjusters, a more expensive and lower satisfaction option
  • Earlier identification of total losses, typically a low satisfaction claim, to reduce storage and rental costs and overall cycle time
  • Work load balancing across claim offices to ensure timelier claim handling and increase staff utilization
  • Increased usage of non-exempt staff for inquiry calls as well as back-office functions to free up adjusters for more complex issues
  • Automation of any part of the claim process that results in reduced cycle time for the customer and reduced adjuster time

Clearly, having the right level of staffing and meeting customer expectations regarding settlement are important to maintaining or improving customer satisfaction.  But hiring more people or paying more than required will not necessarily increase satisfaction unless the fundamental communication and cycle time requirements are met.  Insurers would be better off focusing first on those opportunities that improve customer satisfaction and reduce cost at the same time – creating a “win-win” – as opposed to throwing money at a satisfaction goal, with negligible economic benefit.

How do you increase satisfaction without increasing staff?

In Claims Don’t Let The Process “Thing” Get In The Way Of Doing The “Right” Thing

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Making a check in the process won’t ensure the matter is done right

Mark Suster,  was the founder of Koral, a Palo Alto company which was sold to Sales Force. There he was VP of Product Management and then left to become a member of a venture capital firm.  He is also author of a blog called Both Sides of the Table and recently wrote about Doing the Right Things is More Important than Doing Things Right. In this interesting article he discusses how sometimes companies get caught up in “things”, or process, without worrying about the outcome. Tasks become the driving force not the outcome.

“When you hire people in functional roles they want to show that they’re achieving results and results are easiest to measure by tasks accomplished.  But many CEO’s and management teams fail to set clear guidelines on what the company objectives are and make sure that everybody is driving toward the same goal.  It’s actually quite hard to lay out an annual company strategy that is articulate and underpinned by facts.

So many CEO’s just carry on being … CEO’s –>  fund raise, get media attention, attend conferences, hire staff, “set direction”, whatever.  But this leads to organizational drift because staff will continue to produce “work.”

Everybody should be able to answer the question, “why am I doing this?”  Otherwise they’re likely to be doing things right, but not the right things.”

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

In a recent audit of a hospital system’s claims department I saw an excellent example of what happens when focusing on the doing things right resulted in something not being done right. The claims staff had been instructed, like most claim departments, to place notes in the file on various issues such as coverage, damages and liability. They had previously been cited for poor documentation so a priority was placed on ensuring notes were in the files.

While every file now contained a note, there was absolutely no independent thought to the claims handler’s comments. Almost all the notes had been cut-and-paste word for word from counsel emails. They even went so far to include the salutations and signature lines. One note I found was a complete doctor’s CV that went on for over 30 pages. This type of note taking added little to the claim file and provided no insight into the thought process and evaluation of their claims staff. It was another example where doing things right was not doing the right thing.

Another client required the claims staff to create detailed damage time lines regardless of the nature of the claim. Claims adjusters would spend hours completing outlines, and sometimes even outsourcing the reviews to others, whether the case needed the assessment or not. There was no review as to whether these time lines were adding value to the claims process. Instead of using the process as a tool it was turned into a requirement for the sake of doing a requirement.  Clearly the process was being done correctly it was just not the right thing to do all the time.

So the lesson learned is when focusing on process make sure the process is not the only thing that is being done.

How many of your processes are the “thing” getting in the way of doing the right thing?

Does Hiring More Staff Improve Claims? How To Know When The Time Is Right

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The Age Old Question: If I Add More Resources Will It Solve The Problem?

Alright, maybe the above is a little exaggerated, but it did remind me of how difficult the question of hiring more staff is. Whether it’s today’s or any economy, the decision to bring on more staff is one that needs to be watched closely.  Often there is a knee-jerk reaction that taking on additional staff will solve problems and improve your operations. As Dilbert points out so well, hiring more does not always solve the problem. As I wrote about in With old claims systems come old claims processes – You can’t change one without the other!, knowing what you have in place first is important before making an investment on more. This is true with staffing as it is with claims systems.

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.

What – No Staffing Model? Here Are Suggestions For Creating One

Having a staffing model will allow you to objectively look at your operation and help determine if it’s a good time to hire more staff. How do you know what model to choose? Here are 3 suggestions for creating one:

  • What kind of organization are you? Are you highly technical with low frequency, or are you in a high volume business? Are you a “touchy feely” organization that wants to be in the customers face often, or not? Understanding the strategic position of your claims organization is critical to understanding what kind of staffing model is relevant
  • Decide on a metric to develop your model: The metric you choose will help to determine the model, but will be wholly based upon the types of claims organization you are. If you are an excess carrier that is sharing risks and attaches at a high level, then you may not be concerned about the number of new claims that come in. Maybe your claims settle quickly, as in some property matters, so the number of new claims a handler receives in a month is a more critical metric. It will depend on you business and needs – come up with a number an live with it.
  • You now have the metric – test the staff and come up with the model: Once you settle on a metric, check your top performers against the new metric you have selected. How many files are they handling and still managing files within best practices? At what point does their ability to manage those files well breakdown? Take an average of the top performer’s metrics and you will have a staffing model to give you a benchmark.

Just remember that models are models and they tend to always look good on paper and in photographs – there is always the subjective that needs to be addressed. Regardless, the staffing model is a good management starting point.

So You Have A Staffing Model, How Do I know If It’s Time To Hire?

I am all for the staffing model, but sometimes it just isn’t enough to know when you hire. Don’t forget other claim metrics and trends. Is there a recent influx of claims due to a change in underwriting or because of a CAT loss? Understanding the rest of your organization is just as important when deciding to hire or not hire additional staff. Speak to your underwriters and learn if there has been some new marketing initiatives. Did they write some new account that explains an increase, or decrease, in claims frequency or severity? A blip in the numbers may be just that, a blip. Regardless, ask around and dig into your numbers to see if there is a short term explanation or whether it is the beginning of things to come.

Hold On, A Model Is Good, Knowing Current Trends Is Good, Understanding If You Really Need More Staff…..Priceless!

Even though you have the staffing model in place, and have looked at the metrics for the operation, there is more to explore before jumping in with new staff. Take a regular operational pulse of your entire organization. There is always room to look for waste and improve efficiencies. There are also ways to improve handler efficiency at a more minimal cost, as I wrote about in 2 Cost-Cutting Solutions To Get Work Done Without Overloading Claims Handlers and Cutting Costs Without Overloading The Claims Handler – Part 2 Of The Series.

Do a quick assessment of your operation and determine if there is some issue preventing claims handlers from getting their core job function completed. Maybe some older internal report that no one is using can be eliminated and free up a handler’s time.  Are they being asked to take on tasks that can be done more efficiently, and if so, what would the impact be in eliminating that task.  As organizations grow, process grows, and not always for the right reason. The potential need for more staff is a good opportunity to explore those processes.

Hiring more staff is an expensive proposition for any organization. Take time to truly explore what is needed. Once this done, and you can objectively know the need is there, then hire away.

(For good advise about hiring – check out my fellow blogger Jay D’Aprile in Talent Tracks)

What types of models does your organization use?

Are claim departments’ process and systems ready for the new “Freelance Nation” worker?

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Can claim departments handle the change in the American workforce? In his article The Future of Work; Here Comes Freelance Nation, insurance executive search consultant Jay D’Aprile speaks of a modern workforce that is freelance, temporary, or self employed. As he states:

There is an evolving belief that in the not too distant future, the majority of jobs will be structured as sort of an “on demand” arrangement. With this new concept employers will begin to shift work to a contract concept where talent will be treated much the same as a retailers supply chain. In the future needed skills will be added to a company in a just in time fashion. Then after a project, deadline or contract is completed that person who provided that skill will be released.Comments 1

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?

  • Do carriers have the right technology and sufficient procedures to manage the changing workforce?

  • How do you think claim departments need to adjust for the future claim professional?

What do you think? Post a comment and let us know.