Tag Archives: Opportunities

Kindergarten Management: Getting Back to the Basics

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GettyImages_165879441Guess What – Good Management And Organizations Are Like a Smoothly Run Kindergarten

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 and let’s take a look how this would apply in a claims department.

Relating to others

As in kindergarten, managing claim files effectively requires the ability to socialize well with others both inside and outside the organization. The good claim professional knows how to get along with his or her peers and relates well to claimants who are facing some kind painful loss. In addition, to be a successful claims professional it is important to be able to work well in teams and share and learn from the group. All quintessential lessons learned in kindergarten.

Time management

Time management is a key element in handling claims. Like kindergarten, everything needs to be done at a specific time. With large caseloads and ever increasing demands, the effective claims professional manages their time very well using diary reminders and focusing on the tasks at hand. A well-structured day allows the claims professional to address file demands in a consistent and timely manner.

Controlled creative thinking

Kindergarten encourages a controlled environment with guidelines that still allows for the expression of creativity. Think finger painting. Finger painting allowed one to be wildly creative but still had to be done on the specific paper, in a specific area under certain rules.  Best practices are frameworks that good claims handlers follow to ensure they are managing files in a timely and fair manner.  Regardless of the claims guidelines or best practices however,  creativity in thinking and managing files is essential in achieving some of the best results.  Out of the box approaches to challenging claims issues are welcome and these creative approaches make for very successful operations (see Improve bottom-line outcomes on claims by thinking outside-the-box!).

Rewarding success and learning from mistakes

Kindergarten is about establishing the framework for children to succeed in primary school and ultimately in life. Successes are actively and openly rewarded and shared with the group. Conversely, failures and mistakes are not punished but rather used as learning experiences to encourage and promote improvement. Good claims managers work the same way and openly praise success and work with mistakes to make people better and foster improvement.  It is important to have both. While this is business and there are certainly instances where continued failures must have consequences, regardless, working to correct mistakes often creates a more cohesive high performing organization.

Let’s be clear, Kindergarten Management is not saying employees are children and needed to be treated that way. That is not the message here. Kindergarten Management is going back to the basics and working to foster a fun but controlled working environment that encourages the overall development of not only the individual but the group as a whole.

What other lessons from the past would be good examples of how management?

 

3 Things Good Claims Professionals Won’t Do

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Lider of team.Follow what good claims professionals don’t do and you will lead the pack!

Recently I read an article about things doctors won’t do when it comes to treatment and procedures for themselves. It included things like not having their first child at home, getting a PSA screening test, or taking sleeping pills. Since it is highly unlikely they will sue themselves for malpractice, these are treatments they believe might be adding little value or could cause harm. While managing a claim file is certainly not like managing your health, it got me thinking (which is never a good thing) about what a good claims professional won’t do.

I have audited a lot of claim files over the years and consistently good claims professionals manage their claim files following best practices. And when looking at these well managed files there are certain patterns that develop.  I found that there are three things that good claims professionals won’t do and they are:

Fail to document:  The best claim files are concisely and appropriately documented regularly. When reading a file the claim should speak for itself and tell a story as to what the issues are, potential pitfalls, and an understanding of the plan to resolve the claims. Good documentation is concise, free from extraneous commentary and reflects an understanding of the issues. Recording the events surrounding the claim is part of a well managed file and a good claims professional would never fail to document their file.

Assume this file is the same as the last one: Claim file management requires an understanding of the liability to the company and exposure to the insured, value of the loss and a plan to resolve the matter. Good claims professionals won’t skip any of the key steps needed to evaluate their files. If there is one thing that is consistent across all claim files it is that every file is different with different facts and nuances. One cannot assume that because one case had a certain outcome or facts a similar case will follow the same pattern.  No matter what the issues are the best claims professionals never assume things they don’t know and never assume the file was like the last one.

Stick with the basics: There are no short cuts to getting to the bottom line. Claims professionals are always growing and learning and tyring to improve their craft. Sticking with basics won’t help when a new claim throws in a curve ball. One has to work outside the box looking for new ways to understand a claim or resolve a difficult matter. Trying to go beyond the basics is one reason handling claims can be so interesting. Previously we posted about thinking outside the box about innovative ways claims can be managed.  This post generated over 40 comments in the Linked-In Claims Management Group.  The reason for all the comments is that good claims professionals don’t just stick with what they know and wanted others to learn from what they had done (and maybe one up one another with a better war story).

Good claims practice is about common sense. Like any business it is important to grow and learn and adopt to changing environments. Good claims professionals are always looking for new ways to make sure that they are providing prompt service to assist their clients to secure fair compensation where appropriate.  Seek out the good ones and learn from them!

What are other things that good claims professionals don’t do?

3 Suggestions To Beat The Summer Slow Down In Claims (If You Do Slow Down)

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It’s nice to spend time on the beach, but use the summer slow down to make some improvements

Let’s face it – no matter how busy your organization is, come August often times things begin to slow down. It seems everyone is on vacation, and while there is less coming in, there is still much to do. Now is the perfect time to clean up messes and get set for the fall push.

1. Managers & Supervisors

The summer is a great time to work on performance and training issues with your claims staff. With courts slowing down, fewer crises to deal with and less phone calls to take, now is a good time to work with claims handlers to get stronger. Even if your performance reviews are not due for several months, spend some of the extra time you may have to look for learning opportunities. Help claims handlers clear some “dead wood”, and mentor them to reach new goals for the future.  With the extra time there will be fewer interruptions and spending some of that extra time encouraging a handler to look for new ways to excel will benefit everyone.

2. Claims handlers

Wouldn’t it be nice to clear all those tasked items and clean your desk up. It’s been a busy year and things have been piling up. Emails, reports, bills,  and closings are just a few of items that can so easily stack up on a desk that need to be dealt with.  Pick a few items to clear from your long list of tasks and try and get to a clean slate. Here are a few more suggestions:

  • Clear the email folder and organize that in box so the email cascade can be more manageable
  • Look at your pending for older files that can use a little attention, or even better, be closed. Sometimes those older files just need a little push to get them to to the next level. Use any slow down time to reduce that file count.
  • Get through your snail mail. Yes people still send mail the old fashion way and if you spend a few hours a week cleaning and filing away that stack of papers on the the corner of the desk you will be better off before the next push.
  • Meet with your manager and look for opportunities to learn and improve your skills.

3. Claims Executives

Time to break out the strategic plan.  When was the last time you looked into the future? Don’t wait for Lilly pads to take over the lake (see my posting You Can’t Wait Till The Last Minute To Improve You Operation – Planning Starts Now!) take a look at future issues now. Explore your technology needs and look for opportunities to improve your operation. Focus on some key areas to target for lowering costs such as in areas of subrogation and salvage. There are opportunities there to re-tool your operation and get it ready for future growth.

Tell us how you best use slower times to improve your operation!

Social Media And Claims Investigation: Do You Know About Foursquare?

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It’s amazing what you can learn online to help your claim

Undoubtedly, you’ve read plenty of articles or have been to numerous presentations regarding the use of social media to investigate claimants.  At this point, the novelty of Facebook and MySpace has worn off.  The same can be said about Twitter.  Everyone knows at this point to take a look at those platforms when searching a claimant’s background.  Enough said.  However, seemingly with every new day comes a new social media application.  One relatively new application that you should also take a look at during your claims investigation is Foursquare.

What is Foursquare?

Foursquare is a web and mobile application that allows users to connect with friends and update their location. To use the application, a user must register at foursquare.com and create an account.  This account records the users’ activities from there on.

Foursquare started out in 2009 with limited availability in only 100 worldwide metro areas.  In January 2010, Foursquare changed their location model to allow check-ins from any location worldwide.  As of March 2010, the service had 500,000 users. As June 2010, Foursquare has closed in on 1.3 million users in June 2010.  Thus, this is an application that is quickly picking up adopters.

Foursquare is part game, part micro blog, part status-update tool, and part vehicle for sellers of goods and services to award customer loyalty.  “Checking in” via Foursquare at venues can lead to special offers and deals from a participating venue.  “Checking in” can also lead to “badges” for users, which are displayed on the user’s Foursquare profile.  An example of a Foursquare badge includes the “Crunked” badge, which is awarded for checking into four bars/clubs in a given night.

Users can choose to have their Twitter and/or their Facebook accounts updated when they “check in.” Alternatively, users can opt not to publish their “check ins.”  Nevertheless, all activity – whether published or not – is recorded on the users’ Foursquare account.

How looking to Foursquare can help investigate your claim

Accordingly, in the course of claims investigation, an enterprising analyst can search a user’s Facebook account, Twitter account, or Foursquare account to investigate the users’ Foursquare activity.  To so, the attorney would either need access to an open Facebook and Twitter profile, or alternatively, have access to the users’ login and password information for each of these accounts.  Getting access to login and password information may likely only come once a claim enters litigation.  At that point, defense counsel can either issue a subpoena to Foursquare or attempt to secure the data via interrogatory.

A real life claim example

The value of Foursquare can be realized in a very tangible way when investigating a user and his or her activities. For example, here is a recent Twitter feed of someone in Columbia, South Carolina on a recent Friday night using Foursquare:

I’m at Salty Nut (2000 Greene St, Columbia). https://4sq.com/5qUeGw about 7 hours ago via foursquare from Five Points, Columbia

I just unlocked the “Crunked” badge on @foursquare https://4sq.com/c93hnL about 7 hours ago via foursquare

I’m at Pavlovs (2000B Greene Street, Columbia). https://4sq.com/aLjSsL about 7 hours ago via foursquare from Five Points, Columbia

I’m at Dr. Rocco’s (801 Harden St, at Greene St, Columbia). https://4sq.com/bzIMAA about 8 hours ago via foursquare from Five Points, Columbia

I hate stupid mofos downtown who try and fight. I’m not as drunk as you, and therefore I will beat your about 8 hours ago via UberTwitter

Greene and Harden Streets are in Columbia’s “Five Points” area, which is home to many bars and nightclubs frequented by students at the nearby University of South Carolina.  The locations where this user stated he was “checking in” on Foursquare are all college bars.

In this feed, we know this: the user visited numerous bars in Columbia’s Five Point areas and stated he is “drunk.”  Imagine if this user later was involved in an incident where injuries occurred, which later becomes a claim to the carrier.  If he were the prospective defendant involved in an automobile accident (and an insured of the carrier), we’d know we have the makings of a tough claim.  If he were the prospective plaintiff alleging a claim against the carrier (e.g., he got into a fight with an insured later that night), we’d likely have the beginnings of a compelling comparative negligence defense.

Other things that can be learned by Foursquare

An additional use for Foursquare is finding out what a claimant has been up to since an incident giving rise to a claim.  Imagine this claimant gave a recorded statement or testified in deposition that he or she had been devastated by his or her accident and couldn’t go out and enjoy life.  What do you think the value of the claim would be when his or her Foursquare profile revealed routine “check ins” to Starbucks, the local mall, and other places that demonstrated that perhaps life wasn’t so bad for the claimant?  Every little bit helps when investigating a claim such as this.  The chance exists that Foursquare can help you find out more about a claimant’s post-accident lifestyle.

Bottom line: Don’t forget Foursquare when investigating a claimant’s social media activities.


Improve bottom-line outcomes on claims by thinking outside-the-box!

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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, the best claim handlers always look at different ways to examine even the most ordinary file. Thinking outside the box is an essential element to innovative claims handling. This type of thinking can lead to lower indemnity payments and reduced expenses.

Below are two examples of situations where the claims adjuster’s innovative approaches lowered the overall exposure.

Using Chinese numerology allowed for earlier resolution in a wrongful death claim

In a case involving a Chinese immigrant, the decedent’s family sought damages for wrongful death as a result of a construction accident. Prior to the mediation, the Claims Adjuster had heard that certain numbers in the Chinese culture were considered bad luck and superstitious. In fact the number four, and certain combinations of numbers, are particularly insulting (see Artcile on Chinese Numerology).

As a method to resolve the case at the best possible value, the adjuster made the first offer to claimants utilizing a series of numbers that were considered prosperous in Chinese culture. The plaintiff’s responded in kind with similar combinations of numbers that made it clear that the gesture did not go unnoticed. With this measure of good faith presented to the other party, the case was resolved sooner than anticipated saving the carrier additional legal and investigative costs.

Using excel to graph heart rate changes in a Malpractice suit helped to reduce the ultimate settlement

In a medical malpractice case involving a brain damaged infant, the liability turned on the baby’s heart rate changes during the delivery period. The plaintiff alleged that the doctor should have performed a cesarean section earlier than had occurred. The allegations against the nursing staff were that they failed to appreciate a significant drop in the baby’s heart rate, and should have then alerted the doctor sooner.

The adjuster used excel to graph the heart rates of the mother and the infant over the critical period. With the graph, they were able to show that fetal heart monitoring strips were actually recording the mother’s heart rate rather than the infants (maternal heart rates are significantly lower than fetal heart rates).  The information helped the defense to surmise that the mother’s monitoring belt had slipped out of position. The period of time where the mother’s heart rate was being recorded coincided with the alleged decrease in the fetal heart beat, thus providing an explanation for the precipitous drop. Using this argument, the claims handler was able to mitigate the settlement at trial below the original value.

Think differently and try new approaches when looking at that same old claim file

The above examples are situations where the adjuster’s thinking “outside-the-box” produced better results. It’s not always about proving an absolute defense, but can be about mitigating an already significant loss. Claim handlers should make an effort to look at the normal in a different way. Even using common available tools differently can result in large savings in indemnity or expense dollars. Some other examples of existing tools that can be used to help think outside-the-box would be:

  • Get SIU involved earlier. Sometimes, even though there may not be fraud present, your SIU investigator can help explore different approaches to finding new information about the claimant  or the events at issue. Even minor issues can lead to information that can be used to reduce the loss exposure.
  • Social media is free so use it. Twitter, Facebook and other social media outlets can be a valuable source of information about a claim or claimant.
  • Use reconstruction animations. In the right case animations are a valuable tool that can create a new understanding of the claim. The sophistication of these short videos allow the claims handler to look at events from different perspectives and open new avenues to the defense not previously seen (i.e. ability to look at a crash from different angles and different drivers viewpoints).

Have you saved money by looking at a claim file outside-the-box? Tell me your story and spread the word to help others save significant money on indemnity and expense payouts.

5 expense reduction opportunities insurance CEOs should not overlook

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Increase your profits with efficient claims operations

Take a look at the annual reports of 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. As the Ward Group noted in the Ward’s 50 2009 Property-Casualty Benchmark Report “‘Top performers understand that efficient operations result in pricing advantages passed on to the consumer and keep the customer at the center of the business decision.’ In 2008, expenses relative to revenue were 5.5% lower for the Ward’s 50 property casualty group of companies.” According to the Ward Group, net premiums grew 10.1% for top performing companies compared to 1.8% for the industry as a whole.

In a tight market, doing less with more without sacrificing quality or 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:

  1. Control what you can control: You can’t control the types of losses that can come in, but you can control allocated loss costs with effective oversight programs. Establishing litigation management guidelines can easily save 10% as well as improve outcomes through better communication. Control non-legal vendors with a program to “vet” providers and subsequently rate their performance. Audit your Third Party Administrators to catch harmless, but costly, errors.
  2. Utilize your technology to its full capabilities: Do you have the right technology and has it been implemented correctly? Failing to incorporate technology appropriately can increase costs. Procedures must be coordinated with new or existing technology so claim adjuster’s jobs are easier and the customer, not repetitive tasks, are the focus (also see our post on implementing claims technology and processes).
  3. Create strong reporting tools and use them: Comprehensive reports and analysis are essential to profitable business. You can’t manage growth without accurate benchmark reports and a good reporting tool will allow your claims department to look for trends. Using these reports to work closely with actuaries and underwriters will help ensure pricing is accurate. Good trending will also improve underwriting decisions around expanding or contracting in specific lines of business.
  4. Review your current operational procedures: Old process can equal costly operations, but change for the sake of change is not always a good thing. If you are performing tasks because you have “always done them that way” it’s probably a good time for a check-up. A regular assessment will almost always find cost savings and improve efficiencies (for an example see, Case Study: Improving file set-ups).
  5. At the very least meet minimum expectations: Customers will complain about problems when they arise, but will rarely complain when basic needs are not met. Before you can dazzle your customers with new services make sure you are first providing the basics. Regular communications and flexible reporting capabilities are minimum standards that must fulfilled or you will lose in the renewal process. You are in a competitive environment and providing mediocre performance is a non-starter.

Follow the example of the top performers, and don’t just talk about cutting costs. Take affirmative steps to reduce spending and improve your customer experience. There is no better place to do this than in the claims organization.

Don’t wait for your competitors to be a step ahead of you.