Determining proper adjuster caseloads and developing claim-handling procedures are often top internal agenda items for many claims organizations. The common thread of the two goals involves striking the right balance between resource allocation and consistent claim handling. Both are critical to ensure proper claims administration.
Achieving those goals requires a robust and innovative adjuster training program. But in today’s increasingly complex claims environment, claims organizations need to rethink and retool their training practices to meet current demands and realities.
In this article, the author examines the challenges currently facing claims organizations regarding training and how technological advances can help improve claim outcomes.
What are the challenges?
From an organizational standpoint, claims payers face the constant challenge of watching the bottom line while still ensuring that a sufficient number of people and resources are employed to handle claims effectively.
On a micro level, adjusters are under pressure from a number of factors. For example, if claims don’t close within adequate cycle times, claimants become upset and customer retention is often compromised. Failure to employ proper investigative steps could result in claims being underpaid, or overpaid.
Those and other pressures call for nimble and lean claim-handling approaches. That, in turn, often prompts claims organizations to develop specific claim-handling practices and protocols — the goal being to provide practical direction and ensure consistency.
As part of the process, claims organizations routinely offer some form of training. If employees lack proper training on company best practices, organizations will have less productive claim handling, which can lead to inefficiencies, inconsistencies, and increased expenses.
Here are some of the more common training challenges currently facing claims organizations:
- Adjuster training is an up-front investment and is typically provided in a classroom, which takes adjusters away from their work. While adjusters are in training, they are not addressing or closing claims.
- In the author’s experience, the time adjusters spend in the classroom improves settlement consistency for a while. But according to industry stakeholders, sometimes the benefits don’t even last 12 months. so retraining is required. Repeated training is one way to deliver a primary goal: consistent good-faith claim handling. But that often conflicts with timely and effective claim payments.
- The guidelines typically are generic in nature, and there’s no way to track if they are actually being used. Further, generic guidelines encourage judging for mitigating circumstances on each claim. which leads to inconsistent claim handling and costly mistakes.
Making It Work Better with Technology
To get more value from adjuster training — not to mention improved consistency in general — claims departments need technology-driven operational enhancements to keep adjusters aligned with claim-handling best practices. Such an approach delivers daily operational discipline to the adjustment and settlement process, helping to ensure that adjusters ask the right questions at the right time.
But be careful. Not all technologies are equal. You must ensure that your technology solution delivers results — and isn’t just a conglomeration of bells and whistles.
For starters, the right tool should prompt the questions that lead to the facts of the claim. Some answers generate additional questions — but only for the applicable claims and only for the applicable mitigating circumstances. This effort is already required of adjusters, so technology is not adding more work, except perhaps for those adjusters who simply write checks.
Take, for example, a crossing intersection accident. When the adjuster identifies that the insured “disregarded a traffic control,” the next question is posed to understand what type of traffic control applies. Certain statutes concerning intersections, lights, and stop signs support negotiating the law, rather than relying solely on experience.
If the technology is intelligent enough to prompt for additional information, consistent claim investigations are encouraged. If statutes are readily tied to the facts of the claim, the manual effort to research state resources is minimized, allowing adjusters more time to handle their caseloads.
Further, intelligent technology can be used for systemic training for each open claim on the adjuster’s desktop. This can provide several benefits, including:
- Tracking that best practices are actually being applied
- Making sure each adjuster is pursuing consistent claims investigations, thus promoting consistent good-faith claim handling (This occurs on each open claim, and training reminders are provided every day.)
- Consistent payment of what is owed based on consistently gathering the same facts
- Aggregated answers to provide new insights into behavior, such as who may need additional training and whether the training itself should be improved
- More actionable data (Actionable data is what promotes the application of new predictive analytics in the claims department.)
How ISO Can Help
Proper adjuster training is necessary to ensure consistent claim handling and investigations and to improve overall claim outcomes.
ISO can help you achieve those goals. We provide technology solutions built by claims people for claims people. In addition, we offer auditing services that provide additional objective measures of your company’s claim-handling processes to determine if further training could benefit the claims department. With some benchmarking to similar claims from other companies, ISO can offer some actionable insight into these processes to determine if such a technical investment is even required.
Click here to learn more about how we can help you. For a free demonstration of our technology solutions, contact the author directly.
About the Author
Michael Rivers is manager for Claims Consulting and Analytics for ISO Claims Services. He manages the statistical analysis group, which is responsible for data mining and data analysis of millions of data elements from the property/casualty insurance industry. Mike can be reached at firstname.lastname@example.org or 803-422-9169.