prima 2012 - the three ps of effective claims management v2
TRANSCRIPT
The Three Ps of Effective Claims Management -
PLANS, PROTOCOLS, & PARTNERSHIPS
Gary Jennings, CPCU, ARM, ALCM, AIC, ARe, SCLAPrincipal, Strategic Claims Direction LLC
Gary.Jennings@StrategicClaimsDirection.comwww.StrategicClaimsDirection.com
678.520.3739
When should you consider these issues?
When you are setting up a new program or adding lines of insurance.
When you need to evaluate your current program to achieve the best results you can.
Section 1 - PLANS
“If you don’t know where you’re going, any road will get you there.”
- Lewis Carroll
“If you don’t know where you are going, you will wind up somewhere else.”
- Yogi Berra
PLANS
What do you and your members expect out of the pool?
Cost-effective coverageProfessional claims management that
controls claims costs and expensesAdditional services – e.g., loss control,
trainingOthers?
PLANS
Develop plans based on Expectations Program administration requirementsExecution needed to reach the desired
level of quality, professionalism, and cost controls
PLANS
FOCUS ON CLAIMS ADMINSTRATIONWho will manage the claims?
Self-administration?Third Party Administration?
will you hire (responsibilities, functions, expertise, experience) as claims managers and for ancillary services?
PLANS
What growth plans do you have?type of claims will you manage (now and
in the future)?claims system will you use?guidance and training will you give to
claims staff and to the members?
PLANS
Whenwill you be “up and running”will you add personnel?will you feel comfortable to grow the
program and/or offer additional lines?
PLANS
Where will you locate the claims personnel? All at one site?Field based?Combination?
PLANS
Howwill you measure results?will you deliver training to the members?will you provide regular updates/progress
reports to the members?can you be sure your program attains
leading industry practices?
PLANS
Develop a Business PlanAnswer the WHO, WHAT, WHEN,
WHERE, and HOW questions and address other issues that arise
Review periodically (e.g., semi-annually)Clearly define roles and responsibilities
Section 2 - PROTOCOLS
“When you come to a fork in the road, take it!” -Yogi Berra
“Let‘s get this straight. The police don’t cause disorder. The police are here to preserve disorder.”
-Mayor Richard Daley
PROTOCOLS
For purposes of this discussion, protocols are also known as
ProceduresProcesses
PROTOCOLS
Addresscontrols and authority levels/needsguidelines necessary to achieve leading
industry practicesmetrics needed to measure your
program’s success
PROTOCOLS
Should you document your protocols fully?Yes – to improve adherence to standards
and required practices and to improve and maintain consistency.
No – I have a concern about “discoverability” of the procedures that might work against us.
PROTOCOLS
These should include:“TO DOs““TO DON’Ts”
PROTOCOLS
What should they include?High level plans, philosophies, goalsProgram characteristics
Organizational Structure Staffing and pending workloads –
supervisors/managers and adjusters Supervisory span of control Field personnel or use of independent adjusters
and other partners
PROTOCOLS
Program characteristics (continued)Claims system and documentation
Hardcopy files? Paperless processing? A combination?
How much should I document the individual claim files?
PROTOCOLS
Program characteristics (continued)Communications with claims staff and
members Training “Roundtables” Frequency and type of reports to claims staff and
members Dealing with non-compliant members
PROTOCOLS
Program characteristics (continued)Procedural documentation
Claims procedures manuals with DATED updates when needed
Coordinating internal procedures with system steps and fields
Documentation for partners
PROTOCOLS
Claims Management File documentation Claim intake, set-up,
and assignment Coverage analysis Contact (initial and
ongoing) Investigation and
Inspection
Liability assessment Damage appraisals Damages
documentation Fraud Investigation Payments and
supporting documentation
PROTOCOLS
Claims Management (continued) Reserving Settlement valuations
and negotiations Litigation / hearing
management Potential recoveries
Potential recoveries (subrogation, salvage, risk transfer, excess insurance reporting)
Manager/supervisor control / involvement
File closure
PROTOCOLS
Metrics
“If you don’t know where you’re going, you can’t tell when you’ve arrived.”
-Anonymous
METRICS
Know when you arriveDevelop specific protocolsCreate fields to capture the needed
information to measure compliancePerform regular and objective measurementsCommunicate results objectively and promptlyDevelop corrective action plans when neededFollow up
Section 3 - PARTNERSHIPS
“A Good Ball Club” – on what it takes to make a good manager
-Yogi Berra
PARTNERSHIPS
InternalMembersSafety / Loss ControlRisk ManagementRoad DepartmentMaintenanceSheriff / PoliceOthers
PARTNERSHIPS
External – COMPETITION IS HEALTHYIndependent adjustersAppraisers (auto and property)
Buildings Standard vehicles Heavy equipment / unusual vehicles
Mitigation specialistsSurveillance specialistsDefense counsel
PARTNERSHIPS
Clarify roles and responsibilities“TO DOs”
Specifically inform them the services they are to provide, including time requirements, reports, forms to use, etc.
“TO DON’Ts” We will not pay for services you perform that
exceed our instructions We will remove you from our panel if you do not
meet our standards
PARTNERSHIPS
Clarify your expectations in writing and tell them how they will be measuredAsk them to provide accomplishment reportsProvide regular reports to them based on the
pool’s measurementsReview contract and service requirements at
least annuallyRemove non-compliant vendors promptly and
transfer to compliant vendors
CONCLUSION“It ain’t over ‘til it’s over.”
-Yogi Berra
DISCUSSION / QUESTIONSGary Jennings, CPCU, ARM, ALCM, AIC, ARe, SCLA
Principal, Strategic Claims Direction [email protected]
www.StrategicClaimsDirection.com678.520.3739