The Ultimate Guide to Setting up Your Claims Management System

 

It's in everyone's best interests to create a safe workplace where injury and damage are avoided entirely. But even when accidents happen, your business can set up a second line of defense, saving time and money by improving the way it manages claims. A culture of safety can minimize accidents - and a good claims management program helps insure reimbursement is quick and efficient if an accident does happen.

 

Step 1: The Plan

 

First, you need a blueprint. You'll need to clearly define and document what is expected of which employee and when (and the metrics you use to measure those goals and standards), and specific procedures for handling claims. Your instructions should clarify the importance of the program in a way that employees will find meaningful, as well as how metrics will be used to measure results versus expectations.

 

A good claims management program is defined by these three key qualities:

 

Consistency - Your claims management program should be a well-oiled machine, handling each claim according to the same protocols to ensure timeliness, efficiency, and fairness (for instance, processing all work comp claims in the same way regardless of how the manager feels about the employee filing the claim). The program should also be consistent with your safety programs and best practices, and with employee training. And the metrics for monitoring how the program is actually working (once it is) need to be as objective and straightforward as possible.

 

Accountability - No diffusion of responsibility here! Establish clear, specific roles for everyone involved. All players should understand the particular measurements used (the time it takes to process a claim, for example) to insure that the program is working. At the same, make it clear that the goal is to improve claims management, not punish people: if anyone up or down the chain is struggling to get the work done well and on time, or having difficulty with the training they require to do their part, it could mean the plan itself has a flaw, and additional time or resources should be available to lift up weak areas. If claims management partners like TPAs, medical management vendors, and attorneys are involved, they also need to be held accountable - they may not be part of the company, but they're still part of the program.

 

Urgency - Make it a priority to formalize a program, with clear deadlines for each step of the implementation. And keep it active, even when you have no claims for an extended period of time. When claims are managed consistently, quickly, and well, everyone benefits.

 

Step 2: Implementation

 

To get your claims management plan off the drawing board and up on its feet, you'll first need to be sure each person is clear about their role in the process, and put it in writing. Documentation is essential. Distribute all tasks, responsibilities, and a list or handbook of procedures.

 

Establish the baseline: how is your company currently performing when it comes to managing claims? Set a clear schedule for when each part of your plan should be implemented, and clear monthly and quarterly milestones to mark progress in setting up the plan and putting it to use.

 

If you think that claims management software might improve your process, there are dozens of options ranging from all-in-one packages to coverage-specific options for health claims, HIPAA, cargo and marine claims, truck insurance, and so on.  

 

Step 3: Keep Improving

 

Any claims management plan can be improved. Make sure there are easy procedures for any employee to contribute ideas, or request clarification or additional training. A good claims management program needs to remain a group priority, with regular monitoring to check in and report whether requirements are met, best practices followed, consistency maintained, and, of course, whether everything's in compliance with the insurance company's requirements, too. When goals are met and the program has more than paid for itself, exceed those goals and keep reaping the rewards. 

 

Children throwing tantrums can damage property. Smog ruins holidays. Hotpots burn diners. Now, these kinds of everyday mishaps and embarrassments are covered by some Chinese insurers.

 

Reuters recently reported that insurance companies in China are getting creative with their policies, offering "naughty child" coverage - the tagline: "Why not let us pay for the child's fault?" - and coverage for medical costs related to burns suffered while cooking raw meat and vegetables in a boiling broth hotpot. A couple becomes pregnant before the honeymoon instead of during or after it - there's a policy to cover the costs and inconvenience of canceling or rearranging the trip.

 

In fact, one company offers three tiers of "naughty child" coverage, with higher premiums and lower payouts for the naughtiest of children. We can't help but wonder how one manages to perform an accurate risk assessment of a child's chances of acting out-do you take into account their loss runs (dollar value of property they've destroyed previously), their ex-mod (reports from teachers, parents, police), or your own observation and subsequent assessment of their behavior? Is there an algorithm? Do truly impossible kids end up in the pool, or with an excess and surplus carrier? Can parents take a risk management approach and lower their premiums, perhaps by enrolling the child in anger management classes?

 

Other policies slip over the line between insurance and gambling. The Chinese Insurance Regulatory Commission had to shut down some policies, like one that would pay out if smog levels hit a certain mark, ruining policyholders' vacations. During the World Cup in Brazil, the commission decided a policy covering the "heartbreak" of a team's elimination was more a game of chance.

 

These policies are, of course, mostly tongue in cheek - quirky coverage to attract new customers. Americans, after all, can purchase coverage for vampire and werewolf attacks or the zombie apocalypse, and Lloyd's has sold over 400,000 alien abduction policies worldwide. (Impregnation by little green men is, of course, covered for both genders. Who knows what technology those aliens have?) Chinese insurers are doing it in their own unique way, and hoping that these attention-grabbing, short-term plans will attract customers for more run-of-the-mill coverage. In the world's most populous country, you come for protection from boiling broth and mischievous little ones, and, like anywhere else, stay for meaningful coverage against the big risks.

What could a business coach do for you? Could your business run more efficiently? Could you be a more effective manager? Can you honestly answer "no" to either one of those questions? According to a 2013 study by the Stanford Graduate School of Business, only 33% of CEOs, managers, and executives receive coaching or leadership advice from outside sources, although nearly 100% say they enjoy getting it, and are open to making changes based on the advice they're given.

 

While coaching is sometimes recommended by superiors, nearly three-quarters of the managers who worked with a coach did so of their own volition. The skills they seek to develop the most: delegation and leadership sharing, conflict management, mentoring and team building, and communication.

 

Sound good? Here's a more detailed view of some of the things you'll get from a business coach:

• An honest, objective outsider's perspective of how your business is running and what needs improvement. If you want a yes man, don't hire a coach.

• Someone with the experience and organizational skills to identify solutions you haven't thought of, bounce ideas off of, help you with time management, and basically streamline your business.

• A clear description of what your business goals are and how to achieve them, a timeline for implementing those goals, and accountability to the coach if you're not following through.

• A stronger, more cohesive team of employees who have been taught effective conflict management and communication tactics.

• The feeling that you have support. It can be lonely at the top, not to mention intimidating to be the main or sole decision-maker. Having someone to speak candidly to about your concerns and areas of weakness as an administrator gives you much the same benefit at work as talking to a therapist does in your personal life: a third party who, removed from the emotionality of your situation, can bolster and advise you impartially.