Selecting a third-party claims administrator (TPA) is one of the most important decisions a company can make for their risk management program. Key considerations such as pricing, reputation, cost containment and technology are all essential pieces to review when looking for a new approach to managing claims. Generally, when a company narrows down their TPA options to a few finalists, they are going to hear the same thing from all potential partners: “Our adjusters return calls and emails the same day”… “Initial contacts are always completed timely”… “Our adjusters ensure reserves are accurate in their files” … along with several other similar guarantees. When you really think about it, these assurances are standard best practices in the claims industry and should be happening on all claim files… but are they? And if so, what is being done to confirm these things are happening on a consistent basis?
At CBCS, we believe it is crucial to prioritize the importance of fundamental claims handling. Therefore, we have initiated several standard practices to ensure our clients are receiving the quality of service they expect. By confirming the basic requirements of claims handling are met through the programs implemented below, we have seen improved carrier audit results, better claims outcomes and most importantly, satisfied customers.
QSR (Quality Service Reviews)
The intent of QSR’s at CBCS is straightforward: Ensure adjusters are handling claims to best practice standards and delivering quality customer service to our clients. The process is simple as internal reviews of randomized claims are completed for each adjuster monthly to confirm tasks such as: timely contacts, coverage, reserve adequacy, regulatory compliance, medical management and many more basic requirements. The criteria for the evaluation is objective as the questions require a simple ‘Yes’ or ‘No’ answer in regards to an item being completed timely and/or accurately. Based on the results, adjusters receive a score in each category along with an overall score, so they know where they are performing well and what areas they may need to improve in. Supervisors then use these monthly results for discussion points in their regular 1:1 meetings with their adjusters.
“Mastering the Basics” Training
Facilitated by our Training & Development Specialist at CBCS, this mandatory training session is aimed to achieve exactly what the title reads – mastering the basics of claims handling. All adjusters, no matter what their experience level, are required to participate in this weekly training. It is very engaging and interactive so that the adjusters are able gain additional knowledge or tips on topics such as documentation, reserving, coverage, litigation management, subrogation and many, many more.
In an age of data analysis, technological advancements and predictive analytics, the fundamentals of claims handling can be overlooked. Sure, these new tools can assist in achieving better results and it’s great to see these types of innovations in our industry but without the basics such as frequent communication, timeliness and adhering to best practices, these tools simply won’t improve claims results on their own. So, whenever you are in the market for a new TPA, consider all the new, innovative features they may offer but don’t forget just how important claims handling basics really are.