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In many cases the implementation and
execution of these initiatives have not delivered most
of the benefits intended and in fact have diluted the insurers
ability to do what is not only right but actually best
to maximize profits and customer service; pay legitimate
claims promptly, fairly and accurately while adhering to
the standards set out in the policy and under regulations.
No less, and no more.
Why aren’t all these new programs working
as well as they should to save money and improve the
quality
of the work as intended?
Could it be as simple as the company’s inability
to measure effectively and efficiently what is being done
against what should be done in an objective way, so effective
individual training and performance plans could be implemented? |
Our many years consulting to the
industry lead us to believe this inability to measure
objectively, effectively and efficiently is at the crux
of the issue. If that is true what is needed is a means
to conduct audits/quality reviews in such a way that
the standards and polices are examined and rated systematically
across any section of the claims function, be it by claims
type, national, region, branch, skill sets, knowledge,
experience etc.
We would be very rich if we had a dollar for every
time we have heard: “But we have all that or do
all that,” and “We have the finest, most
sophisticated claims system available. It keeps track
of everything, stores picture, produces management reports
and we’re paperless! We can look at anything anytime
we want!” But are these statements accurate?
More often than not, the people making these all-encompassing
statements are actually telling us what they are looking
or hoping for. You don’t need the ability to look
at anything any time you want. What you do need is to
be able to look at the right things at the right time
and the opportunity to determine whether your people
are using valid information to apply the proper procedures.
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