Feature Story b Y CHriStiNA brAMLet AND MArK SNYDer
Continuous Claims Quality Assurance
ity improvement programs and therefore
provides the basis for this editorial series.
Integrating these principles into your
claim organization’s culture helps ensure
the adoption and continuous application
of best practice behaviors that will improve financial performance and enhance
This article is the first in a three-part series about the core principles underlying successful claims
quality improvement programs. The next installment will appear in the October 2012 issue.
We often stress the importance of “best practices,” but it is actually best- practice behaviors that drive cultural shift at organizations. It is im- portant to keep in mind that certain core guidelines transcend com- pany-specific protocols. To that end, this exclusive three-part series,
we examine “best practices” for claims quality assurance at virtually any size carrier.
Lack of adherence to best practices continues to be a large impediment to claims handling excellence. This disconnect can have far-reaching and quite damaging repercussions, including compromising quality, customer satisfaction, and financial strength.
Therefore, it is essential to accurately diagnose issues in order to determine the full impact on business results.
Introducing the Framework
The first cornerstone of continuous
quality improvement is identifying, documenting, and embedding highly measurable claims best practices into your
Organizational policies and best practice guidelines are the marching orders
for a claims organization. They are the
dynamic elements of an operational
strategy, reflecting the impact of constantly changing regulatory standards,
market conditions, customer expectations, competitive pressures, and technological innovation.
To be effective, process guidelines must
be easily understood and achievable.
Clearly define expectations, which should
be documented in such a way as to not
put the organization at risk of bad faith
litigation. Let’s assume you have compiled
and published your best practices operational guidelines. You have also trained,
tested, and certified that your adjusters
know how to apply these best practices.
Why then might you still observe performance variance in excess of expectations?
The reason can be surprisingly subtle.
Individual claims handlers have differing
levels of knowledge and skill, and consequently varying degrees of understanding best-practice behavioral expectations.
Calibration In Context In the context of quality measurement, calibration refers to the degree to which claims field operations—including the various regions, reviewers, and supervisors working in the trenches—not only understand organiza- tional best practices but also measure compliance with these best practices. The less synchronization there is between the field and the home office team, the wider the calibration gap. The goal is to narrow these gaps, there- by ensuring claims protocols are followed and the organization is paying exactly what is owed in each case, meaning not a penny more, or less.
“Measuring quality is a function of measuring compliance with best practice guide-
lines,” explains Russ Kelly, vice president of property and auto claims at Liberty Mutual
Agency Corp. “From that, your best practices speak to ensuring that you are paying the
right amount for both loss and expense.”
The chart on page 34 outlines four core principles underlying successful claims qual-
Through frequent commitment
to actionable results, it is
possible to drive true change
in a claims organization. To do
so, there must be collaboration
between the unit manager and
the claims handler.
F Mark Snyder
Additionally, each claims handler has a
unique desk-level process, a pattern of
behaviors applied to every file he or she
touches. Effectively, claims handlers are
translating operational guidelines and