Some examples of best practices are:
1. Make two- or three-point contact
within 1 working day of claim receipt/
2. Input initial reserves within 1 to 5 days
of claim receipt (requirements may
vary up to 30 days).
3. Complete the investigation within 5
working days of claim receipt.
4. Develop an action plan within 14 days
of claim receipt.
5. Create updated action plans every 45
6. Require the claims supervisor to review
the claim at 30 days after receipt.
These and other best practices are im-
In late 2013, we discussed thorough audits as a way to update and im- prove claims programs at p&c insur- ance organizations, beginning with
the Sept. 2013 Claims article, “Why Auditing is a Springboard to Cost Reduction.” After all, one of the most important
outcomes of effective claims management
is reducing claims costs and expenses to
the lowest reasonable values while adhering to the legal and ethical requirements
inherent in good faith claims handling.
Late last year, we also began a discussion about some of the steps involved in
auditing workers’ compensation, liability,
and property claims. However, claims
audits represent just one of the many
components of a quality assuranc
program that must be implemen
not only maintain but also impro
claims-handling operations. Now
in mind the size, scope, and com
of QA programs can differ signif
The size of the organization.
The lines of business.
The geographic spread of the
The training program for claims
The experience and expertise of
The structure of the program—
ample, claims are managed by i
or TPAs versus self-administere
The extent to which vendors are
The client mix that you target.
Other market-specific and in
Development of a comprehensive
program, however, is beyond the sco
this article. Rather, let’s focus on met
evaluation methods that insurers can
on an ongoing basis to augment the c
audit component of any QA program
Activity Based Metrics
The balance of this article will concentrate on two major items: activity based
metrics and results-based metrics.
We refer frequently to activity based metrics when discussing claims-management
best practices. It would be fair to describe
best practices as the requirements and
guidelines that many claims administrators
believe will provide the path to optimal outcomes. Unfortunately developing and tracking performance according to compliance
with best practices focuses on the activities
instead of the results or outcomes, which are
more difficult to measure.
Often adjusters may concentrate on
reaching the milestones or “checking the
To Foster Claims Excellence,
Begin with the Right Metrics
Implementing and Maintaining an Effective QA Program
By Gary Jennings, CPCU, AIC, ARM