THE CRITICAL BUT SOMETIMES OVERLOOKED IMPORTANCE OF EMPLOYEE TRAINING
Resonsible for many different lines of business or several offices. Responsible for claims
quality at a higher level; monitors office perfomance; reviews office, exception or focused
reports; determines some of the needs/topics for formal training; and will track each claims
manager to ensure training (formal and informal) is done. Based on audits, may identify
particular topics that require training or strengthening.
Claims manager reviews claims processes and performance at a higher level
than supervisors, some of which will be provided by exception reports. Their
responsibiilities include assurance that the supervisors are performing their
responsibilities by review of randomly selected claims files. They may also select
training topics based on supervisors’ or adjusters’ audits.
Supervisors must review the work performed by the adjusters and their
vendors, and provide praise for well-performed work as well as direction for
work performance that must be improved. This includes review of new claims
at specific intervals, but also claims audits of randomly selected claims or
claims that reach certain thresholds.
Manages individual claims, possibly limited to one line. This requires the
adjuster to manage his/her work as well as that of vendors or partners
used for specialized services.
overall claims management quality is
low. This occurs because there is often
little focus on the outcomes. Adjusters
may complete the required steps and
gather useful information, but may
not develop a meaningful action plan
to resolve the claim.
There is nothing wrong with documenting best practices, however, when
the adjuster is not trained for the next
level — e.g., investigating a claim, analyzing claims and the factors that affect
the outcomes, developing meaningful
action plans and effective strategies,
researching case law, and preparing reasonable settlement ranges and reserves,
the outcomes will come up short.
2. Improving supervisors’ general per-
formance. Supervisors arrive at that
position after a successful tenure as an
adjuster. However, some have never
been trained on how to properly super-
vise and effectively guide adjusters and
they may also fall prey to the problems
of best practices by focusing on activi-
ties instead of meaningful supervision.
They may be required to perform an
initial supervisory review at 10, 15 or
30 days, with periodic reviews every X
days thereafter. In some cases, supervi-
sory comments in claim file audits are
limited to “revie wed claim” or “reserves
OK” or similar comments with no real
supervisory comments or direction.
This means these supervisors have
not received appropriate training, and
their ongoing performance has not
been evaluated to ensure they provide
guidance to the adjusters for whom
they are responsible.
3. Broadening knowledge. One of the
steps that many insurers or TPAs have
taken is to limit their adjusters to just
one line of insurance. While this makes
sense from an expertise and efficiency
perspective, it may leave the adjusters
without the knowledge necessary to
make other important decisions. For
example, a Workers’ Compensation
adjuster who has had no exposure to
General Liability claims may not iden-
tify or properly investigate incidents in
which a third party might be liable and
responsible for reimbursement.
4. Improved time and work management. While auditing claims it becomes apparent that many adjusters
and supervisors are not yet efficient in
managing their time and work product. Part of this may be due to an incomplete understanding of the features
of the claims system they are using or
a fear of relying on the system. Also,
some of the adjusters and supervisors
have not yet developed an effective
schedule for performing their daily
tasks. Since part of their ongoing work
is to talk with their clients, employees, claimants, medical providers, at-