How do you know if your claims organization is producing a quality product? After all, there are numerous ways to identify quality, right? While no two carriers or claims processes are alike, there are often similarities. From the first notice of loss (FNOL) abandonment rate and contact timeliness to cycle time and average indemnity, there seems to be no shortage of usable metrics. But is this the optimal way to gauge performance?

During my years as a process and quality director for a large multinational insurer, we grappled with a myriad of metrics in our quest to find the ideal formula behind quality. Much like a football team, the claims organization was measured on statistical data points that were supposed to be indicative of outcomes. Just as a lot of points should win football games, prompt contact and inspections should win the claims race.

So what happens when all of those metrics are surpassed, yet there is a rise in blown coverage, errant liability decisions, or litigation? While I am not minimizing the importance of statistical claims data points, I do like to put them into perspective. Just like football, there is only one statistic that truly matters. Your wins and losses are based upon accurate outcomes.

When designing a quality assurance process, placing emphasis on ultimate outcomes takes into consideration all else. Components such as timely contacts and inspections, accurate coverage and liability decisions, effective negotiations, and recovery opportunities are all addressed under the broad heading of accuracy.

In our situation, we moved from a multitude of metrics that seemingly encompassed every conceivable aspect of the claims process to one of overall file quality. In the former model, so little emphasis was placed on any singular data point that very little was a priority. For example, if subrogation identification is 2 percent of an annual evaluation, how much emphasis will be placed on identification and referral? To the contrary, in a total quality model missed subrogation may result in a file not meeting expectations. If the cumulative total quality score supplants the individual metrics, then the paradigm of the organization will change from chasing numbers to chasing results.

To emphasize accuracy, certain key milestones should be addressed during the evaluation process. At a minimum, this should include data compliance, coverage, liability, investigations, subrogation, salvage, timeliness and accuracy. Within each milestone there should be a subset of data that is measured to determine if a file is worthy of replication, or reproduction. When this occurs, a file may be deemed to meet expectations.

It is also important to re-emphasize exactly what constitutes an acceptable work product and calibrate the organization so that everyone from the executives to the rank and file employees are on the same page. Doing what should be done in a file, consistently, timely and accurately, is precisely what should be defined as meeting expectations. Nothing more, nothing less.

To exceed expectations, one must go above and beyond the call of duty. Calling someone in 7 hours versus the 8-hour requirement hardly constitutes exceptional work. Rather, a person must take the initiative to think outside the box, dig deeper and farther and turn up critical pieces of information that alter the outcome of what a standard claim investigation would have done. It can be done; it is the exception.

As I discuss in “Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary to Extraordinary,” using one key metric, that of total quality, can fundamentally transform any team. It will move from reactive to proactive an entire workflow that will expose inefficiencies that can be remediated, resulting in continual process improvement to ostensibly offer adherents a significant competitive edge in the marketplace.

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Key Metric for Accurate Claims Settlements

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