Filed Under:Claims, Education & Training

Opinion: The Economies of Claims Quality

The Correlation Between Skills, Strategy and Organizational Success

"To me, a claims man is a surgeon. That desk is an operating table. And those pencils are scalpels and bone chisels. And those papers are not just forms and statistics and claims for compensation, they're alive, they're packed with drama, with twisted hopes and crooked dreams. A claims man, Walter, is a doctor and a bloodhound...and a cop and a judge and a jury and a father confessor all in one.”  ~Barton Keyes, Double Indemnity (1944)

Through the prism of history, adjusting of insurance claims has been a skill, some of which can be learned and some of which is innate. It is for this very reason that not everyone is cut out for the trade. Sadly, much of the profession has been “dumbed down” over the years, with cross sections of the job dissected and turned into processing roles. While this can have a positive impact on productivity, it adversely affects true claims quality.

Simply put, there is not a consistent focus on the fundamental execution of basic blocking and tackling skills. After all, isn’t that precisely what a liability assessment is? It, along with damages, serve as the foundation upon which claims outcomes are built.

While this concept seems so simple, it often is overlooked. Liability, however, isn’t the only aspect of claims where there are significant opportunities. For instance, are claims personnel asking the right questions at first notice of loss (FNOL)? Are they canvassing for witnesses and conducting scene investigations? Other considerations include: locating alternative parts for damaged vehicles, investigating fraud indicators, and identifying pre-existing injuries to refute new allegations. The list goes on.

Identifying the skills for an organization has to start at the top, as the acquired talent will ultimately define the corporate culture. By recognizing the difference between “A” players, “B” players and “C” players, leaders can build an organization destined for success.

The key is to first recognize that there is a talent gap between the top and bottom performers, with the latter, or C players, comprising about 20 percent of a typical organization yet being the cause of 80 percent of administrative and technical problems. Simply put, if your left tackle is weak, then your quarterback will consistently get sacked. Replacing the tackle not only protects your biggest asset but also creates a solid line of defense against potential problems.

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