Filed Under:Claims, Education & Training

Driving consistency in claims outcomes

Carriers will see a dramatic improvement in claims quality, consistency and outcomes by focusing on the basics.
Carriers will see a dramatic improvement in claims quality, consistency and outcomes by focusing on the basics.

As I speak with claims executives at various insurance companies, their concerns are often quite similar and generally revolve around the lack of organizational consistency. They lament that giving the same claim to different adjusters can result in markedly different outcomes. This is true, as adjusters often perform claim-related tasks very differently.   

In any business there is a spectrum upon which employees perform ranging from outstanding to not so good. This is part of the reason that we go through the annual exercise of performance reviews, so that those who exceed expectations can be rewarded, while those with opportunity for improvement can be counseled. 

In the book "Re-Adjusted: 20 Essential Rules to Take Your Claims Organization from Ordinary to Extraordinary," it is suggested that there are A, B and C employees. “A” employees are your future leaders. These are the outstanding performers of today that consistently deliver over the top results. At the other end of the spectrum are the “C” performers, where inconsistency and excuses find a home. “A” players typically make up about 20% of an organization as do “C” players. In the middle are the “B” players, typically 60% of an organization and the people who do a solid job but need the occasional guidance and reinforcement to produce an “A” level product.  

Related: What drives customer satisfaction?

Successful organizations get stellar results by emulating “A” team behavior across the organization. Think about it for a second. Imagine the potential for improvement if all employees could perform just like the top performers. What would that do to results? How would that impact your claims handling strategy? 


(Photo: Thinkstock)

There are many challenges to replicating a behavior across an organization, most notably that of longevity. As we often see in our organizations, “fire drills” tend to immediately yield results, but they are not sustainable.  

Consider a scenario in which the latest mandate is to improve comparative negligence. Adjusters will suddenly start assessing comparative negligence in many more files. But are they applying it? Consider mandates to improve subrogation referrals. Suddenly the subrogation department gets inundated with new referrals, the majority of which are not collectible.

Herein lies the challenge. Do we focus on the soup du jour or claims item of the week, or do we try to fundamentally transform our organization from ordinary to extraordinary? Achieving the latter can certainly be done.  

The key is to adopt a process by which all aspects of claims best practices are identified and replicated across the entire claims organization. Effective deployment of decision support tools, such as ClaimIQ, can not only accomplish this, but set the stage for markedly different outcomes based upon fundamental execution of basics. 

Once the sought after claims behaviors are effectively modeled and deployed, they become institutionalized in the claims organization. Longevity is also assured as claims-based reporting will provide key details as to any outliers, which can trigger more effective claims audits. By focusing on such outliers, the underlying issues can be more effectively remediated.   

By focusing on the fundamental execution of claims, instilling the proper behaviors, leveraging proven tools and reporting, carriers will see a dramatic improvement in claims quality, consistency and outcomes.

Christopher Tidball is a casualty claims consultant and the author of multiple books, including the recently released claims investigation thriller, "Swoop & Squat." He has spent more than 25 years in property and casualty industry as an adjuster, manager and claims executive. To learn more, visit

Related: Highlights from the 2015 Claims Professional Salary Survey

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