Harried Adjusters Need Proper Tech Aid

Besides the problems balancing the competing interests of employer, claimant and insured, a soaring workload for adjusters over the last decade has made conditions even more difficult.

One veteran adjuster remembered starting out 17 years ago with about 100 simple claims–no coverage issues, no liability, just paying damages. Now he typically handles the most complex claims his company receives–and he still has over 100 open at a time. In high-volume lines of business, such as personal auto, caseloads of over 200 open claims are not uncommon.

On top of this, compensation for claims adjusters has not kept pace with the increasing demands of the profession, or with the increasingly attractive opportunities available in other fields.

The result has been the often decried "skills crisis" in claims adjusting, forcing insurers to struggle with high turnover rates and long-term understaffing.

However, these trends are compounded by yet another factor–claims adjusters are not given the basic tools they need to do their job.

Despite larger caseloads, faster cycle-time targets, and higher customer service standards, too many adjusters are still struggling with "green-screen" systems built in the 1970s and 1980s, memorizing arcane keystroke combinations and managing their workloads using stacks of paper.

There are two critical deficiencies with the claims systems that most adjusters confront on a daily basis–usability and guidance.

Number one, these mainframe systems, or their client/server cousins, are very difficult to use. Poor layouts require switching between multiple screens to track down information. The inability to open two screens at once means that every time a claimant calls, the adjuster loses whatever he or she was working on at the time. Note files cannot be filtered or searched, forcing users to read through pages and pages of notes to find a phone number.

Secondly, existing systems provide little or no guidance through the process of handling a claim. To keep track of the hundreds of company policies, state regulations, and recommended best practices that could be relevant for any single claim, adjusters must rely on their memories, their training manuals, and–most often–the Post-It notes they have attached to their computer monitors.

The claims system provides a place to put information but does not assist adjusters with the most important aspects of their job–gathering information, evaluating complex issues, making decisions, and settling claims fairly.

At its core, claims adjusting is about making accurate decisions at key points in the claim lifecycle. Current claims systems are no help in making those tough calls.

Todays software technology can do much better.

Modern software applications can provide easy-to-use interfaces that guide skilled knowledge workers through complex and demanding activities. Better, more flexible screen layouts can consolidate needed information when and where the end user needs it.

Simple, repeated tasks such as composing form letters or looking up information in multiple systems can be automated away. Re-entering data from one system into another can become a thing of the past.

Examples of these user-focused, productivity-enhancing applications are found throughout the working world.

Salespeople take advantage of sales force automation applications to streamline the complex process of gathering leads, managing sales cycles, and closing deals. These applications give them a powerful tool to manage contacts, qualify prospects, calculate prices, and generate proposals, allowing them to focus on building relationships and differentiating their products.

Customer service representatives use modern call center applications to identify cases, browse technical support databases, generate communications, and track issues to resolution. These systems can analyze new cases, compare them to databases of historical cases, and suggest the best way to handle them–saving representatives the trouble of reinventing solutions.

Its not hard to imagine how modern software technology could improve the life of the claims adjuster. Features that are trivial to todays developers–opening multiple windows at once, context-sensitive help, text searching, intuitive navigation of claim files–could eliminate hours of hassles and frustrations.

Prioritized task lists could help adjusters focus on their most important activities. Built-in rules could analyze claims to highlight "must-do" tasks (such as paying medical bills before state-mandated deadlines), and suggest recommended courses of action for more complex claims.

So why are most adjusters still condemned to arcane, unfriendly systems that colleagues who retired 15 years ago would still recognize? There are several reasons.

In many insurance companies, underwriting and distribution–as the "revenue-generating" sides of the business–receive more investment than claims, too often considered a necessary evil of selling policies.

For some companies, the mainframe has taken on a life of its own. After years of maintenance and incremental "enhancements," no one in the information technology department can quite imagine life without it. For others, the "not invented here" mentality makes it difficult to adopt solutions designed and built outside the four walls of the enterprise.

However, claims adjusters have the right to demand better. And giving them the tools they need to do the job is only common sense for insurers.

Besides basic productivity improvements, up-to-date tools can help ensure that every claim is handled the right way, reducing the errors that inflate indemnity costs and preventing the expensive litigation that ensues when claims get out of control.

Finally, better tools might even help to compensate for the increasing pressures on the frontline adjuster, reducing turnover and alleviating the looming skills crisis in claims adjusting.

John Raguin is chief executive officer for Guidewire Software, a Menlo Park, Calif., insurance software provider that assists property-casualty insurers in eliminating avoidable claims costs. He can be reached at jraguin@guidewire.com.

Reproduced from National Underwriter Property & Casualty/Risk & Benefits Management Edition, October 28, 2002. Copyright 2002 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.