Technology and process engineering are being used to analyze results in new ways and to construct more efficient and accurate outcomes. Simultaneously, the amount of information that passes through a claim as medical billing or detailed parts and repair information has skyrocketed. Estimating tools, medical bill processing engines, injury valuation applications, liability determination, document management, and litigation management are but a small sampling of software solutions that have been brought to bear. These applications help manage the information, but they are incomplete without individuals who understand how to move a claim toward a good outcome.
Developing employees to operate in this environment requires some rethinking. Training programs have not traditionally been built around good decision-making, but rather around building knowledge. For instance, they have focused on learning concepts like tort, policy language, and medical procedure. They have done a less effective job developing the judgment that is so critical to good performance and job satisfaction. In claims, the core skills for the job revolve around making the decisions and judgments that separate bad outcomes from good ones.
Instilling judgment requires a different approach. Decision-making is a skill that employs knowledge and experience to find an effective solution. In claims, this occurs across a broad range of contract, tort, and damages issues, where there are situations in which there are often no perfect solutions, but for which some choices are much better than others. The point is not for adjusters to be exact every time, but for them to be right more often and to own the responsibility for the result.
How Critical Decisions Are Made
There are many decisions being made during the course of a claim, but a small set are essential to getting it right. Strict rules don't apply in these cases. In fact, they often cause unintended consequences as adjusters lose the ability to understand when the rules don't apply. For instance, how does an adjuster decide that a vehicle should be totaled? What pattern of treatment necessitates an independent medical examination?
Keep in mind that you are not solving every circumstance. Most cases are not complicated. In fact, they are easy and training for these cases follows an easy step-by-step path. Instead, you are creating training that allows people to identify when the normal approach won't work. The competencies from this perspective are in picking up cues, determining their importance, and responding when they are. You are teaching a process more than delivering raw knowledge.
To find the cues, use your experts. Identify what might go wrong in each step and how to recognize the potential problem. Experts can quickly list issues and what information starts to emerge that signals them. Capture these items and organize them by problem type.
For instance, when investigating a commercial vehicle loss, an injured passenger might not seem to present a coverage issue. Experts will know this signals a potential co-worker exclusion. The existence of a passenger does not always trigger an exclusion. Your best adjusters can tell you how they rule out complications.
This is an important step. It may seem natural to dive into detail about how employment law works in an effort to make sure no stone goes unturned. Most cases don't need this level of detail and some basic information can rule out the issue. An in-depth review of employment law should be reserved for very few people on your staff. For example, the passenger might not be an employee of the insured. This is much simpler to conclude.
A more detailed investigation should take place only when the issue cannot be ruled out. Ask your experts what information they gather and what conclusions they are trying to reach. Focus on the process they use more than their command of technical details. When dealing with exceptional cases, it is more important to train staff how to get needed information.
This seems wrong at first. However, each exception is different and contains its own nuances. You need only point out the types of considerations that need to be made. Adjusters develop their abilities by learning the process and applying it. Training should encompass what they need to think about and how they can confirm their decisions.
This information has to be distilled into training. To remain practical and effective, the learning objectives have to focus on recognition first and response second. It is of little value to have someone deeply knowledgeable in technical information if they cannot rapidly figure out whether or not it matters in a given case. Training that repeatedly exposes someone to scenarios bridges this gap.
Training for Decision-Making
Decision-making is not a skill that can be acquired simply by getting knowledge. It must be developed through repeated exposure or experience. Training has to incorporate repeated opportunities to learn and provide feedback in the process.
Training that builds experience is completed in three stages: Introductions deliver the core concepts and the purpose of the training; workshops start the practice; and on-the-job instruction and feedback helps solidify the skill.
Introductory material delivered in stage one can often be done remotely. This can be arranged through reading material or with web conferencing technology that is widely available and easy to use. It is critical to introduce the participant to the kinds of decisions that will be important and provide background on the cues they will encounter. It is also important to set expectations that completion is tied to what the adjuster can do, not what information they can recite.
A workshop is critical in stage two. Here the adjuster has to increase his knowledge level and apply it. These should be filled with exercises. Interactive presentations that involve students also provide them with practice. As instructors walk adjusters through the decision-making process, they should be questioning them constantly to test comprehension. Frequent exercises are used to test recognition and train effective response activities. Examples should be progressively harder and stretch abilities. Adjusters should be able to apply their skills across a range of examples.
Post-workshop training during stage three moves the responsibility for development from the trainer to the manager. This connection must be explicit. Breaking the learning cycle at the classroom generally means ending the learning process and results in confusion for the adjuster. When the manager is not using the same material for the same purpose as the trainer mixed messages are sent and progress is stifled. The work between students and their managers is a specific extension of the training.
Specifically, the work should revolve around real claims. Classrooms build a good base, but only actual files can provide the context for getting it right. The manager's job is to review the response that is being taken, not to tell the adjuster what the response should be. When faced with a hectic environment, it can be easy for the manager to simply provide direction, rather than feedback. To help managers accomplish this, specific training material should be included.
Pay Me Now, or Pay Me Later
The new claim environment cannot operate effectively without good decision-making skills. In fact, the speed of execution in processes today demands it. When process and technology try to pull back adjuster discretion in favor of speed, learning slows down. Technology and process design can help control the information, but this doesn't remove the need for good judgment. Quality results are still the end game and they are not just a function of process and systems. The most sophisticated operations would not earn their reputations without people who knew how to run them.
Making this change in training is not easy. Moving away from a formal procedure to guidelines for acting may seem counterintuitive to the way processes are run. Managers are extremely busy and this has the appearance of "another responsibility." However, this is really a choice about investing in people. Computers and rules can't solve the more complicated problems — the ones in the gray area.
Adjusters want to learn how to handle these problems. This is what makes the job interesting and keeps them committed to doing it right.
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