With the advent of AI-powered customer call centers the promise is of easier navigation and improved service. Many current call centers have yet to transition to this technology. Great customer service is a primary responsibility of the CEO of every company in our industry. I firmly believe that having the senior executive of the company actively regularly (once a month on the calendar) testing the customer service call centers, would…
When I was the GVP of Risk at Safeway we performed an analysis of our corporate culture to design a safety program that would have the opportunity to maximize the success of our goal of reducing claims frequency. The two essential traits of our corporate culture were: 1. What my boss found interesting I found fascinating 2. The company was driven by competition (comparing and competing divisions, districts, stores and even departments) …
A containment room is a highly protected area to store flammable and combustible items in a warehouse to avoid catastrophic fires. Items such as cigarette lighters, candles and other highly flammable products are usually segregated from the rest of the warehouse in a “containment room.” Having a containment room in a distribution warehouse is part of having a warehouse that is designated as a “Highly Protected Risk.” HPR is a…
The workers’ compensation industry faces a daunting challenge: a severe shortage of qualified claims examiners. This crisis threatens to inflate costs, delay crucial benefit decisions, and undermine the quality of claims management. By understanding the root causes and implementing proactive solutions, industry leaders can navigate this turbulent landscape and safeguard the integrity of the workers’ compensation system.Impact of Examiner Shortage: The shortage of skilled claims examiners is not merely a…
Roger was the most knowledgeable worker's compensation claims person I ever met. He knew the labor code; he knew all the case law and how each legal opinion applied to that claim which was in his hand. He knew how to accurately and consistently reserve claims (he was exceptional with this), he knew how to audit claims, and he knew how to resolve claims. Roger was not very tactful. He…
Introduction Within all claims operations, the claims manager and supervisor are responsible for balancing the examiners’ caseload to make sure that the examiners not only have the right caseloads but also have the right claims within that caseload. Properly done, the assignment process will allow the examiner to produce optimum results. The right balance is based on the experience of the examiner, the support level of the claims team (number…
Introduction The “Optimum” throughput of claims always results in the lowest total cost of claims. Instead of focusing on caseloads the industry should focus on the throughput of claims to measure productivity and staffing needs. Optimum throughput of clams is; When claims are immediately reported, where compensability is promptly determined, when prompt appropriate medical care is provided, when early return to work is achieved, where indemnity benefits are accurately and…
Employers have a direct positive impact on their claims results if they partner with the claims examiners. When employers treat the claims examiner as a professional partner, claims results are always better. When employers work well with the claims examiners the examiners are happier and more productive. Employer actions also have a direct impact on examiner retention. In an industry full of negativity, acknowledgements and thank you notes to examiners…
Every job in the insurance industry requires good negotiation skills. It remains a mystery to me that few in the insurance industry are formally trained in the art and nuances of negotiations. Each job has its unique nuances and language. There should be a specific training program for the sales staff, the underwriters, the safety professionals, the clams examiners the attorneys and the medical professionals. Here are a few negotiations concepts…
There are many different life situations facing parents. One of the most rewarding and challenging is the balancing act of raising children while meeting work responsibilities. The fundamental obligation of a parent is to make sure that their children obtain the necessary education to be successful in life. Children who are engaged and supported at school usually become successful adults. Many times employers ignorantly create work situations that do not…
