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Hiring a New Claims Management Team? Make Sure They Do These Four Things

Thursday, November 19, 2020
Amber Ramirez
Hiring a New Claims Management Team? Make Sure They Do These Four Things

Over the next several years, commercial insurance brokers will face a growing claims advocate staffing gap. Since February 2020, the number of retired Boomers has increased by about 1.1 million, many leaving in the wake of the COVID-19 recession.  While 10,000 baby boomers retire each day, 25 percent of which are leaving the insurance and financial services sector, fewer adjusters are entering the business to fill the gap.  

With the new year approaching, now is the time to ensure that your Claims Management team is fully staffed with skilled professionals. The Horton Group is fortunate to have a robust team with years of experience and no current plans to retire. Our team of advocates consists of former third party administrator (TPA) and insurance carrier Claim Professionals. They understand the inner working of the claims cycle and specialize in adding, or perhaps more appropriately, saving your company claim dollars.

When evaluating your future Claims Management team, you want to see professionals who go above and beyond to produce successful results.

Here are four actions that separate an experienced employee from a novice one: 

  1. They analyze your experience modification factor. There are risks and opportunities when it comes to managing claims. A major goal of your Claims Management team is to help reduce the severity of your claims and, ultimately reduce their impact and frequency. Our team will carefully calculate your experience modification factor to ensure accuracy and help you prepare accordingly. We will pinpoint your weaknesses and recommend solutions to strengthen them, so we can assist in lowering your experience modification factor, which will ultimately result in a discounted premium.
  2. They thoroughly evaluate the investigation process. We don’t want to simply “do” our job – we want our job to be done right. We believe that all claims should be thoroughly investigated and managed to ensure the appropriate benefits are paid in a timely manner. When evaluating your case, we will work closely with the carrier and TPA to verify that the appropriate investigation is completed, the evidence is protected, and actions are taken to prevent future occurrences. We provide oversight to make sure the carrier’s / TPA’s claim professional remains on task with actions in order to move the claim toward timely resolution. We also take an active role in and coordinating your claim file reviews, offering suggestions to the carrier/TPA, and providing direction to the claim professional on your behalf.
  3. They provide navigation, coordination, and communication. Filing any kind of claim can be a complicated and daunting process. However, your Claims Management team should make it a priority to ensure you are informed, comfortable, and confident throughout the whole process. We will be completely transparent and will update work with you to develop an agreed-upon communications plan. If you are confused about any aspects, we are readily available to answer all of your questions and concerns in a timely manner – even during nights, weekends, and holidays. 
  4. They review the accuracy of reserves. Your Claims Management team’s main objective is to ensure your case is reserved for a realistic outcome, which is why they will conduct a thorough assessment before we establish your reserves. Horton evaluates the cost of the claim over time to provide the most thoughtful analysis, carefully considering the facts, laws, behavioral issues, expectations, and experiences. This is a delicate process that requires a sense of foresight and proactive thinking, so it’s crucial to hire a team like Horton’s that possesses a wealth of experience.

We challenge you to take a critical look at what “high performance” means to your business and future success. Don’t risk leaving your claims advocacy in the hands of a broker who has exposed you and your business to the impending staffing gap. Contact US to learn more about how our Claims Team can help your business. 

Material posted on this website is for informational purposes only and does not constitute a legal opinion or medical advice. Contact your legal representative or medical professional for information specific to your legal or medical needs.