Skip to main content
1.800.383.8283
Library
  • Industries
    • Construction
    • Education
    • Healthcare
    • Manufacturing
    • Moving & Storage
    • Municipal
    • Non-profit
    • Welding Supply & Gas Dist.
  • Events
  • About
    • History
    • News
    • Office Locations
    • Team
    • Culture
    • Contact
    • Careers at Horton Group
  • Services
  • Online Bill Pay
1.800.383.8283
Client Login
Search

Choose a login.

  • Client Logins
    • Business Insurance
    • Employee Benefits
    • Personal Insurance
  • Library
    • Benefits
    • Commercial
    • Personal
    • Safety
    • Thought Leadership
    • Wellness
Home
1.800.383.8283
  • Business Insurance
  • Employee Benefits
  • Consulting Services
  • Personal Insurance
  • Industries
    • Construction
    • Education
    • Healthcare
    • Manufacturing
    • Moving & Storage
    • Municipal
    • Non-profit
    • Welding Supply & Gas Dist.
  • Events
  • About
    • History
    • News
    • Office Locations
    • Team
    • Culture
    • Contact
    • Careers at Horton Group
  • Services
  • Online Bill Pay
  • Library
    • Benefits
    • Commercial
    • Personal
    • Safety
    • Thought Leadership
    • Wellness
      • Population Health Management
  • Client Logins
    • Business Insurance
    • Employee Benefits
    • Personal Insurance
Close Menu
  • Property & Casualty
  • Mergers & Acquisitions
  • Risk Transfer
  • Professional Liability
  • Claims
  • Cyber Liability Insurance
  • Automobile Liability
  • Captives & Alternative Risk
  • International
  • Surety Bond Services
  • Workers Compensation
  • Management Liability
  • ACA/DOL Compliance
  • Core & Voluntary Benefits
  • Executive Benefits
  • FSA / HSA
  • Group Medical
  • International Benefits
  • Private Exchange Technology
  • Retirement Services
  • Stop Loss
  • ThinkHR
  • Zenefits
  • Home Umbrella
  • Life & Health
  • Private Client
  • Speciality Recreation
  • Safety & Loss Control
  • Wellness
‹ Back to Resources

How Are Your Claims Managed?

January 25, 2018 at 12:00 AM
Share

By Penny Solski, AIC

During the past 20 years, insurance companies and third-party administrators (TPAs) have dramatically changed and minimized their claim management processes.

Considering the current economic conditions in the United States, expect a further reduction of claims staff as a cost-saving effort on the part of insurance companies. With these changes, many processes performed on behalf of the insured (you) have been reduced or eliminated. If your current insurance broker does not have a claim professional acting on your behalf, you may be surprised at the results of a claim audit.

Consider an Audit

Depending on the pricing mechanisms for your insurance policies, previous claims either affect your total premium, based on prior losses, or your bottom line due to the deductibles for which your business is eligible. There are many reasons to consider allowing a claims advocate to audit your open claims.

During an audit, claims advocates focus on several aspects of your open claims. An investigation determines whether claim reserves, amounts set aside for unsettled claims, are adequate, especially whether the reserve amounts are set too high. A reserve that is set too high negatively affects future premium pricing, as companies with high reserves are often viewed as less desirable by insurance companies. Claim advocates also review the claim handling processes by your insurance company to make sure that proper care was taken and no steps were missed while managing your claims. Finally, for audited open claims, advocates set appropriate and aggressive action plans for claim resolution.

Missing Pieces

Recently, insurance carriers, TPAs, and outsourced claims managers have cut costs by rationalizing the reorganization and consolidation of their operations. This often means the loss of more experienced, senior claims professionals. With these changes, details of your claims could remain unmanaged, costing your company money in terms of premium pricing and lengthy claim processes.

The use of claim management technology by insurance carriers is expanding. Many carriers currently utilize databases for handling and reserving claim files. While technology is efficient and constantly advancing, it is impossible to incorporate the human element into a computer program. There are several individuals involved in most claims, including the plaintiff, the plaintiff’s attorney, physicians, and more. Each individual drives the direction of the claim differently. The idea that a claim professional can rely on a computer-generated projected claim outcome, established at the onset of a claim, is not realistic.

The outsourcing of claims and unbundled claims services by insurance carriers and TPAs has led to a rise in the overall cost of claims. While insurance carriers audit the big picture performance of their services, they do not address how individual accounts are managed. Only claims advocates acting on your behalf zone in on the details of your specific claim management. While State agencies perform audits of insurance carrier processes, they generally have objectives unfocused on individual clients.

An Insurance Carrier’s Perspective

Most insurance carriers do not object to claims audits when they are approached properly by claims advocates. A discussion of potential audits is better received when a claims advocate meets with the insurance carrier at the carrier’s location. Clear communication regarding the objectives of an audit should be shared with the insurance carrier or TPA.

As a best practice, risk managers should consider the benefits of having a claim audit performed on their organization’s insurance program. An audit provides an overall analysis of the financial impact of claims on your company. Allowing a claim advocate to audit your claims could potentially save your company thousands of dollars, as well as a great deal of time.


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 needs.

Human Resource, Compliance, and Employee Benefits Focused Events

Interested in sharpening your skills and potentially earning Continuing Education (CE) credits?
Join us for one of our upcoming events:
April

April 13, 2021 | A Better Way to Provide Life, Disability and Employee Assistance Programs for Schools

April 14, 2021 | How to Survive an OSHA Inspection

April 22, 2021 | Deep Dive into the COBRA Subsidy Rules

April 23, 2021 | NonProfit Connecting Your Wellness and Safety Programs

April 23, 2021 | Deep Dive into the COBRA Subsidy Rules

May

May 06, 2021 | At-Home Ergonomics: The Proper At-Home Workstation Setup to Avoid Pain & Discomfort

May 11, 2021 | The Importance of Cyber Incident Response Planning

May 12, 2021 | OSHA Targets Healthcare for COVID-19 Compliance – How to Survive an Inspection

May 20, 2021 | The Advantages of Group Purchasing for Employee Benefits - NonProfits

May 20, 2021 | Regulatory Update

May 20, 2021 | The Advantages of Group Purchasing for Employee Benefits - NonProfits

May 20, 2021 | Medicare 101

June

June 17, 2021 | Why investigate? The importance of having a strong accident investigation program. (NonProfits)

June 17, 2021 | Medicare 101

June 24, 2021 | Common Benefits Mistakes Employers Make

July

July 14, 2021 | The Importance of Cyber Incident Response Planning

July 15, 2021 | Medicare 101

Safety Focused Events

Interested in sharpening your skills and earning Continuing Education (CE) credits?
Join our mailing list to learn about new and upcoming events!
JOIN MAILING LIST

Footer: Call-To-Action

Contact the Horton Group today to discuss how you can achieve a higher level of performance.

Contact Us

Find Us

Horton Group
Corporate Headquarters / Orland Park, IL
(800) 383-8283

Bourbonnais, IL
Chicago, IL
Edina, MN
Estero, FL
Indianapolis, IN
South Bend, IN
Sturgis, MI
Waukesha, WI 

  • About
  • News
  • Our Team
  • Career
  • Office Locations
  • Contact
  • Forms & Applications
  • Assurex Global
  • Awards
  • Privacy Policy

Join Our Mailing List!

Sign up to receive email notifications for upcoming events and important industry news.

  • Facebook
  • LinkedIn
  • Twitter
  • YouTube
  • Instagram

Copyright Menu

  • Privacy Policy
  • Sitemap
  • Terms & Conditions
  • Ethics Reporting System
  • Compensation Disclosure
Copyright © 2021 The Horton Group