Working with Common Claimants Creating the X-Factor

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1 Introduction In the ever-increasing competitive insurance landscape, where policy provisions from many carriers often mirror each other, many companies push service to their policyholders and claimants as their differentiator. Insurers proudly sell additional products to current policyholders and tout their level of coordinated service. Yet, all too often, the superior service promised across product lines at claim time does not happen. It takes a certain X-factor for an insurer to live up to their promise for true coordinated handling of a common claimant. According to the Oxford Advanced Learner s Dictionary, X-factor is defined as a special quality, one that is essential for success and is difficult to describe. 1 That s an accurate description of what insurance carriers must possess in order to be successful in dealing with a common claimant. Common claimants can cross over life, health and property and casualty products. Common claimants can be defined as individuals who have coverage under more than one product with the same insurance carrier. These could result in a number of claims from the same individual for the same event; each handled by multiple examiners in different departments. Some examples of common claims are: Disability and life waiver of premiums Short term disability, long term disability, waiver of life premium, long term care Individual and group disability Individual and group life Health, disability, long term care Critical illness, health, disability FMLA, short term disability, health

2 Page 2/4 The Customer Experience When dealing with a company that bundles services and products, such as a bank, you expect a consistent level of service for all those products. If you ve ever been passed from one department to another in an attempt to have questions answered about each of your accounts, and had to repeat yourself each time, you probably got increasingly frustrated. What if you were asked to fax or mail a form to one area of the bank, but other areas show no record of it and ask, Can you just fax it again? You may have a small bank where everyone knows your name and accounts, or you re managing all of your financial transactions online, but, even in those circumstances, there are numerous opportunities for you to shout in frustration, This is the not the type of service I was promised. Insurance customers expect a high level of service, especially in difficult situations. Customers value and praise highly-integrated and coordinated service processes in the insurance industry. However, insurance companies often make it very difficult to deliver quality service, including coordinated claims. There are frequent barriers many self-imposed that a carrier must overcome in order to coordinate claim information across department lines. What does your sales force and marketing materials say about the customer experience? Does it match the reality of what your customers actually experience? What does your own claim office promise to the customer regarding service for common claims? The following topics will give you some ideas that will help you create the X-factor. Your Message Fifteen years ago the biggest X-factor in group business was the 24-hour product. This was a plan to integrate worker s compensation, short- and long-term disability and family medical leave into a tight, highly-controlled claim unit. The pitch to group clients was that their employees will only have to deal with a few people all working closely together for all of these types of claims, and the client would get an amazing amount of integrated data from all products. Unfortunately, the bundled products and services for 24-hour coverage never took off as expected, in part, due to group clients not being structured in a way that made the integrated process meaningful for them. Integrated and seamless claims services are only as good as the processes supporting them. Ten years ago the term seamless was marketed in describing claim processes, during which the claimant would not notice any handoffs or have to file multiple claims. However, most companies did not design sys tems to support these processes and relied heavily on manual work by the staff to make the processes appear seamless to the claimant. This presented problems in main tain ing consistent service over time. The concept of integrated claim handling is still used as a marketing message. After all, who would really want to buy a series of products from the same company when the message is, At claim time, you ll fill out a claim form for this coverage and mail it to this address, but, for the next coverage, you ll have to complete a form on our website and, on another, you ll need to have your employer fax a form. Also, if you have a physician filling out a form, you ll have to send it to three different addresses. Wait a minute, isn t that what still happens for a number of insurers today?

3 Page 3/4 Your Systems It s too simplistic to say that having one system robust enough to capture eligibility information across product lines will solve this whole issue. However, such a system is integral in easily identifying the parts of your company which will need to interact with the claimant, as well as assisting in effective communications and setting appropriate expectations. Historically, many companies have developed systems in silos, while others still operate older legacy systems. Based on a Munich Re survey of 38 group life insurance carriers, over half of the responding companies use entirely different claim systems for their Group Life and Long Term Disability (LTD) claims management. 2 For many carriers, the technology to share eligibility information across product lines does not exist. Also, for group products, many carriers have to rely on their clients that self-administer their employee eligibility to provide appropriate coverage verification. Technology supporting ease-of-use and information sharing are essential. A company should assess what options are feasible for capturing eligibility information. One solution to explore could be a graphic user inter face (GUI) system which overlays the legacy systems and pulls data from each system, arranging it in a user-friendly format. Staff in all departments can access claimant data from multiple systems through the GUI, enabling more people within the company to answer claimant inquiries. This type of overlay system is often developed in-house, but there are off-the-shelf options which can be adapted to a company s needs. Another system-related solution is imaging claim documents that can easily be shared across departments. Imaging reduces the need for multiple copies of forms, physician statements and other documents required for claim handling. However, as an industry, imaging is not yet the accepted norm. The same survey showed that only 42 percent of direct carriers have a group life claim system which allows for storage of images. An additional 29 percent had some type of image document storage system, but separate from the claim system. 2 That leaves almost 30 percent with no imaging capacity, including some of the largest carriers with the broadest array of products. Implementing imaging technology, or enhancing your current capabilities, will significantly increase your company s ability to serve clients with multiple coverages, as well as improve your claim workflow. Your Processes Regardless of the level of your systems contribution to serving common claimants, you need consistent internal processes to be successful. It is unrealistic to expect your employees to be experts in all of your products. However, high level cross-training and easy access to updated resource material is advised. At the very least, employees of insur ance companies should be able to identify coverages they don t nor mally support, and be aware of the process when an unfamiliar situation arises for multiple coverages. Consistently relying on heroic customer service efforts of a dedi cated employee is not an effective way to overcome barriers that exist when serving a common claimant.

4 Page 4/4 Successful adjudication of common claims starts with knowledgeable, empowered staff. Most claimants will understand when claims for different coverages will be handled by different experts (especially if that is explained early in the process). Frustration rises, however, for the claimant when he must furnish redundant information and documents or explain the same circumstances over and over. One suggestion is to limit the number of examiners in each claim area who will work on claims from common claimants. That will allow expertise to grow for each of the common claimant examiners, while limiting the number of people who need access to common claimant resources. This is where the documentation processes are vitally important. Clearly, there must be a way to document a conversation with the claimant and have that documentation accessible to others in the company. There should also be a method to record when a key piece of claim documentation was received. Even if a manually-devised process for these common claimant examiners to share information is developed, it will be moving in the right direction toward providing good service for the claimant. Some coverages are similar in nature, such as Life waiver of premium and LTD claims. The smaller carriers are more likely to utilize the same claim examiner for these two claims, while 75 percent of larger carriers use a stand-alone waiver team and a separate LTD team 2. Taking into account claim volumes, combining similar types of claims under the same examiner may be effective. Another process to consider is a consistent lead examiner for common claimants. For example, if a company sells both individual and group disability, it s likely to occasionally have a common claimant between the two coverages. A process could be designed so that the individual claim examiner always takes the lead on the action plan steps, signalling to the group examiner to discuss group claim needs with the individual examiner. Together, they can decide the next steps and decide who will contact the claimant. Your Tools One of the most effective ways to ensure you are identifying all potential claims from a claimant is to utilize a centralized claim intake area. Whether you allow telephonic or web-based intake or paper submission of claims, having one area to search and identify all products associated with a claimant can alert all departments at the same time of a potential claim. In the event of varying elimination periods (e.g., three months for disability, nine months for life waiver of premium claim), claims can still be identified at the time of filing for any one of the coverages. The initial claim filing is the best opportunity to identify potential additional claims. Once a common claimant initiates a claim, an excellent way to provide good service is the use of a call center or trained call intake staff. As a best practice, these representatives have access to company-wide customer information another reason why shared information on systems is so important and can answer questions from the claimant. When a question is beyond their basic knowledge, it would be transferred to the examiner for an appropriate explanation. This allows for the common claimant to get many of the basic questions answered with relative ease.

5 Page 5/5 Other Points to Consider Being able to deliver quality services across multiple departments is not inexpensive. Leaders in the company have to visibly support the belief that systems and processes are important to the service provided to their customers, and deliver that message consistently throughout the organization and over time. As a bonus, management might find that, in addition to providing better service, there are internal operational improvements which result from improved data sharing. Management buy-in, maintaining customer confidentiality and effectively dealing with regulatory requirements are other key factors to address. We are in the age of ever-increasing needs for protection of claimants personal information. Insurance carriers need to continue to be mindful of confidentiality concerns when designing processes that involve multiple departments. Related to this, the HIPAA-compliant release of information form should be reviewed to ensure it allows the company to obtain all appropriate information for its products. You might subscribe to the philosophy that it is not the insurance company s responsibility to file additional claims for the claimant. However, your company s marketing message aside, there are other reasons to consider making it as simple as possible for common claimants to file for all potential benefits for which they may be eligible. Insurance regulators have shown a recent propensity to question the practices of insurers that, in the regulators view, are not in the best interests of customers. This is evidenced by the questions posed during evaluations of retained assets accounts and the use of the Social Security death match database for life proceeds. The regulators could eventually require new processes for common claimants if they view that the industry is not doing enough. Additionally, market conduct exams look for practices that do not treat claimants fairly or should be improved for the benefits of claimants. Regulators also frown upon different claim decisions when there are similar policy definitions. This is a key reason to make sure common claimant examiners are aware of decisions being made elsewhere in the company for the same claimant. It s Your Decision Rick Denman is Assistant Vice President of Group Claims and Administration for Munich American Reassurance Company. You may not have a high volume of claimants with multiple coverages, but you should have procedures and systems in place to provide those with excellent service. If you do not already have them, you will be wise to design processes which will better address this need in the future. By aligning your message, systems, processes and tools, your company s service reputation and the potential for new and continuing business will be enhanced and you will have the X-factor of service for common claimants. 1 Oxford University Press, Oxford Advanced Learner s Dictionary, 8th ed Print 2 Munich Re, Group Life Claims & Waiver of Premium Industry Survey Report, June 2011 Not if, but how 2012 Munich American Reassurance Company, Atlanta, Georgia

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