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How Auditing Your Claim Block Can Improve the Customer Experience

How Auditing Your Claim Block Can Improve the Customer Experience

After 28 years in the industry, I’ve been fortunate to participate in many different approaches to disability claims management. Although all are designed with noble intentions, unseen flaws eventually become evident.

Since joining SALT as a claims analyst in 2015, I’ve had the chance to peek under the hood at many other insurance carriers’ claim operations. I perform audits and operational assessments of short term and long term disability claim blocks.  As the objective, independent party, I look to identify opportunities for improvement in claims management processes, workflow designs, staffing models, and systems infrastructures.

Every carrier has its strengths. However, it’s always difficult to remain objective. It’s like trying to edit your own term paper; you can easily remain blind to your own errors. Pulling in an outside party just makes sense, and it’s rewarding work when I think about the impact.

When I perform an audit, one important area I look at is timeliness and effectiveness of communication. This includes telephonic, electronic (email/text), and the old fashioned written word (letters).  Typically, what we observe is that in a very busy, metric-based environment, communication is often the first thing to suffer.  Working towards best-in-class communication can significantly improve the customer experience while generating better mutual outcomes.

Most carriers have standardized templates and efficient processes documented. However, because this is a difficult process to measure for quality, lapses in performance often go unnoticed until you bring in that second set of eyes.

The way I look at communication in my claim reviews is simple: be clear, be professional, and set mutual expectations. Convey decisions or requests for information the way you like to be treated as a customer. So how do you put that into practice?

1.    Use the telephone every chance you get.

Although we all should use the phone as often as possible, it can be difficult if we find ourselves in a game of phone tag. While we might be frustrated when we can reach a claimant, it's worse when they have a hard time reaching us.

In a recent example, a claimant from the West Coast had left a message for a claims analyst on the East Coast. Instead of returning the call that day, the analyst did so the following morning. However, given the time difference, this meant not connecting until nearly 24 hours later. This small detail and acknowledgment that the claimant is your customer can go a long way to ensuring an efficient and timely process for all involved.

2.    Craft letters that are as concise and clear as possible - without industry acronyms and using limited “jargon” if you can avoid it.

I often see terms like “adjudicate”, “elimination period”, and “provisions,” which are just plain confusing. These are words that we in the industry may understand, but most people don’t encounter in daily conversation.

Let’s face it - medical information and legal terms are accurate and necessary but don’t always inform the claimant of what is happening to their claim. This only causes more frustration and confusion and reduces or eliminates trust.

3.    Set mutual expectations.

As claim analysts, we have commitments to the claimants that we have to live up to.  If we say we’re going to call them back tomorrow, then we need to follow through.

We should also let the claimants know that they have some responsibilities in the process. For example: “Mr. Customer, if I reach out to you with questions, you need to get back to me in order for our partnership to work.”

Making sure the expectations are acknowledged by both parties is a best practice that can truly improve outcomes.

In Summary

“Audit” is often looked upon as a burden or an invasion by outsiders.  However, if thought of as a way to enhance continuous improvement practice, audits can often help identify opportunities for carriers to build on their strengths, build a better claim workflow, and most importantly, improve the customer experience to achieve the best possible outcomes.

Contact us if you’d like to discuss our audit services – we’d love to talk.

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