WHY QUALITY OF CLAIMS SERVICES MATTERS

For an adjuster or examiner, the process of administering a claim and dealing with several providers for a single claimant is typically quite common and routine. However, the claims process from a claimant’s perspective can be rather complicated and, more often than not, a major source of frustration for claimants. This is doubly true when multiple providers are involved in a single claim.  When high quality services are provided to claimants at all points throughout the claim, claimants will experience a higher level of satisfaction and therefore will be much more likely to renew their policies with your insurance company. There are several areas that your insurance company should be gathering and analyzing data on to determine how the quality of claims services is impacting your claimants and their renewals.

The first touchpoint of many claims begins with the adjuster or examiner assigned to the claim. Not only are they responsible for indemnifying the claimant while concurrently managing the cost of the overall claim, but it is vital that they ensure each claimant is satisfied with his or her experience. Put simply, it is no longer enough for a claimant to simply be indemnified by the insurance company. Renewals are impacted by the claims experience so delighting claimants is mandatory.

Providing an exceptional claimant experience may prove even more challenging when a claimant requires physician prescribed services from multiple providers. As an insurance company, you must ensure that all providers are meeting your high standards of claimant care. This encompasses everything from offering prompt, courteous customer service to the availability of clean and well cared for equipment. If a claimant requires the use of a wheelchair and will need home health care for a period of time during recovery for instance, the claimant is much more likely to be satisfied with the claim when he or she is treated with respect and kindness and has access to the proper size and type of wheelchair.

In light of the challenges involved with managing the quality of services in any given claim, insurance companies should consider working closely with a third-party administrator (TPA) such as Northwood. A TPA will be able to streamline the claims process for claimants and adjusters and examiners in a variety of ways that also assure high quality claims services.

Partnering with a TPA offers an array of benefits such as a network of quality providers and convenience for claimants. For instance, Northwood has curated an extensive network of the highest quality providers that offer convenient access to physician prescribed services for claimants. We also implement pre-authorization processes that assure injury relatedness and eliminate claimant out of pocket expenses.

By analyzing the quality of claims services and optimizing them, you will ensure your claimants experience a more streamlined claims process that fuels a higher level of claimant satisfaction. In turn, this will impact your bottom line because satisfied claimants are much more likely to renew their policies with your company.

For a customized audit of your claimant experience and personalized improvement recommendations, please contact Rosanne Brugnoni at 586-755-3830 ext. 3771.

Is your claimant experience resulting in renewals?

At first glance, claims experience and policy renewals may not seem directly linked. However, insurance companies must uphold stringent standards of excellence to ensure their claimants experience the highest levels of satisfaction throughout the entire claims process. Unsatisfied claimants translate into unhappy insureds, which can often lead to the loss of those same insureds when it comes time for them to renew their insurance policies with your company.

The frequency and style of communication factors in to the level of claimant satisfaction as well. According to Agencybloc’s blog entitled, “The #1 Reason Clients Leave Your Insurance Agency,” a Rocket Referrals study showed that 81% of clients exit due to the absence of consistent contact with the agent or agency. Furthermore, another study cited in the same piece showed about 44% had been in touch with their agent in the last year and a half.

It’s important that your insurance company keeps these statistics top of mind when administering claims. Even though the claims department is not an agency, these facts highlight the need for regular communication with claimants on all levels. The direct reason for this is because that even though your adjusters and examiners are dealing with claims every day, your claimants typically are not. Claimants may be calling in to report an auto accident with injuries and may be experiencing an array of emotions; adjusters and examiners have an opportunity to excel at customer care with these types of claims especially.

https://www.northwoodinc.com/claimant-experience-resulting-renewals/

Northwood: Helping to Improve Your Claimant Engagement

The administration of claims can be incredibly complex, particularly if the claimant involved suffered catastrophic injuries. Adjusters and examiners are often on the front lines of the claim, tasked with many duties including claimant indemnification. Whether a claim falls under workers’ compensation or automobile no-fault coverage, it’s important for an insurance company to also focus on claimant engagement and claimant satisfaction levels. Ultimately, an increase in claimant satisfaction levels translates into increased retention for an insurance company. The reverse is also true: if your insurance company fails to improve claimant engagement and satisfaction, your retention levels will drop and you may lose insureds.   

https://www.northwoodinc.com/northwood-helping-to-improve-your-claimant-engagement/

Impact Of Provider Networks With Discounted Rates

Within the field of claims administration, there are many avenues that insurance companies may choose to take to assist in holding down costs and in lessening the administrative burdens placed on adjusters and examiners. One such avenue that brings a multitude of benefits to an insurance company is to partner with a third-party administrator (TPA) on each claim, whether auto no-fault or workers’ compensation claims.  

One major benefit that comes from a partnership between an insurance company and a TPA involves the access that the insurance company will gain to a network of providers that has undergone a thorough credentialing process. Northwood is a TPA that has been in operation since 1992 and has drawn upon its extensive experience to create an expansive network of such providers. Providers within this network must adhere to Northwood’s high standards, including accreditation,  applicable licensure and the assurance of liability insurance coverage. Northwood maintains an electronic database of the providers’ insurance expiration dates and requests updated certificates annually. Once providers have been credentialed and become part of this trusted network, they are recredentialed every 2 years. 

https://www.northwoodinc.com/impact-provider-networks-discounted-rates/

Benefits of a Pre-Authorization Process

The proper and efficient administration of workers’ compensation and automobile no-fault claims is vital to an insurance company’s continued success. As every adjuster and examiner knows, the first duty is to restore the claimant to his or her previous state after he or she experiences an injury due to a claim. Another responsibility of adjusters and examiners is to control costs, improve productivity, decrease cycle time and improve customer service.  

With the myriad of responsibilities and tasks assigned to adjusters and examiners daily, it can be incredibly challenging for them to efficiently administer claims at times. Having an experienced resource to draw upon can dramatically increase adjuster and examiner productivity as well as assist in controlling claims costs. In addition, productivity levels can be increased when adjusters and examiners have access to proven systems within this resource that streamline claims adjudication. These benefits are realized through a partnership with a trusted third-party administrator (TPA) that has the experience and knowledge to act as that resource as well as implement efficient processes that can impact an insurance company’s bottom line. 

https://www.northwoodinc.com/benefits-of-a-pre-authorization-process/

HOW THE HEALTHCARE COMMON PROCEDURE CODING SYSTEM CAN COST YOU MONEY

As all adjusters and examiners working within an insurance company know, both automobile no-fault claims and workers’ compensation claims come with inherent complexities and intricacies. Besides being responsible for indemnifying each and every claimant, adjusters and examiners are also responsible for holding down the cost of each claim administered. Controlling claims costs and preventing overpayments and unnecessary payments is not an easy task and requires a significant portion of administrative time on each claim.  

While there are many factors that come into play when it comes to the increasing cost to administer both auto no-fault and workers’ compensation claims, one particular factor stands out. The Healthcare Common Procedure Coding System, or HCPCS, as it is commonly referred to within the industry, contains its own unique complexities that can be tricky to navigate. The time-consuming nature of reviewing provider HCPCS codes for accuracy means that adjusters and examiners may spend a significant portion of time on this aspect of many of their claims. Increased time spent on this facet of no-fault and workers’ compensation claims translates eventually to an overall increase of claims costs for an insurance company. 

https://www.northwoodinc.com/healthcare-common-procedure-coding-system-can-cost-money/

Workplace Eye Wellness Month

March is Workplace Eye Wellness Month. Your eyes are something you use every day and sometimes take for granted. You just expect them to work and do their job. A startling fact is that over 2,000 Americans, every single day, suffer some form of eye injury. This equates to over $300 million in medical expenses, workman’s comp claims, and lost work time.

When you think of an eye injury, you most likely think of something striking the eye, splashing into the eyes, or having debris or dirt enter the eye, but these are only some of the injuries that can happen to your eyes. With the advent of all the electronic devices that you can use, eye strain and fatigue is also a frequent problem. If you work on a computer, you could be staring at your screen for six to eight hours per day. This is work time computer use; most people also jump on their computers at night to catch up with family and friends. If not their computers, then they are looking at their phones to catch their mail or text messages. This can lead to eye fatigue and possibly dry eye, along with headaches and body aches from remaining in the same position for an extended period. With all of these potential dangers to your eye, how can you protect yourself?

https://www.northwoodinc.com/workplace-eye-wellness-month/