Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Claims Triage - How to Do It Well


Published on

Triage is a French word meaning “to sort.” Developing a claims triage strategy allows a company to obtain a good overview of the claims situation and allocate resources appropriately. Attend this session to learn more about sorting your claims to make the best use of available resources.

Published in: Software
  • Be the first to comment

  • Be the first to like this

Claims Triage - How to Do It Well

  1. 1. Claims Triage How to Do It Well Phil Reynolds CEO / Founder BriteCore
  2. 2. Triage: /trēˈäZH,ˈtrēˌäZH/ “to assign degrees of urgency”. French word trier ‘separate out orsort by nature.’ Developed by military physicians.
  3. 3. Claims Triage is the process of sorting and responding to incoming losses.
  4. 4. Triage may be necessary following a high volume claims event.
  5. 5. Plan Ahead
  6. 6. “Before anything else, preparation is the key to success.” -Alexander Graham Bell
  7. 7. “By failing to prepare, you are preparing to fail.” -Benjamin Franklin
  8. 8. “Success is where preparation and opportunity meet.” -Bobby Unser
  9. 9. Don’t bury your head in the sand!
  10. 10. Hope for the best. Plan for the Worst.
  11. 11. Complex Planning
  12. 12. Not great when drowning.
  13. 13. People tend to panic in a crisis.
  14. 14. Panic is a survival mechanism for the brain.
  15. 15. Amygdala Sends Alarm Triggering Fight or Flight Response
  16. 16. Effects Panic 1. Suppresses Pre Frontal Cortex, Inhibiting Rationality • Emotional Outbursts 2. Reduces our Ability to Make Decisions • Analysis Paralysis or Self-Destructive Behavior 3. Hyper Awareness of Threat-Related Information • Exaggeration and Paranoia 4. Negative Bias Toward Ambiguous Stimuli • False Conclusions and Red Herrings
  17. 17. Freak Out!
  18. 18. Staff under high Pressure.
  19. 19. Staff under high Pressure. • Working Under Increased Volume • Unfamiliar Procedures and Job Roles • Extra Hours and Responsibilities • Ratings Downgrade • Forced Liquidation of Assets • Insolvency
  20. 20. Customers experienced Loss
  21. 21. Customers experienced Loss • Lost valuables, keepsakes, memories • Lost loved ones • Where do I live? What do I wear? How do I eat? • How will I replace everything? • Can I hold down a job and manage all this? • Is the insurance company going to take care of me?
  22. 22. Perfect storm to divide people. You Customers
  23. 23. Teamwork and Cooperation
  24. 24. Show Concern and Empathy
  25. 25. Can’t Rely on Willpower! Our ability to exercise judgement is limited when we feel panicked.
  26. 26. Willpower is Like a Muscle
  27. 27. Willpower Experiment
  28. 28. 8 minutes 19 minutes Willpower Experiment
  29. 29. Performance Follows Practice
  30. 30. Practice Forms Habits
  31. 31. Cue HabitReward The Habit Loop
  32. 32. Smoking Habit
  33. 33. Eating Habit
  34. 34. Habits Can Be Shaped
  35. 35. Willpower Becomes Automatic
  36. 36. Triage Planning
  37. 37. Carriers should devise a Triage Plan that can be executed consistently under high pressure.
  38. 38. Prioritizes and sorts losses.
  39. 39. Reduces unnecessary loss expense.
  40. 40. Increases customer satisfaction.
  41. 41. Lay a solid foundation. Triage Planning
  42. 42. 1. Communication 2. Loss Notice 3. Response Team 4. Adjusting Losses 5. Risk Management Triage Planning
  43. 43. 1. Communication Triage Planning
  44. 44. • Build Awareness • Show Concern and Empathy • Proactively Advocate • Set Expectations GOALS
  45. 45. Awareness plays a critical role in preparing for unfortunate claims events.
  46. 46. How do you build awareness among policyholders, staff, and agents?
  47. 47. Educate before, during, and after events.
  48. 48. i. Contact Management ii. Outbound Messaging iii. Notification Channels Communication
  49. 49. i. Contact Management
  50. 50. At the vary least, you need to be collecting name, risk address, mailing address, email, phone number, and preferred method(s) of contact. Deploy a centralized CRM
  51. 51. Hubspot • Manage contacts (syncs with Gmail or Outlook) • Create, automate, measure, and optimize online marketing • Publish search-friendly blog posts • Build landing pages without IT USE CASE: Contact Management, Agent and Insured Communication
  52. 52. ii. Outbound Messaging
  53. 53. Communication should be sent to customers when a threat is known.
  54. 54. • How to prepare for a natural disaster (each type) • Disaster recovery locations and instructions for customers • Periodic updates with recommendations • How to seek assistance and file a claim Outbound Examples
  55. 55. iii. Notification Channels
  56. 56. Dashboards Website Email Push Notifications Social Media iii. Notification Channels
  57. 57. Channel - Dashboards
  58. 58. Consider All Audiences Policyholders Adjusters Agents Admin Staff
  59. 59. Channel - Website
  60. 60. Set up a landing page that can either take over your company’s home page during a disaster or direct traffic flow to a specific task page.
  61. 61. Page Purpose: To help claimant’s quickly and efficiently file claims directly following a catastrophe.
  62. 62. SquareSpace • Quick WebSites from Beautiful Templates • Fully Managed Deployment • Business User Can Build and Edit • Optimized for SEO, Search, Usability, etc. USE CASE: Landing Pages
  63. 63. Channel - Email
  64. 64. Email Campaigns Email is a great way to send frequent communication that drives traffic to other landing pages and dashboards.
  65. 65. Once you’ve created content on your website or blog, you can easily paste it into an email to send to your customer base. Recycle Content
  66. 66. Mail Chimp • Email Communications • Stock and Customizable Templates • List Management • Analytics USE CASE: Agent and Insured Communication, Warnings, Alerts
  67. 67. Channel - Push Notifications
  68. 68. Percentage Opened 2% 98% Opened within 3 min 10% 90% Texts and Push Notification
  69. 69. Texts and Push Notification A disaster warning has been issued in your area. If you experience a loss, file a claim at Text STOP to 17568 to unsubscribe from notifications.
  70. 70. Automated Call Systems “A disasterwarning has been issued in yourarea. Fortips on how to prepare fora disaster, please visit ourwebsite"
  71. 71. Plum Voice (IVR) • Easily launch campaigns • Completely cloud-based • Decision trees with business logic • Simple opt out options • Integration with policy and claims systems USE CASE: Automated phone campaigns
  72. 72. Channel - Social Platforms
  73. 73. Social Platforms Policyholders / Community
  74. 74. You should already have an established Social Media presence and actively connect with customers via Facebook, Instagram, Twitter, Youtube, etc.
  75. 75. Buffer • Share to All Social Media Platforms Equally • Schedule Posts For Peak Times • Promote Consistent Messaging • Reduce Administrative Overhead USE CASE: Facebook, Twitter, Linked In, Instagram, Google+, Pintrest
  76. 76. YouTube • Channel for Your Company • Playlists Per Project • General and Personalized Training • Allow People to Learn Onsite USE CASE: Agency Training, Insured How Tos, General Promotions
  77. 77. Company-Wide Disaster Training
  78. 78. 2. Loss Notice Triage Planning
  79. 79. Develop a Script
  80. 80. To effectively assign levels of priority to incoming claims, you’ll need to develop a standard script to use at FNOL.
  81. 81. Ask policyholders 5-10 questions to determine how quickly they need your assistance. How Urgent is the Claim?
  82. 82. Example Questionnaire Major Weather Event
  83. 83. 1. What are the names, current or temporary addresses, and phone numbers for each policyholder? Example Questionnaire
  84. 84. 2. What is the extent and severity of the loss? Example Questionnaire
  85. 85. 3. Is your home livable? Do you have a place to stay? Example Questionnaire
  86. 86. 4. Is there any property damage that might worsen if left untreated? Example Questionnaire
  87. 87. 5. Did you lose personal property? Example Questionnaire
  88. 88. 6. If so, do you have a way to purchase replacement items until the company can reimburse based on policy coverages? Example Questionnaire
  89. 89. 7. Are you planning to return to work? If so, what is best time to reach you? Example Questionnaire
  90. 90. 8. What else can we do to make your family more comfortable? Example Questionnaire
  91. 91. Rank Losses
  92. 92. To make the best use of available resources, sort claims by severity.
  93. 93. Prioritization takes an overwhelming number of claims and classifies them into manageable groups.
  94. 94. Going from this…
  95. 95. … to this.
  96. 96. Carriers can use a 3 Level Model to help determine which policyholders need assistance first.
  97. 97. Involve conditions that are likely to deteriorate or change, or the scope of the loss requires an adjuster’s immediate attention. Level 1 Claims
  98. 98. Require field inspection but the conditions of the claim aren’t immediately urgent. Level 2 Claims
  99. 99. Field inspection for these claims could be scheduled out further without significantly impacting the outcome.
  100. 100. Can easily be handled in the office and do not require an adjuster’s field inspection. Level 3 Claims
  101. 101. Digital Assistant Instant Message Mobile App Web Form Phone You should offer many convenient channels for a policy hold to file a first notice of loss. 1 2 3 4 5
  102. 102. 1. Phone • Call center / CSRs • BPO providers can assist • VoIP systems • IVR for automated screening
  103. 103. Plum Voice (IVR) • Self-service phone interactions • Speech recognition • Interactive dialogues with rules engines • Integration with Policy and Claims Admin Systems USE CASE: Loss Notices, Ranking, and Routing.
  104. 104. 2. Web Form Create web form that can automatically post to your claims system. Setup workflows to notify staff when a FNOL is filed from the web.
  105. 105. SquareSpace • Quick WebSites from Beautiful Templates • Fully Managed Deployment • Business User Can Build and Edit • Optimized for SEO, Search, Usability, etc. USE CASE: Landing Pages
  106. 106. Dedicated FNOL Vendors • Complex rules engines • Connected to other service providers • Frequently include a BPO service as well
  107. 107. • File a claim directly from your policyholder app • Leverage phone features such as gps, and camera • Post directly into your claims management system 3. Mobile App
  108. 108. 4. Instant Message I want to file a claim. >> I want to view coverage. >> I want to add coverage. >> I want to pay my bill. >> Automated chat assistants can be added to your customer apps or portals to help policyholders quickly find answers to questions.
  109. 109. 5. Digital Assistant Services like Amazon Alexa allow customers to file a claim by talking to a digital assistant.
  110. 110. 3. Response Team Triage Planning
  111. 111. Help staff prepare. Create a company-wide First Response Plan that outlines responsibilities.
  112. 112. COMPONENTS A. Notify Team B. Dispatch Responders C. Set Up a Crisis Center
  113. 113. A. Notify Team Triage Planning > Response Team
  114. 114. Who should be contacted when help is needed?
  115. 115. Notification Tree • Company Directory • Assigned Order • Response Team • Notification System • Signal v. Noise
  116. 116. Channels Direct Messages Threads Integrations Alerts Search VoIP Screen Share
  117. 117. B. Dispatch Responders Triage Planning > Response Team
  118. 118. Activate those with designated responsibilities to ensure all functions of the Triage Plan are carried out as quickly and efficiently as possible. Dispatch Key Responders
  119. 119. Key Responders • Home Office Administrators • Claims Director • Claims Assistant • Marketing / Communications • Department Managers • Catastrophe Response Team • Triage Team Directors • Triage Team Members • Adjusters • BPO Providers
  120. 120. C. Setup Crisis Center Triage Planning > Response Team
  121. 121. • Secure a facility for triage, media, and housing. • Secure a lease if needed for the remote site. • Transport and setup supplies and equipment. Setup a Mobile Office
  122. 122. Mobile Office Will you rent or buy chairs, desks, computers, etc?
  123. 123. Necessary Supplies • Emergency Supply Kits • Emergency Vehicles • Power Tools • Company Signage
  124. 124. Hardware Needs • Computers / Devices • Phones • Printers • Chargers • Internet
  125. 125. Software Needs • Communications • Claims Management • Payment Systems • Productivity Suite • Expense Tracking
  126. 126. Ring Central • VoIP, Conferences, Video Chat, Messaging • Includes PBX Features (Forwarding, Voicemail, Extensions, etc) • Supports All Desktop and Mobile Devices • Very High Quality USE CASE: Call forwarding, Automated Voice Alerts, Remote Access
  127. 127. Web-Based Claims Admin • Accessible from anywhere • Supported from a wide range of devices • Minimal infrastructure requirements • Team-based interaction USE CASE: All software systems, mobility, accessibility.
  128. 128. Google Docs • Accessible from Anywhere • Replaces Microsoft Office • Realtime Collaboration • Advanced Permissions USE CASE: Documents, Spreadsheets, Slides, Forms, Diagrams
  129. 129. Amazon Workspaces • Virtual Windows Workstations • Centrally Managed Environments • Mobile Device Access! • Integrates with Work Docs USE CASE: Mobile,Temp Employees, Remote Workers, Tech Partners
  130. 130. Expensify • Expense tracking in the cloud • Per Diem allotments • Image recognition with auto-categorization • Auto generates receipts below $75!!! USE CASE: Expense Tracking, Expense Reports, Audits
  131. 131. 4. Settle Claims Triage Planning
  132. 132. A) Independent Adjusters B) Web Software C) Mobile Apps D) Drones E) Electronic Signature F) Electronic Funds Transfer Settling Claims
  133. 133. A) Independent Adjusters
  134. 134. Use independent adjuster networks for overflow capacity during high claims generating events.
  135. 135. How do you build great relationships with independent adjusters?
  136. 136. You will receive better service from independent adjusters if you are working to build relationships with them on a regular basis and not just during an emergency.
  137. 137. Regular contact maintains a healthy working relationship. Engage Often
  138. 138. Kindess Wins Loyalty Be Nice!
  139. 139. Make jobs a piece of • Write good estimates using accurate measurements. • Include detailed explanations as much as possible. • Submit all pertinent pictures for adjuster’s file. • Make timely submissions with few supplements.
  140. 140. Support your adjusters in front of policyholders whenever you possibly can. Be Supportive
  141. 141. Resolve customer issues. Happy customers make for happy adjusters. Give adjuster a heads up on customer complaints. Notify the adjuster of action plan with customer. Send updates to adjuster regarding issue.
  142. 142. B) Web Software • Accessible from Any Location • Desktop and Mobile Support • Managed and Dependable • Connected to Data Sources
  143. 143. C) Mobile Apps • Accessible without an internet connection • Process claims on the go, upload data later • Utilize device features such as camera and gps
  144. 144. D) Drones • Review damage quickly • Take photos and measurements easily • Limit risk of adjuster injury • FPV goggles make it very easy to fly
  145. 145. Not This!!!
  146. 146. This
  147. 147. E) E-Signature • Review and settle onsite • Reduce processing and turn around time • Encrypted and secure • Legally binding
  148. 148. F) Electronic Funds Transfer • Remit Payment Immediately • Requires simple account information • Encrypted and secure • Close many claims in the field
  149. 149. Questions? How to Contact Me (417)299-1119 Phil Reynolds CEO / Founder BriteCore