This session outlines the characteristics and components of a healthy and effective relationship between employer and insurer/TPA. Discussed are the essential components of an effective claims program and best practices for defining and maintaining the proper roles and responsibilities for the claims administrator and the company representatives.
Let me introduce our esteemed panelists to you.
Ed Beecher, Risk Manager, City of Pompano, FL
Susan Langley, Director of Human Resources, Florida's Natural Growers, Lake Wales, FL
Kimberly Simmons, Property & Casualty Claims Manager, Fidelity National Financial, Jacksonville, FL
It is easy to point fingers and blame the other when a program goes in the wrong direction. Successful programs require teamwork and a clear understanding of expectations and goals. Let’s get right into hearing from our panelists so we can all get closer to achieving the best in class program with the best outcomes.
Just because a program is running smoothly, does it mean, that it is running well. How do you determine your program is achieving the outcomes you expect? How do you measure your results?
Ed
Kimberly
With so much data and so many reports available, what data elements or reports do you feel are most important to you? How do you avoid analysis paralysis?
Susan
Ed
Kimberly
Examples
Susan and Ed – claims scorecard
Examples
Susan and Ed – claim details
Examples
Ed - Bill Review
Examples
Ed - Pharmacy
Examples
Kimberly – closed claims
Examples
Kimberly – closing ratio
Not all TPAs are created equal. What are the 3 most important qualities you look for in your TPA?
Ed, Kimberly, Susan
Service instruction are the roadmap for a program. How do you use your service instructions to set service expectations?
Ed
We’ve discussed data analytics and reporting, but what are the KPIs you establish or would like to establish for your program?
Kimberly
Successful risk managers are always looking for new ideas, new solutions and creative ways to improve outcomes. Can you share an example of a program enhancement made based on actual data and how it has impacted your program?
Kimberly - legal bill review program
Ed – do you have an example?
Susan – Nurses using tools and data in CareMC to improve outcomes and close claims
The speakers discussed specific examples of best practices from their successful programs, including how to determine and implement key performance measuring metrics in order to generate and distribute practical reports which capture and deliver relevant information. Developing focused programs that address areas actually driving claims outcomes and costs requires cooperation and coordination.
Esteemed panelists – Thank you
Ed Beecher, Risk Manager, City of Pompano, FL
Susan Langley, Director of Human Resources, Florida's Natural Growers, Lake Wales, FL
Kimberly Simmons, Property & Casualty Claims Manager, Fidelity National Financial, Jacksonville, FL
