Claims Training Solutions - Part 1

Thursday, November 29, 2001 | 0

The workers' compensation insurance industry has a shortage of knowledgeable workers' compensation claims examiners. Contract examiner costs have escalated as demand exceeded the limited labor pool of contract examiners. Empty desks result in excessive caseload size, caseload re-distributions, and productivity downtime. This directly impacts product quality.

In a series of two articles, we will explore claims examiner training issues and solutions.

Defining the Problem

A claims carrier/administrator develops a need for examiners as a result of staff turnover, company growth, account acquisition, etc. Clients must perceive that a carrier/administrator provides quality claim services for the carrier/administrator to retain the business. Increased staff costs affect the pricing of insurance and may impact a carrier/administrator's ability to compete in a price-sensitive marketplace.

The following options are available to carrier/administrators:

* Turn away business due to lack of claim department capacity.

* Pay exorbitant wages for temporary, knowledgeable claims examiners.

* Expend resources on penalties, fines, and lawsuits over poor claim handling practices.

* Establish a claims examiner training program to ensure consistent claims handling at reasonable wages.

Implementation of Claims Examiner Training

The most practical and cost effective solution over time is to implement a professional development program for claims examiners. The following steps accomplish this solution:

* First, select & train internal examiner trainees such as claim assistants that have some knowledge of workers' compensation.

* Second, recruit, hire and develop external examiner trainees who will need expanded training to develop their skills.

* Third, offer performance incentives as part of on-the-job training to ensure quality claim handling and to reinforce classroom training.

* As corporate training requirements are defined, provide continuing education training for existing staff focused on cost control and statutory handling requirements.

Delegating educational responsibility to external trainers maximizes the claims manager's and claims supervisors' ability to monitor claim handling to ensure that corporate procedures and statutory requirements are handled consistently throughout the claims department.

The next article in this series discusses implementation of a training program in detail.

Author is Vice President in charge of Training for Cambridge International. She can be reached at ckcyndi_koppany@cisgi.com.