It takes a Village – to Handle A Claim

by Cassandra Hand Gallegos, AIC, CEO, and Chief Claims Officer, CCMS & Associates

“It takes a village to raise a child” is where the concept is given in this Proverb that many people support, give knowledge, and care into a child as they are raised. I have often found this proverb to guide the way complex claims are handled. With a village of experts, adjusters, specialists, and managers.

Key aspects in “village” claim handling are that everyone must have a full concept of their role, purpose, and authority. They also must be in step with the village leader, the carrier desk adjuster, and carrier management goals.

While developing specialized claim handling programs with our carrier partners, we have identified the key to success is the alignment of position and goals with the client’s vision. If claim service organizations follow guidelines, instructions, and direction all should follow in place. Seems simple right?

For complex claims, the variations of outcome for an action becomes exponentially risker. Often the interaction with the field adjuster and policyholder is where a beginning complexity is identified. A question is submitted and moved through the chain of command. How often does that answer provide the final needs for the policyholder? How quickly does that “alignment” question call happen with the desk adjuster and the field team?

Is everyone in the process on the same page?

Often communication between the field adjuster and the carrier desk adjuster fails to include the adjusting firm’s quality assurance manager. When this happens, the report can be delayed, requiring revisions before submitting. As a result – the alignment that had occurred between the field adjuster and carrier desk adjuster does not happen.

Often the carrier desk adjuster wonders “how did my direction on this claim not get handled the way I needed it to?”

Time saving solutions and desired outcomes take place when you align the village by explaining the “why” and communicating with dedicated account claim managers with authority to make an impact. The village is not only the field adjuster and desk adjuster or engineer. It is the management team and quality assurance focused account manager that ensures direction and movement for desired outcomes.

This article should not be construed as legal advice on any specific facts or circumstances. The contents are intended for general information purposes only. If you would like more information regarding this subject, please contact her at 727-234-1967.

This is a publication of Southern Loss Association, Inc., P.O. Box 421564, Atlanta, GA 30342. The articles published on this website are in a general format and are not intended to be legal advice applicable to any specific circumstances. Legal opinions may vary when based on subtle factual differences. All rights reserved.