claims triage - how to do it well
TRANSCRIPT
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Claims TriageHow to Do It Well
Phil Reynolds CEO / Founder BriteCore
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Triage: /trēˈäZH,ˈtrēˌäZH/“to assign degrees of urgency”.
French word trier ‘separate out or sort by nature.’
Developed by military physicians.
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Claims Triage is the process of sorting and
responding to incoming losses.
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Triage may be necessary
following a high volume claims event.
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Plan Ahead
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“Before anything else, preparation is the key to success.”
-Alexander Graham Bell
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“By failing to prepare, you are preparing to fail.”
-Benjamin Franklin
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“Success is where preparation and opportunity meet.”
-Bobby Unser
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Don’t bury your head in the sand!
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Hope for the best. Plan for the Worst.
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Complex Planning
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Not great when drowning.
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People tend to panic in a crisis.
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Panic is a survival
mechanism for the brain.
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Amygdala Sends Alarm Triggering Fight or Flight Response
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Effects Panic1. 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
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Freak Out!
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Staff under high Pressure.
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Staff under high Pressure.• Working Under Increased Volume
• Unfamiliar Procedures and Job Roles
• Extra Hours and Responsibilities
• Ratings Downgrade
• Forced Liquidation of Assets
• Insolvency
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Customers experienced Loss
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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?
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Perfect storm to divide people.
You
Customers
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Teamwork and
Cooperation
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Show Concern and Empathy
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Can’t Rely on Willpower!Our ability to exercise judgement is limited when we feel panicked.
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Willpower is Like a Muscle
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Willpower Experiment
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8 minutes 19 minutes
Willpower Experiment
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Performance Follows Practice
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Practice Forms Habits
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Cue
HabitReward
The Habit Loop
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Smoking Habit
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Eating Habit
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Habits Can Be Shaped
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Willpower Becomes Automatic
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Triage Planning
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Carriers should devise a Triage Plan that can be executed consistently
under high pressure.
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Prioritizes and sorts losses.
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Reduces unnecessary loss expense.
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Increases customer satisfaction.
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Lay a solid foundation.
Triage Planning
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1. Communication
2. Loss Notice
3. Response Team
4. Adjusting Losses
5. Risk Management
Triage Planning
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1. Communication
Triage Planning
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• Build Awareness
• Show Concern and Empathy
• Proactively Advocate
• Set Expectations
GOALS
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Awareness plays a critical role in preparing
for unfortunate claims events.
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How do you build awareness among policyholders, staff, and agents?
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Educate before, during, and after events.
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i. Contact Management
ii. Outbound Messaging
iii. Notification Channels
Communication
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i. Contact Management
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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
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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
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ii. Outbound Messaging
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Communication should be sent to customers when a
threat is known.
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• 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
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iii. Notification Channels
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Dashboards
Website
Push Notifications
Social Media
iii. Notification Channels
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Channel - Dashboards
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Consider All AudiencesPolicyholders
Adjusters Agents
Admin Staff
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Channel - Website
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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.
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Page Purpose: To help claimant’s quickly and efficiently file claims directly following a catastrophe.
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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
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Channel - Email
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Email Campaigns
Email is a great way to send frequent communication that drives traffic to other
landing pages and dashboards.
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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
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Mail Chimp• Email Communications
• Stock and Customizable Templates
• List Management
• Analytics
USE CASE: Agent and Insured Communication, Warnings, Alerts
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Channel - Push Notifications
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Percentage Opened
2%
98%
Opened within 3 min
10%
90%
https://www.txt180.com/article/insurance-agents-mobile-marketing/
Texts and Push Notification
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Texts and Push Notification
A disaster warning has been issued in
your area. If you experience a loss, file
a claim at www.britecore.com/losses.
Text STOP to 17568 to unsubscribe
from notifications.
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Automated Call Systems
“A disaster warning has been
issued in your area. For tips on
how to prepare for a disaster,
please visit our website
www.britecore.com/disaster."
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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
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Channel - Social Platforms
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Social PlatformsPolicyholders / Community
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You should already have an established Social Media
presence and actively connect with customers via Facebook,
Instagram, Twitter, Youtube, etc.
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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
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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
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Company-Wide Disaster Training
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2. Loss Notice
Triage Planning
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Develop a Script
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To effectively assign levels of priority to incoming claims, you’ll need to develop a
standard script to use at FNOL.
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Ask policyholders 5-10 questions to determine how
quickly they need your assistance.
How Urgent is the Claim?
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Example Questionnaire
Major Weather Event
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1. What are the names, current or temporary addresses, and phone numbers for each policyholder?
Example Questionnaire
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2. What is the extent and severity of the loss?
Example Questionnaire
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3. Is your home livable? Do you have a place to stay?
Example Questionnaire
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4. Is there any property damage that might worsen if left untreated?
Example Questionnaire
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5. Did you lose personal property?
Example Questionnaire
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6. If so, do you have a way to purchase replacement items until the company can reimburse based on policy coverages?
Example Questionnaire
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7. Are you planning to return to work? If so, what is best time to
reach you?
Example Questionnaire
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8. What else can we do to make your family more comfortable?
Example Questionnaire
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Rank Losses
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To make the best use of available resources, sort claims by severity.
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Prioritization takes an overwhelming number of claims and classifies them into
manageable groups.
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Going from this…
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… to this.
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Carriers can use a 3 Level Model to help determine which policyholders need
assistance first.
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Involve conditions that are likely to deteriorate or change, or the scope of the loss requires
an adjuster’s immediate attention.
Level 1 Claims
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Require field inspection but the conditions of the claim aren’t immediately urgent.
Level 2 Claims
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Field inspection for these claims
could be scheduled out further without
significantly impacting the
outcome.
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Can easily be handled in the office and do not require an adjuster’s field inspection.
Level 3 Claims
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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
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1. Phone• Call center / CSRs
• BPO providers can assist
• VoIP systems
• IVR for automated screening
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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.
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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.
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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
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Dedicated FNOL Vendors
• Complex rules engines
• Connected to other service providers
• Frequently include a BPO service as well
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• 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
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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.
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5. Digital AssistantServices like Amazon Alexa allow
customers to file a claim by talking to a digital assistant.
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3. Response Team
Triage Planning
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Help staff prepare. Create a company-wide First Response Plan that outlines responsibilities.
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COMPONENTS
A. Notify Team
B. Dispatch Responders
C. Set Up a Crisis Center
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A. Notify Team
Triage Planning > Response Team
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Who should be contacted when help is needed?
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Notification Tree• Company Directory
• Assigned Order
• Response Team
• Notification System
• Signal v. Noise
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Channels
Direct Messages
Threads
Integrations
Alerts
Search
VoIP
Screen Share
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B. Dispatch Responders
Triage Planning > Response Team
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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
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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
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C. Setup Crisis Center
Triage Planning > Response Team
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• 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
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Mobile Office
Will you rent or buy chairs, desks, computers, etc?
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Necessary Supplies
• Emergency Supply Kits
• Emergency Vehicles
• Power Tools
• Company Signage
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Hardware Needs
• Computers / Devices
• Phones
• Printers
• Chargers
• Internet
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Software Needs
• Communications
• Claims Management
• Payment Systems
• Productivity Suite
• Expense Tracking
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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
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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.
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Google Docs• Accessible from Anywhere
• Replaces Microsoft Office
• Realtime Collaboration
• Advanced Permissions
USE CASE: Documents, Spreadsheets, Slides, Forms, Diagrams
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Amazon Workspaces• Virtual Windows Workstations
• Centrally Managed Environments
• Mobile Device Access!
• Integrates with Work Docs
USE CASE: Mobile,Temp Employees, Remote Workers, Tech Partners
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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
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4. Settle Claims
Triage Planning
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A) Independent Adjusters
B) Web Software
C) Mobile Apps
D) Drones
E) Electronic Signature
F) Electronic Funds Transfer
Settling Claims
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A) Independent Adjusters
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Use independent adjuster networks for overflow capacity
during high claims generating events.
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How do you build great relationships with independent adjusters?
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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.
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Regular contact maintains a healthy working relationship.
Engage Often
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Kindess Wins Loyalty
Be Nice!
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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.
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Support your adjusters in front of policyholders whenever you possibly can.
Be Supportive
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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.
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B) Web Software
• Accessible from Any Location
• Desktop and Mobile Support
• Managed and Dependable
• Connected to Data Sources
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C) Mobile Apps
• Accessible without an internet connection
• Process claims on the go, upload data later
• Utilize device features such as camera and gps
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D) Drones
• Review damage quickly
• Take photos and measurements easily
• Limit risk of adjuster injury
• FPV goggles make it very easy to fly
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Not This!!!
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This
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E) E-Signature
• Review and settle onsite
• Reduce processing and turn around time
• Encrypted and secure
• Legally binding
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F) Electronic Funds Transfer
• Remit Payment Immediately
• Requires simple account information
• Encrypted and secure
• Close many claims in the field
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Questions?How to Contact Me
www.britecore.com [email protected]
(417)299-1119
Phil Reynolds CEO / Founder BriteCore