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This Might Sting -- But It Will Keep The Disability Claims Process Healthy

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It’s been a long day at the office, and you’re ready to pack it up and go home when, “Ding. You’ve got mail.” Of course, curiosity gets the best of you and you just have to open that e-mail before you leave. Now you wish you hadn’t. It’s the result of a recent disability claims audit. As a disability claim manager, you’re always troubled by these e-mails, but should they really trouble you?

And, if you’re not the disability claim manager, but an agent or broker who sells disability insurance, what should you think about claims audits?

Quality Assurance is more than a squad of critics looking over the claim managers’ shoulders, waiting to find “something” done incorrectly during the management of a claim. Quality audits can provide real value for the disability claim managers, the disability insurance companies and the disability insurance customers.

Any company that manages disability claims is subject to a number of state and federal regulations. These regulations are in place to protect consumers, and to ensure that organizations adhere to appropriate claim management processes and quality measurements. External regulators and auditors routinely review companies to make sure these mandates are followed. QA is a fundamental part of ensuring that a claim manager’s company complies with these requirements and meets the quality commitment that it has made to the customers. If a company relies on the customers to tell it about the effectiveness of its services, it may be too late.

Audits serve other important purposes: identifying trends and training needs, resulting in continual staff development and improved process efficiencies.

Quality Assurance And Customer Service

When it comes to customer service, the disability insurance industry is no different than any other industry: Our clients and customers demand and expect that top-notch customer service accompany the products, services and solutions they purchase. It is imperative that a disability insurer or independent claim management organization be able to review and measure the effectiveness of its services. It most likely has its own internal review process, but the best way to gauge the quality of the services is through an independent QA audit.

Your customers know if the disability claim management practices are not meeting standards. They will see the results of problems with claim management, but they may not know or understand why the results happen the way they do.

QA audits will outline areas needing improvement and/or modification. And while some of the results may be painful to hear, an organization can use the results of QA audits to demonstrate to the customers that it is managing their disability claims using the highest possible standards, and addressing those areas that need improvement.

QA results are a key indicator of the effectiveness of a company’s internal processes and staff proficiency. By compiling and evaluating the data, a company can identify areas of excellence, as well as areas where additional training, coaching and/or tools are needed. Of course, the company must be committed to providing the necessary tools, training and coaching required to capitalize on this critical information.

But just how can a company that manages disability claims create an environment that promotes and welcomes QA audits as fundamental and essential to the organization? How can the company build an organization that is also committed to ongoing training and tools for continual improvement and excellence?

Here are steps that a company can take to improve claim management — and that a disability insurance agent or broker can expect to see the insurers and independent claim managers, they do business with, take.

A company should:

1. Determine its needs and what is important to measure.

A company should create a QA audit tool that captures important data in what it feels are the key areas. If a company assigns a score to audits, it should determine a point value for each item it will be assessing. Not all items may have the same point value. The point value for a file that does not have a “pre-existing” evaluation completed appropriately should be different from one with correspondence that contains a typographical error. Remember: You can’t manage what you don’t measure.

If a company assigns a numeric score to the audit, it is imperative that the score does not overshadow the “real learning” from the audit. A company should consider sharing the score with the managers and the content of the audit itself with each individual. This can be a “Catch 22.” Some individuals will want to know the score and some will not.

2. Determine what types of information are wanted from the QA process and results.

A company can’t assume that it can create an audit tool in a vacuum. It must be sure that it has representatives from all of the appropriate areas to provide input in advance.

3. Determine how the QA team will need to segment the data.

If claim managers create on-line audit tools, they can run the QA data in different ways and segment the information as needed. Managers could consider segmenting the data by individuals, by job function, by team, etc.) Depending on the sophistication of the QA system, the claim manager may want to ensure that the data can be transferred into an Excel spreadsheet or CRM to slice, dice and analyze.

4. Develop a quality audit team with individuals who possess strong technical skills and are able to communicate “what the audit results really mean.”

All of this preparation ensures that a company will capture the appropriate measurements for its organization, and allows it to segment the data to create multiple reports, which are useful to the organization. Along with performing the audits and identifying trends, helping employees understand the audit is equally important.

Of course, agents and brokers can use variations on this process to improve their own management of relationships with disability insurance clients.

To ensure the findings from the QA audit are not lost, companies should:

- Ensure that the true nature of QA audits is part of the management team’s mindset.

- Be sure that the entire organization understands the management team’s mindset that the QA audit is not “policing”. Management must believe in the true value of QA audits and the overall positive results audits have on the company, the employees, and the customers.

- If possible, use auditors who communicate the QA audit results in person with the appropriate parties.

- Include Training and QA in one team to ensure that the appropriate training, coaching and mentoring occur as quickly as possible.

- Provide quarterly reports outlining the organizational, team and individual results. The relationship between QA, Training and the Claims organization is one of Partnership.

- Recognize what is done well. When sharing the results be sure to include not only what needs improvements, but also where the organization shines! Celebrate those successes!

In summary, when the QA role is understood and supported by management, the entire staff can begin to understand its importance and support the function. Staff understanding and buy-in is a vital component to attaining the true value of this function. In addition, the company must support the findings with a commitment to ongoing training and coaching required as a result of the audits.

Cindy Bellefountaine is manager of quality assurance for settlements, policy/procedures and training at Custom Disability Solutions Inc., South Portland, Maine. She can be reached at [email protected]