Assessments, reviews, and audits are a fact of life for claim professionals. They are conducted by reinsurers, financial accountants, insurance regulators, home office staff, and occasionally by an external firm retained by senior management. The auditors look at processes, review claim files, talk to staff members, ask question after question, and take up a lot of valuable adjusting time.
Since claim departments are the subject of numerous audits each year, the process may become routine. In the vast majority, the results are what were expected with only a few occasional surprises. It may seem like it is almost impossible to gain points but highly possible to lose points. It is risk without benefits.
So the question becomes, how do you minimize the risk while creating and maximizing the benefits? The essential part is creating benefits. These have to be created or identified first in order to maximize. By maximizing the benefits, the risk will be minimized.
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