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When Rules Don't Apply

Training programs have not traditionally been built around good decision-making, but rather around building knowledge. Instilling judgment requires a different approach.

By Jim Kaiser | Updated on August 03, 2010

Technology and process engineering are being used to analyze results in new ways and to construct more efficient and accurate outcomes. Simultaneously, the amount of information that passes through a claim as medical billing or detailed parts and repair information has skyrocketed. Estimating tools, medical bill processing engines, injury valuation applications, liability determination, document management, and litigation management are but a small sampling of software solutions that have been brought to bear. These applications help manage the information, but they are incomplete without individuals who understand how to move a claim toward a good outcome.

Developing employees to operate in this environment requires some rethinking. Training programs have not traditionally been built around good decision-making, but rather around building knowledge. For instance, they have focused on learning concepts like tort, policy language, and medical procedure. They have done a less effective job developing the judgment that is so critical to good performance and job satisfaction. In claims, the core skills for the job revolve around making the decisions and judgments that separate bad outcomes from good ones.

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