What Causes these Malfunctioning Junctions?

Sometimes malfunctions occur because managers and supervisors require or allow their adjusters to carry workloads that exceed reasonable levels, dispatching more traffic through the junction than appropriate. Reasonable levels vary by line of insurance, type of claim, efficiency of the workflow and the claims system, experience of the adjusters, and many other reasons. However, as more TPAs and insurers try to differentiate themselves from their competitors, they realize that poor claims service due to excessive workloads is not the type of differentiation they want. Therefore, many of them are reducing and limiting the number of claims or features that their adjusters handle. Also, clients are insisting on more manageable workloads, and these requirements often find their way into the special handling instructions that the claims administration and client negotiate.

The issue I see most often in the course of claims audits and efficiency assessments is that many adjusters and supervisors lack good time management skills, and also fail to manage their work efficiently. Even in cases with low caseloads, adjusters often complain that they do not have sufficient time to properly manage the claims that they are assigned.

This also occurs when much of the work that was previously performed by adjusters has been farmed out to vendors. In some cases, the presence of specialty vendors aids the adjuster because the vendors perform tasks for which they may be better trained. However, in some cases the coordination of these various services requires more organization and execution, resulting in another malfunction junction at the adjuster if they are not properly managed.

Lastly, in some cases the adjusters have assigned work to specialty vendors and have abdicated their responsibilities, relying on the vendors to update them and handle various parts of the claim with inadequate direction. Unfortunately, this often leads to poor results, even when the vendors may be fully qualified and are conscientious about performing their duties.

Insurers or TPAs may have also failed to efficiently develop their claims workflows, resulting in excessive hand-offs, redundant activities, staff/work mismatches, and other issues that require adjusters to perform many manual tasks that should be automated. For example, an adjuster or supervisor may be required to review a long list of open claims to identify those that need large loss reports, rather than relying on reports that identify those claims and automatically route them to the person with the appropriate authority.

One of the greatest efficiency-stealers that I have noted, however, is when adjusters fail to properly plan their workdays. Rather than have a daily or weekly work plan, adjusters let the many daily distractions take them away from their most important responsibilities — planning and resolving the claims.

How to Avoid or Mitigate the Malfunction

There are many efficiency experts who provide excellent guidance on how to work more productively. Execution of these recommendations, however, is the most difficult part of using the tools.

What can insurers, TPAs, or self-administered claims programs do to help their adjusters manage their time and work better? What can adjusters to improve the quality of their daily lives, and provide higher-quality service with better results? The following matrix provides some recommendations, which are categorized by management or adjuster responsibilities:

If management has established a better environment for efficiency and productivity and the adjusters have been properly trained, then the most difficult part begins — discipline and execution. Management and the adjusters must work hard to adhere to these principles and procedures. They must identify and fix distractions that enter their daily lives, and management should formalize the requirements in association with the company's "best practices." The use of these tools to create more effective work environments will allow management and the adjusters to avoid "malfunction junction" and get traffic going in the right directions.