claims personnel require perhaps the most diverse skill set in the industry. Claims personnel require perhaps the most diverse skill set in the insurance industry. (iStock)

Whether because of a dispute over policy language, the circumstances surrounding a loss, or the potential for outright fraud, claims professionals have a delicate balancing act to perform. They need to pay legitimate claims in a timely manner, which should keep most customers satisfied. But they also have to hold the line if their investigations justify lower reimbursements than requested, or result in outright rejection — even if that means going to mediation or litigation, which could make the relationship adversarial and raise the reputational and financial stakes even higher.

If adjusters are too strict or overly suspicious, they may drag out or deny valid claims unnecessarily. In such cases, even if they eventually pay up, any delays or unnecessary hassle may still leave policyholders with a bad taste in their mouths. This could undermine retention and may prompt complaints that go viral over social media. There even might be regulatory implications. Yet if adjusters are too trusting, lenient, or eager to please, they risk giving away the store and sending a carrier's loss ratio through the roof, even while customer satisfaction ratings rise.

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