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Risk professionals see ongoing training, role playing as key to effective claims management

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Risk managers and consultants are advocating a shift away from focusing on claims management metrics such as closure rates toward continuing education, feedback and scenario-based learning for claims professionals to enhance their skills.

Forty-six percent of workers compensation claims professionals surveyed recently believe claims adjusters gain expertise after four to six years on the job, according to a study released Tuesday by Rising Medical Solutions. Rising, a Chicago-based national medical-financial solutions firm that provides medical cost containment and medical care management services to the workers comp industry, surveyed 572 claims professionals, with questions covering such topics as training and what they measure to gauge effectiveness at their job.

Of the organizations that close more than 91% of their workers comp claims, 53% of them provide training in customer service; 50% provide training in communication skills; 48% provide training in active listening skills; 49% provide training in critical thinking; and 53% provide training in empathy. Of organizations who close fewer than half of their claims, 6% or fewer provide training in all those same areas.

“Claims mastery requires more than a sheer volume of hours, days or years of practice, certain conditions and skill development methods must be present to elevate adjusters to experts,” said Rachel Fikes, Rising’s study program director who coauthored the report, in a press statement.

In speaking with Business Insurance, report contributor Barry Bloom, San Francisco-based managing principal at The bdb Group, a risk management consulting firm, said he prioritizes continuous training instead of years on the job:

“Emphasize that continual educational is very important (and) pays dividends” on effective claims closure, he said. “What the survey is saying is just because you have 20 years of experience doesn’t mean you have 20 years of expertise,” he said.

Dan Holden, manager of corporate risk and insurance for Daimler Trucks North America, who contributed to the report, said the focus on claims-closure ratio is often the only metric shared with adjusters and that more in-depth feedback is too infrequent.

Mr. Holden, in an interview with Business Insurance, said there is too much focus on statistics and not enough feedback — and he’s cautious of the training-alone model.

“I think that is the wrong way to manage claims personnel because they need constant feedback because they are not going to do things better,” he said. “What often happens is (new claims professionals) are trained on the job or they are sent to a claims course and then they are handed a stack of files and they are off to the races.”

The study also highlighted best practices that can help improve claims management. Of them, role-playing between a junior claims handler and a more experienced claims manager was cited by Denise Algire, Pleasanton, California-based director of risk initiatives and national medical director for the grocery chain Albertsons Companies L.L.C., who contributed to the report.

“Very few claims organizations take advantage of a really inexpensive tool, which is scenario-based learning,” she told the report’s authors of the simulation approach to learning how to effectively manage claims.