每个第三方索赔流程需要的5个要点

Recent third party claim costs have risen significantly— from the start of 2018 through the end of 2020, average charge per claimant in Mitchell’s aggregated industry data has increased 53% for third party claims. 随着成本上升, 索赔组织需要确保其组织的设置是一致的, 准确有效的索赔评估. 跟上最新的技术或趋势是保持相关性的重要方法, 保持竞争力，提高效率, 但如果运营商不把建立良好的第三方基础作为优先事项, 他们可能会在整个组织中造成不一致. This makes it challenging for adjusters to succeed and for carriers to ensure accurate claim evaluations, 在索赔成本不断上升的环境下，哪一点尤其成问题. Carriers should try to avoid focusing too much on the latest trends or only managing to their bottom line, 而不是, 首先检查他们的第三方索赔处理基础，以确保他们有一个全面的, 端到端的责任和伤害计划，支持解决索赔准确, 高效和一致.

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汽车亚博真人官方版APP可以做出重大改进, 比如提高一致性或提高评估的准确性, 只是要特别强调正确处理第三方索赔的要点. Mitchell has worked with more than half of the top 20 auto insurance carriers to help build out their third party claim workflows. We’ve analyzed why programs succeed and the common challenges that sometimes cause inconsistent or inaccurate evaluations. 结果是, we’ve compiled a list of the top five third party claim processing fundamentals we think every carrier should have in place.

1. 建立和规范第三方索赔处理流程的最佳实践

取决于航母的大小, 可能有几百个, 或数千, 整个组织的第三方索赔理算员. 庞大的调整人员队伍往往转化为巨大的专业知识和行业技能, 哪些是运营商真正的最佳资产和竞争优势. 而理算员则具有专业知识和实践经验, 没有护栏或指导方针, 他们可能会为索赔评估制定个人最佳实践, 在这个过程中, 即使是最好的调适者也可能养成坏习惯和盲点，或者变得过于激进. 当调整团队没有使用一组通用的最佳实践时, 这可能会导致承运人错过有效解决索赔的机会, 准确有效. 为了避免不一致, carriers should establish and maintain their own third party claim handling best practices for various claim scenarios. 通过这样做, carriers set the baseline for what type of information adjusters should collect and how that information should be used to evaluate the claim. 只要迈出这基本的一步, 承运人可能会注意到整个组织的一致性显著提高.

2. Establish a Clear Process to Connect Senior Management’s Goals and Adjusters’ Day-To-Day Claim Processing Practices

正如前面提到的, Mitchell has worked with many claims organizations over the years and has witnessed first-hand why certain carriers succeed. 根据我们的经验, organizations that maintain a keen focus on consistency and take the time to create processes within their workflows that help them achieve it, 与纯粹管理其底线费用的流程相比, 一次又一次地成功. It’s not enough to solely determine best practices—carriers also need to establish a way to connect those best practices with adjusters’ everyday claim handling processes. One of the most effective ways to do this consistently is to use a liability and injury evaluation technology system. This type of technology collects information about the claim and provides liability and general damages recommendations that companies can then use to reach a settlement for the claim.

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3. 提供自动化，技术和合作伙伴关系，使调整人员能够专注于他们的核心任务

第三方理算员通常被赋予各种各样的任务, 从处理复杂的人身伤害索赔到研究警方报告和需求文件. 除了他们的核心索赔解决职责, 许多索赔组织中的理算员还需要管理许多管理任务. 在他们的工作中有相互竞争的优先级, 索赔处理中的一些最佳做法可能会受到影响或得不到解决, 影响结算精度. Each carrier’s goal should be to let their third party adjusters focus on what they do best—evaluating and resolving claims. 为了做到这一点, carriers should consider incorporating some of the following foundational elements into place in their workflows:

• Outsource demand-sorting to a trusted partner to eliminate the need for adjusters to endlessly sort through documents and find the claim information they need.
• 自动化和技术，表面上最重要的索赔见解, 例如, flagging when a medical bill was submitted for a treatment that went outside of the expected treatment timeline, 因此，调整人员可以在正确的时间做出明智的决定.
• A medical bill review platform to automate parts of the medical specials evaluation process by applying custom business rules and pricing adjustments to consider during negotiation.
• Technology that facilitates automated triaging to assign specific types of claims to certain adjusters, ensuring claims are routed right from the start and helping promote specialization for adjusters (i.e. 高额美元索赔).

4. 为理算员创建一个高效、集成的理赔工作流程

如上所述，理算员很忙，第三方索赔处理可能特别复杂. 运营商可以通过提供一个集成的, end-to-end third party evaluation solution that makes it easier for adjusters to accomplish their jobs. Here are a few of the most important essential elements every carrier should establish to build an efficient workflow for their adjusters:

• 在调度员需要的时候提供正确信息的技术系统.
• 标准化数据导出, 确保理算员不仅得到他们需要的事实, 但也要确保它每次都以正确的格式自动交付, 减少所需的任何行政工作.
• Systems that synthesize and store data in a way that can be leveraged by a carrier to evaluate adjuster performance.
• A workflow and interface that encourages adjuster critical thinking by presenting key findings and guidance throughout the claim process.
• 为调节器提供响应灵敏、现代且易于使用的用户体验的平台.

5. 使用报告和管理工具获得清晰的见解

没有适当的报告工具, pinpointing outliers or identifying problematic types of claims can be like finding a needle in the haystack. 建立基本的报告和管理实践对于 成功的第三方索赔处理. One of the benefits of applying some of the technology systems suggested above is that those types of platforms will also generate data needed for reporting that gives managers and other decision-makers clear insights into their third party performance at multiple levels. 例如，运营商可以使用运营报告来帮助确保 遵守法规 或者在调整者或团队水平上轻松识别表现差距和指导机会. 其他类型的报告可以显示承运人的医疗专题和一般趋势, 让他们专注于特定的领域，比如某个县或受伤群体. Using reporting tools as a regular part of an organization’s bodily injury processes can help claims managers spot potential problem areas before they become worse, make shifts and improvements in real-time and easily identify ways to help employees reach their potential.

建立基础

首先确保正确的基础对于第三方索赔的长期成功至关重要. 在米切尔, 我们希望鼓励每一个第三方索赔机构退后一步，问问自己, 在这五个最基本的要素中，他们现在还具备哪一个呢, 他们的机会在哪里? 在他们的计划中启动这五个要素可以帮助运营商建立一致性, 准确和有效的索赔处理方法, 为现在和未来的成功做好准备.

米切尔可以帮助你建立一个坚实的基础，为您的第三方索赔计划. Find Out How Now >