You are never going to please all people all of the time. Nothing could be more correct, especially in the insurance industry. The claims profession is littered with conflict over many things right from the start. Experienced professionals know how to properly diffuse a tense situation. But it is an asset that is learned over time.
Here are a few important tips to remember:
Stay Calm
Regardless of the negative attitudes or unpleasant tones an angry caller may have, it is essential that you do not get emotional as well. Using phrases such as “I hear what you are saying” or “I understand” can help to calm angry callers. Remember they usually have no idea what is going on or why these decisions are being made on their claims, so take the time let them vent a bit then calmly explain to them the situation.
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Listen & Be Patient
Do not attempt to interrupt angry callers. Be patient and let them finish speaking. Sometimes they just need to vent their frustrations. After that they will relax a bit and work with you to resolve their issue. Explain to them what is going on, and what options they may have for moving forward.
Remain Professional
Above all remain professional. Remember you are in the customer service industry, and there is a lot of competition out there. Every phone call should be dealt with in a professional matter, no matter the conversation.
Do Not Raise Your Voice
Raising your voice or talking in a sarcastic tone is only going to irritate your claimant further, which will resolve nothing. If anything, you can get in trouble with your supervisor. Many carriers record telephone conversations, and if this discussion gets pulled for review you are going to look foolish.
Try Not to Argue
Your main goal in diffusing a heated conversation is to resolve the problem. But a direct argument will rarely resolve anything. Instead, explain to them what is going on, and what they can do to help themselves. It may be that getting medical records or a more detailed report from their doctor is the piece of evidence you need to complete your investigation. Remember the claimant does not have the experience that you do in handling claims day in and day out, so cut them some slack and try to help them instead of just arguing point/counterpoint.
Speak Slowly and Clearly
Nobody likes to have to repeat themselves, so speak in a clear voice. Also try to avoid talking in legal terms or in claim shorthand. The claimant will probably have no idea what you are talking about, which will frustrate them. Pretend you are explaining the issue to someone who has zero experience in this situation, and you may end up with better results than you planned.
Empathize & apologize
How would you feel if you are in the same situation? What would you want to be said to you to make you feel better about the call? Claimants want to know that you understand where they are coming from, and they want the reassurance that you can help them with whatever issue they may have. Even if you know the caller is wrong, take a moment and apologize for the confusion. Many callers simply want acknowledgment from the carrier that a mistake may have been made, if applicable to your scenario. An apology is the first step to overcoming their anger and opening a dialogue about resolving the issue.
Offer Solutions
People are coming to you with questions about their claim, or why a decision was made. But oftentimes these decisions are not written in stone. Denied claims can be accepted later, and vice versa. Maybe your claimant can file for mediation on their denied claim. Or maybe they did not submit enough information in the beginning for their claim to be accepted. Whatever the reason may be, explain to them what options they have for moving to the next level. If you cannot answer a question immediately, let them know that you will work on it and get back to them with some answers or options and go from there.
End the Call if the Person is Repeatedly Abusive
Your goal is to bring a successful closure to each phone call. However, you do not have to tolerate abuse. Kindly interject with an “Excuse me” if necessary and inform the caller that their language or behavior is not acceptable, and it will not help them resolve their conflict. It is well within your ability to end the call if the person continues to be belligerent and abusive if you have asked them to calm down several times beforehand.
Do not take it personally
In the end, this is your job. A lot of claims adjusters have a lot of hours of work invested into each file, and sometimes they can wear their heart on their sleeves. But at the end of the day, you have to accept the decisions you made on a claim. I recall a young adjuster I knew that was first starting out in work comp, and he used to agonize over his decision about whether a claim was compensable or not, and if he was making the right call. This is a good asset to have, but only if it is a healthy concern. The process that is in place with supervisor reviews and audits is there to catch your errors, if you have any, and to help you make confident decisions on claim outcomes. Trust in the process in place, and believe in your decisions that you make. Sometimes you have to go with your gut decision.
Summary
An adjuster is on the phone for the majority of their day, every day. And in the field of claims, conflict will arise. There is just no way to avoid it. But you have to be armed with the proper way to handle yourself on the phone–not just for certain calls but for every call. Implement the tips above, and hopefully you will be known around the office as a person that can diffuse any tough situation that is thrown their way. Knowing how to work the phone is one of the best assets an adjuster can have.
Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.
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