This is the second part in our coverage of how to become a more effective claims supervisor. As we mentioned in Part 1, a claims supervisor is not exactly a cake job. You can only be as good as the claims team that is working under your supervision. It is your team’s performance that gets measured during audit season, along with the auditing benchmarks that you have to hit as the leader of the team. In order to get good marks, you have to have a team that is motivated and works hard to maintain the reputation and success of their team leader. With that in mind, let’s continue with part 2 of our 2 part series:
1. A Performance review needs to take into account both objective and subjective file/desk performance.
Most adjusters are held to strict auditing standards that are based upon key objectives throughout the life of a claim. Some of these auditing points include timely contacts, statement of policy coverage in relation to the injury or accident, medical causal relation statements, timely reserving updates, and so on. These are only a few of the many points an adjuster is audited on.
But there are some subjective issues that can be included in an audit as well. Some of these points include client satisfaction, customer service issues, hard and soft leakage, and litigation outcomes. These points are not factors that are exactly black and white in nature. How these issues pertain to a claim outcome can vary depending on the details within the file. Some may have thought that litigation could have been avoided, or it could have been initiated at a sooner point in the file. Claimant complaints in the file can also be very subjective in nature, etc. Because no two files are exactly the same, there is no one certain way that these things can be judged—it will depend on what happened during the handling of the file and how those issues were resolved considering ultimate file exposure.
For example, an injured worker may voice a complaint that their calls are not being returned but upon review of the file notes, you can see that the adjuster documented a few return phone calls that were made and voicemails that were not received because the claimant’s voicemail was full, or they had no voicemail, etc.
It is important to take both the subjective and objective matters into account when rating an adjuster on their overall performance. Other factors to take into account can be claim counts, working on special side projects that could steal precious time away from the adjuster’s work on some files, extended sicknesses or pregnancy leaves, and so on. An adjuster should not be audited and judged purely on the objective factors within a file alone. It is the global performance of the adjuster at their desk that should be judged and critiqued.
2. The supervisor for a team must have tangible claim experience that is pertinent to the team they are leading
The best supervisor is one that knows what the adjuster has to deal with day in and day out. The only way this can happen is if the supervisor was a claims adjuster in the past. Probably 9 out of 10 supervisors have exactly that: a professional past that started out as a claims adjuster. But, just because you have claims experience doesn’t mean that you were exactly purely a work comp adjuster, or a PIP adjuster, or auto claims examiner, etc.
One way to create disconnect within a team is to have a leader that does not have applicable business line experience to the claim team they are leading. I know a lot of supervisors that were auto examiners in their past but now they are leading work comp teams, or liability teams, and so on. Right away the adjusters on the team know that this is the case, and they can lose some respect for their leader should this be the case. It doesn’t mean that the supervisor is not qualified to lead the team; it just means that they do not have the exact same business line experience.
In order to have the best team outcome, you need to have a manager that has the same business line experience as the adjuster. Work comp should stay with work comp, auto with auto, and so on. If this is true, then the supervisor knows the work comp doctors, the clinics, the applicable state statutes, and so on. Nothing will irritate an adjuster quicker than a supervisor that is always coming to them with questions on a claim that could have been easily answered or addressed had the boss had the same business line experience. This is especially true now, when a lot of carrier/TPAs are trying to do more with less by having multiple business lines answer to a specific set of supervisors who may or may not have that same multiple business line adjusting experience. This doesn’t mean that they are not great leaders, it just means that there will be disconnect between the adjuster and their supervisor. That disconnect could lead to some issues in the future, which can affect team performance, auditing scores, etc.
3. Teams that are the most efficient and the highest scoring on audit will usually have the lower claim count per adjuster
If you have all of these auditing points that you have to hit on every file, and you have a skeleton team to begin with, it is going to be hard to hit every single key pillar in a performance audit. Because claim counts are higher than ever, once you throw in increased auditing and best practice standards, you have a recipe for disaster.
Joe Adjuster is under the microscope more than ever with hitting best practice standards, and the first sign of falling behind will be swiftly dealt with from upper management. The thing to remember is there are only so many hours in the day. If an adjuster is falling behind, it is the role of the supervisor to bring this up to find out why. Is it because they were covering for another coworker that was out on vacation? Have they been involved in a few special projects on the side and this is taking away from the attention to their own claims? Or is it because they have a high volume of high exposure and highly active claims, and the newer claims they are receiving are just not getting tended to? Whatever the reason may be, the supervisor needs to find out, and address the issue. If every adjuster is falling behind, then maybe it is time to ask upper level management to hire a new employee, or even a temp employee until claim counts are more under control.
An Influx of new claims comes and goes. There are busy times, and there are busier times. Rarely, if ever, is there a “slow” time for a claims adjuster. Other things that can rob an adjuster of time spent on their myriad of claims include multiple file roundtables, phone conferences, excessive meetings, travel to seminars, time out of the office, and anything else that could remove the adjuster from the attention of their desk. To be a good leader, you need to be aware of all of these factors. Maybe an adjuster that is behind just needs a break from getting new claims in order to get their other files caught up. Maybe they need help from support staff filing state forms, requesting medical records, or doing background checks. Chances are you have a lot of options available to help your adjusters should you notice them falling behind. The worst thing you can do is ignore it and hope that the adjuster just catches up, because chances are they will only dig themselves deeper and deeper into the hole.
Summary
The tips given in this two part series do not touch all of the factors that one needs to have in order to become a great supervisor. It is a combination of all of the above factors. To be a great supervisor, you have to be an effective leader. You have to know how to delegate. You have to be part HR dept, part adjuster, and 100% multitasker. You have to know how to read a file, to let the adjuster do their job, and how to step back and let the adjuster take charge. You want your team to work not only for you, but with you, for one common goal: To give the best service to your client, the best attention to their injured worker, and to get that injured person recovered from their injury and back to their normal life as quickly as possible.
