If you are a claims examiner or adjuster, you know that your job isn’t exactly a bed of roses. To be honest, it is a job filled with conflict, deadlines, audits, and plenty of stress. Most adjusters also have the opinion that being a claims supervisor is a piece of cake. After all, the supervisor doesn’t have to actually handle the physical file. Sure, they review the files and give direction from time to time, but it is not like they are in the trenches day after day, slugging it out with combative claimants.
But being a supervisor is not a bed of roses either. They have their own deadlines, audits, and people that they have to be accountable for as well. Below we discuss ways to become an effective supervisor and how you can attain the best results from your army of adjusters.
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“How Do I Get My Adjusters To Follow My Account Handling Instructions?”
1) Use the diary system to your advantage
As a supervisor, you have to delegate tasks to the examiner that is handling the file. This is usually done using the diary system within the claims software. To those unfamiliar, think of the diary system as a Post-It note, or your daily “to-do” list. An adjuster will usually look at their diary every day when they come to work to see what needs to be done.
The supervisor needs to place appropriate timeframes in the diary as to when certain tasks are due, such as the initial 14-day report on compensability or to mark the first 30-day initial internal reporting that is due. By doing this, it ensures that the claim continues to move forward without stalling out or falling through the cracks from the get-go. By using the diary system, you also remind yourself of when key facts should be placed in the file. Examples include policy coverage, exclusions, when initial contacts are due, when medical reports should be in, when reserving and reports are due, and so on. In fact, most software places these key times automatically into the diary when the new claim is being set up. But for those that do not, then you must do so at first report of a claim, so these critical timeframes are not overlooked.
2) Avoid the copy/paste method of claim review
Since supervisors have to review each file for each adjuster they are responsible for, this can be a difficult task to tackle. Think about it: If an adjuster has 175 files, and you have 8-10 adjusters on a team, then the supervisor could be responsible for reviewing 1,750 files every 60-90-120 days. And this doesn’t include new claim assignments!
The easiest way the manager tries to accomplish this is to cut/paste from a template that hits all the points they have to hit to accomplish an effective claim review. Sadly, this is not the best way to get the job done. In fact, it really doesn’t accomplish anything. If you are not really reviewing the file and giving direction on what needs to be done, why are you even wasting your time pasting in a generic review?
Coming up with an effective way to review a file varies per supervisor. Just like an adjuster, a supervisor has their own way of doing things. But you cannot get around the fact that you have to review the file. That doesn’t mean that you have to read every single line in the file, but you have to read most of them, no matter how time-consuming it may be. This is where you can pick up facts that may not make sense, or other red flags that the adjuster may have missed. This also doesn’t mean that you have to re-read the file on every single review. You should pick up where your last review left off. By placing in the notes a “to-do” list for the adjuster, you can easily see what has been completed since your last review, and what has still yet to be completed. This may be the hardest thing for the supervisor to accomplish, but good supervisors have their own way of getting it done without pasting generic template-style notes into the file.
3) Let the adjuster handle the file! You are there to provide guidance when needed
Probably 100% of claim supervisors were at one-day claims adjusters. Just because an adjuster has a different style than you doesn’t make them ineffective at handling the claim. And it doesn’t mean that you have to hold their hand through the entire claims process. I know plenty of supervisors that just cannot accept the fact that if it is not done their way, it is not done the right way. Nothing will irritate an adjuster faster than a supervisor that is not letting them handle their own file. These supervisors will pick the IME doctor, pick the vendors used, pick the attorney, and so on.
I do not think this should be the role of the supervisor. And if it is, then there is no way they could possibly be involved in this capacity in every single file. In fact, a supervisor that tends to “supervise” in this manner is really not cut out to be a supervisor. They would be a better claims adjuster because they are not delegating in an efficient manner. Let the adjuster get the job done. You should give them a list of things that they should accomplish by the next reporting period, and let them accomplish them in their own manner.
4) If the adjuster is not returning phone calls/emails, it is not the supervisor’s job to return them
Returning routine phone calls/emails on a claim is not what the supervisor should be doing. Every now and then, an upset claimant may ask to talk with the supervisor because they feel they are not being treated fairly, but outside of this, the supervisor shouldn’t be spending a ton of time on the phone or sending emails.
However, it is a red flag for the adjuster if the supervisor is getting a lot of their calls/emails. This obviously means that the adjuster is not properly returning their calls/emails that need to be completed. If the adjuster is failing in this aspect, then there is no way they can handle the job they are doing. An adjuster spends most of their time on the phone and sending out emails. If the adjuster cannot handle this aspect of the job, then maybe it is time they find a new line of work.
Summary
These tips only scratch the surface of what it takes to be an effective claims manager. This role demands efficiency, and it also is a very important job within the claims atmosphere. The supervisors are the lieutenants steering their adjuster armies on the front lines. Any type of breakdown in communication can result in a massive failure on the handling of the claim, and ultimately the supervisor will be held accountable. But these supervisors need to lead properly, ethically, and effectively in order for the entire claims process to be as effective as it should be.
Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.
Contact: [email protected].
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