Claims Success Vision

Many Claims leaders get uncomfortable and move toward the exits when they are asked to contemplate and discuss their "vision", as in the vision statement of a strategic plan.  For most of us, that discomfort originated from participation in ritualized annual strategic planning events, where our company's leadership team got together to participate in intense wordsmithing exercises designed to produce a strategic plan document.  Vision, Mission, Values, Strengths, Weaknesses, Threats, Opportunities, Critical Success Factors, Objectives, Key Performance Indicators--all of these topics were tossed onto the table, to be debated and scrutinized with the assistance of a cadre of skilled facilitators.  I remember these planning events as contentious and dramatic, featuring break-out sessions, flip charts, storyboards, critiques, soliloquies, and of course mandatory camaraderie, all of which culminated in team solidarity and consensus on a newly minted strategic plan. Whew!

While I am an unapologetic strategy fan (I believe it takes both planning and execution to achieve the best result) I am not a fan of the strategic planning process used by many insurance companies.  I think the process itself has become more important than the plan it produces. In other words, getting through the strategic planning ritual and producing a plan that complies with the company's prescribed format/template has become the primary goal--the quality and utility of the plan is secondary.  Which is too bad, but it does help explain why strategic plans at many companies are so irrelevant.  Once completed, they are tucked away like sacred scrolls, not to be seen again until the next year's strategic planning event. So while most insurers have strategic plans, many of those plans have nothing to do with their day to day operations or decision making.

Google the question "Why do strategic plans fail?" and you'll get over 7 million results, although they sort down into a familiar handful of reasons:

·         plan was not communicated effectively

·         company vision, mission, values and value proposition were poorly defined

·         unrealistic goals

·         disconnect between strategic plan, operating plan, individual performance plans

·         invalid assumptions about internal and external environments

·         lack of resources and commitment to implement plan

·         lack of accountability and ownership

·         lack of meaningful performance metrics to track execution

But don't despair. Even if your company's strategic plan is nothing but fluff, you can still use proven planning techniques to help keep your Claims operation focused on what's important.

Years ago I was doing planning work with a motivational expert from the UK.  She told me about a process called "success visioning" in which leaders visualize what success would look like in their operation and then make a list of 8 to 10 things that, if true, would signal success. The concept was familiar to me, as I enjoy Stephen Covey's books and I’ve read my copy of The Seven Habits of Highly Effective People so many times it is falling apart. What she was describing was essentially Covey’s second habit:  Begin with the end in mind. If you are setting out to do something, it helps to start with a clear visualization of your objective: an image, a picture, or a description that can serve as a touchstone and frame of reference as you move forward.  And if you keep that visualization in mind, you’ll have a better chance of achieving it.

So I prepared a Claims “success vision” document and adapted it over the years to address challenges at the different companies where I worked.  My final version, prepared about five years ago, looks like this:

1.    Effective, efficient claims management operation producing the best claims outcomes

2.    In control: creating and maintaining a “no surprises” claims operating environment

3.    Known for providing industry leading claims service and expertise

4.    Attentive and responsive to stakeholder needs and concerns

5.    Reliable and consistent in setting accurate and adequate case level loss cost reserves

6.    Sought after source of claims thought leadership and timely, actionable, loss-related      information

7.    Seamless operations, utilizing a single claims system and a shared services operating  environment

8.    Skilled at integrating acquisitions and new programs

9.    Viewed as an employer of choice and a developer of people.

To make the list actionable, I included bullet points to provide details and specifics, and developed metrics to track performance. I used to look at the list every month, and think about what had been done and what else needed to be done to make these statements come true.  Why? Because I knew if we could turn these aspirations into reality, and if we could support improved performance with objective metrics (evidence), and if our stakeholders (individuals or groups who have a vested interest in or dependency upon how well the Claims operation performs) were saying and believing these things, then our Claims operation would be a success.

Give it a try.  It's easier, more useful and considerably less painful than strategic planning, and it will give you most of the raw material you need to talk about your vision at your next strategic planning event.

Dean K. Harring, CPCU, CIC is a retired Chief Claims Officer and an expert and advisor on Property Casualty insurance claims and operations. He can be reached at dean.harring@gmail.com or through www.linkedin.com/in/deanharring/

Five Troublesome Truisms About Claims Management

Originally posted on November 20, 2013

I was driving home from Pennsylvania recently listening to an NPR program about historical misconceptions (http://www.npr.org/2013/11/05/243293489/misconceptions) and I started musing about some of the persistent fallacies concerning claims management that I encountered during my years as a Claims officer.  Here are just a few of my favorites:

1.  A claim is a claim is a claim

No doubt lifted and adapted from Gertrude Stein’s famous quote about roses, this identity platitude asserts that claims always have been and always will be claims, and nothing more.  In other words, claims don’t vary much from period to period so neither should claim costs or resolution approaches. This chestnut regularly surfaces when the Claims department observes that claims of unusual or unexpected frequency or severity are adversely impacting productivity, case reserves, loss payments, and expenses.  If the loss ratio is trending higher than projected (see fallacy 5), this slogan is often used to attempt to redirect the responsibility spotlight from underwriting to claims.

2.  The best claim is a closed claim

Since insurance company claims handler productivity is measured by closed claims, and TPAs usually don’t fully earn their fees until a claim is closed, it’s easy to understand why this one persists.  Of course a claim closed too soon (without proper coverage verification, damage investigation, analysis and evaluation) probably won’t result in the best claim outcome. Most claims people understand that the objective is a bit more complicated, i.e., claims should be closed as promptly as possible consistent with claim handling best practices and regulations.  Yet I still remember standing in a TPA office in New Jersey a few years ago at the end of a month, listening to a manager imploring claims handlers to “close claims now” so they could increase that month’s revenue.

3.  It’s all about claims cycle time

Cycle time refers to the amount of time it takes to resolve a claim, so this assertion is closely related to fallacy 2.  Cycle time is a great example of a performance measure that appears to be valid, yet encourages the wrong behavior if it isn’t balanced appropriately by other objectives.  So while cycle time may be important from a productivity and customer service perspective, it is only one of many claim quality control objectives that are critical to producing the best outcome.  Others include paying the right amount on a claim at the right time, resisting fraudulent claims, denying claims that aren’t covered, managing allocated expenses, pursuing subrogation recovery, complying with regulations and communicating with stakeholders.

4.  Just listen to the voice of the customer

I always get a kick out of this cliché since it sounds so easy and obvious that most people nod in agreement when they hear it.  And in terms of apparent applicability, it transfers effortlessly from industry to industry so even a neophyte COO can feel comfortably righteous when uttering it.  But what on earth does it mean when it is applied to a claims organization? Which customer’s voice is controlling? Claims departments have lots of different customers, although they are commonly called stakeholders.  A stakeholder is any individual or group who has a vested interest in or dependency upon how well the claims operation performs, and stakeholders often help define and influence programs, products, and services offered.  Claims’ stakeholders include business units, underwriters, insureds (premium paying customers), distribution partners, actuaries, employees, investors, and regulators. Their wants and needs are extensive and varied and sometimes in conflict, so they don’t speak with a single voice.  It takes a full-blown stakeholder needs analysis to record all those voices and successfully harmonize them into a balanced plan. Note to self: not easy, not obvious, but necessary.

5.  The loss ratio is the best measure of Claims’ effectiveness

The loss ratio, as the term implies, represents the ratio of net claims incurred (reserves, payments, claims expenses) to net earned premium.  Claims certainly is responsible for the numerator of the loss ratio, but the denominator (net earned premium) is determined by other factors that are not managed by Claims, such as rate levels, policy terms, and risk selection criteria. The two parts of the ratio are basically independent. So if Claims does a fantastic job of managing payments and reserves, but underwriting chooses the wrong risks, at the wrong rates, and with the wrong policy terms, the loss ratio will explode.  It makes no sense, however, to hold Claims solely responsible for the entire loss ratio when it is only responsible for the numerator of that ratio.  That’s not to say that Claims shouldn’t have to demonstrate its effectiveness in managing the magnitude of that numerator, but that’s a story for another day.

Dean K. Harring, CPCU, CIC is a retired Chief Claims Officer and an expert and advisor on Property Casualty insurance claims and operations. He can be reached at dean.harring@gmail.com or throughwww.linkedin.com/in/deanharring/

Loss Cost Management in Claims

Originally posted on November 21, 2013

Years ago I joined a large, troubled insurance company and the CEO asked me to do just one thing—fix the Claims department. He wasn’t sure what was wrong with it, but he knew it needed work.

I called the claims management team to a meeting and asked one question:  How does Claims contribute to profitability here? I wrote their answers on a flip chart, dozens of them. After about 15 minutes, I told them they were describing important things that Claims did, but they hadn’t mentioned the most important contribution Claims makes to profitability: loss cost management.  Claims organizations exist to manage loss costs. The puzzled faces looking back at me told me what needed to be done to fix that Claims department.

Loss Cost Management is nothing more than the ability to consistently generate superior claims results and outcomes while nurturing stakeholder relationships and complying with applicable laws and regulations

Loss costs have three components:

• ULAE–unallocated expenses (salaries, rent, etc.)
• ALAE–allocated expenses (outside attorneys, independent adjusters, TPAs, appraisers, etc.)
• Loss–loss dollars paid to insureds or third parties.

At most companies, graphically stacking these three components by dollars spent yields a triangle with ULAE at the top, ALAE in the middle and Loss at the base. This is often called the loss cost triangle.

Managing loss costs means managing all three components of the loss cost triangle.  The costs are interrelated, so fewer dollars spent on ULAE may translate into more dollars in ALAE or Loss, while fewer dollars spent on legal expense may increase Loss dollars paid to third parties, and so on.

The challenge for Claims managers is straightforward: understand how the loss cost components interact, then deploy and incur the most effective combination of allocated and unallocated expenses to produce the most appropriate level of loss payments.

Although as a concept it is often misunderstood, the best gauge of loss cost management effectiveness is the level of loss cost leakage (loss dollars paid in error due to breakdowns in claim handling) identified through closed file reviews. World class claims operations operate with leakage of less than 5% (percentage of loss dollars paid that shouldn’t have been paid.)  As it turned out, the troubled insurance company I mentioned earlier was operating with a leakage rate above 20%.

Here’s a quick primer on loss cost leakage:

• What is loss cost leakage?
• Leakage is the amount paid on a claim above and beyond what should have been paid. 
• Leakage is reported as a % of the total amount paid on a claim (or sample of claims), so if $10,000 was paid on a claim that should have been resolved for $9,000, the leakage % is the amount overpaid ($1,000) divided by the total paid ($10,000) or 10%. 

•  How is leakage measured?
• Usually a calibrated team of claims experts reviews a sample of closed files periodically.  They analyze claim handling decisions and track compliance with best practices, ultimately estimating the amount of loss cost leakage on each claim.

• What causes leakage?
• There are dozens of root causes, but some of the most common involve failure to apply best practices in investigation, evaluation and resolution.  
• Coverage errors, inadequate subrogation investigations, evaluation based upon unverified damages—these are examples of breakdowns that can inflate claims payments.

• How can leakage be reduced?
• Since the closed file review process reveals, by line of business, where in the claims handling process leakage is happening and the root cause analysis reveals why it is happening,  it is actually fairly easy to identify what needs to be done to eliminate causes of leakage. 
• Training, decision support and process improvement aimed at the root causes of leakage usually produce rapid improvement.

• Do leakage reductions improve loss ratios?
• Since leakage reductions imply that overpayments on claims are being reduced, they certainly have a favorable impact on the numerator of the loss ratio (losses.) The denominator of the loss ratio (earned premium) is influenced by other factors, however, including rates charged and policy terms, so there may not always be a direct cause-and-effect relationship between leakage and loss ratios.  The leakage number is a useful indicator of the loss cost management effectiveness of the claims operation since it reveals the extent to which claims are being overpaid.

Dean K. Harring, CPCU, CIC is a retired Chief Claims Officer and an expert and advisor on Property Casualty insurance claims and operations. He can be reached at dean.harring@gmail.com or through www.linkedin.com/in/deanharring/