Claims Operations: A Practical Guide
Claims, Caselaw, Legal
About This Product
Claims Operations: A Practical Guide will help you navigate the complexities of claims operations, whether you are a risk manager trying to evaluate a TPA, an agent trying to set up an in-house claims advisory service, an experienced P&C claims executive, or a newcomer to the claims side of the business.
Written for both experienced and new insurance professionals, this book provides a comprehensive overview of how the claims process is handled, controlled, and managed, and its interrelationship with other functional departments.
Nonclaim professionals will gain a better understanding of how to improve profitability through effective technical claims handling and claim management (including proper caseloads) and recognize when and why a claims operation or TPA is not meeting industry quality standards.
Individual Subscription
Enterprise Subscription
Product Description
Claims Operations: a Practical Guide covers these topics.
- Claims Operations Overview
- Types of Claims Operations
- Core Operational Issues
- Claims Management Overview
- Management Controls
- Recruitment and Retention
- Financing and Banking
- Technology
- Claims Process Overview
- Investigation and Adjustment
- Statements and Interviews
- Coverage Issues
- Evaluation and Resolution
- Going to Court
- Reserve Management
- Recovery
- Third-Party Administrators Overview
- Operations
- Legal and Regulatory Compliance
- Claims Handling Guidelines Overview
- Auto Physical Damage
- Auto Liability
- PIP/No-Fault
- First-Party Property and Inland Marine
- Cargo
- General Liability
- Professional Liability and Management Liability
- Public Entity
- Workers Compensation
Benefits to You
- Gain a better understanding of all claims operations and how the operations interrelate with other departments.
- Learn the details of the variety of claims operations in different risk financing structures, such as captive insurance companies.
- Gauge the results of proper claims staffing on the claims operation, and the impact from utilizing an effective staffing model.
- Understand the impact of reserve management on profitability or loss.
- Takes the mystery out of third-party claim administration (TPA) operations.
- New adjusters will receive a consolidated understanding of the claims process. Perfect for a claims trainee program.
- Claims adjusters and claims managers will better understand each other's role in the claims process and their combined impact on results.
- Achieve a balance between adequate adjuster caseloads and meeting budgetary constraints.
- Understand the TPA pricing models and factors impacting pricing.
- Learn how increased staffing with manageable caseloads can positively impact results with reduced loss costs.
- Provide guidance with a "best practices" claim model.
- Implement a best-in-class claims trainee program.
- An excellent resource for understanding the TPA operations and their impact on the core services provided of technical claims handling and claims management.
- Understand the effect of inadequate pricing on results and client retention.
- See examples of adverse results from improper or inadequate staffing decisions.
- Learn how improper claims handling can affect the financial stability of the company with errors and omissions and poor quality.
- Learn how claims investigations and reserves impact results.
- Get the right questions to ask about claims operations and their impact on your agency.
- Understand what is behind the loss run numbers and if the incurred losses are adversely affected by the claims operation.
- Gain insight into whether the insured’s workers compensation experience modification factor is adversely affected by the claims operation.
- Outlines how to develop a company-owned claims facility to handle claims within self-insured retentions.
- Understand how improper claims handling can affect the financial stability of the company.
- Gain insight into whether the insured's workers compensation experience modification factor is adversely affected by the claims operation.
- Learn how claims investigations and reserves impact results.
- Provides a practical guide to which questions to ask during the selection process for insurers.
- Learn how results are impacted by claims handling (re: loss ratios) and claims investigations as the basis for claims reserves.
- Understand why adequate staffing is so important in a claims operation and how it impacts underwriting results.
- Gain a better understanding of how claim reserves are established, including the evaluation basis for bodily injury case reserves.
- Provides guidance for a "best practices" model.
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