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.

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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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