克里斯·威廉姆森
产品管理总监
从2018年初到2020年底，最近的第三方索赔成本大幅上升, 在Mitchell汇总的行业数据中，第三方索赔的平均费用增加了53%. 随着成本上升, claims organizations need to make sure their organizations are set up to make consistent, 准确有效的索赔评估. Keeping up with the latest technologies or trends is an important way to stay relevant, 保持竞争力，提高效率, but if carriers lose focus on establishing good third party fundamentals as a priority, they may create inconsistencies across their organizations. 这使得理算员取得成功和承运人确保准确的索赔评估具有挑战性, which is especially problematic in an environment where claim costs are on the rise. 运营商应尽量避免过于关注最新趋势或只关注自己的底线, 而不是, first check their third party claims processing foundations to ensure they have a comprehensive, end-to-end liability and injury program that supports settling claims accurately, 高效和一致.
Want to Learn How You Can Establish The Fundamentals of Your Third Party Program? Talk to a Mitchell Expert >
Auto insurance carriers can make significant improvements, like boosting consistency or improving evaluation accuracy, just by putting an extra emphasis on getting the essentials of third party claim handling right. 米切尔曾与排名前20位的汽车亚博真人官方版APP中的一半以上合作，帮助他们建立第三方索赔工作流程. 我们分析了项目成功的原因，以及有时导致评估不一致或不准确的常见挑战. 结果是, 我们编制了一份清单，列出了我们认为每个亚博真人官方版APP都应该具备的五大第三方索赔处理基本原则.
1. Build and Standardize Best Practices in the Third Party Claim Handling Workflow
取决于航母的大小, 可能有几百个, 或数千, of third party claims adjusters throughout the organization. A large adjuster workforce often translates to monumental expertise and industry skillsets, which are truly some of the carrier’s best assets and competitive differentiators. 而理算员则具有专业知识和实践经验, 没有护栏或指导方针, they will may develop individual best practices for claim evaluation, 在这个过程中, even the best adjusters may develop bad habits and blind spots or become overly aggressive. When adjuster teams are not working from a common set of best practices, it can lead to missed opportunities for a carrier to settle claims efficiently, 准确有效. 为了避免不一致, 承运人应针对各种索赔场景建立并维护自己的第三方索赔处理最佳实践. 通过这样做, 亚博真人官方版APP为理算员应该收集什么类型的信息以及如何使用这些信息来评估索赔设置了基线. 只要迈出这基本的一步, a carrier might notice a dramatic increase in consistency across the organization.
2. 建立一个清晰的流程来连接高级管理层的目标和理算员的日常索赔处理实践
正如前面提到的, 多年来，米切尔与许多索赔组织合作，亲眼目睹了某些运营商成功的原因. 根据我们的经验, 关注一致性并花时间在他们的工作流中创建过程来帮助他们实现一致性的组织, versus processes that purely manage their bottom line expenses, 一次又一次地成功. 仅仅确定最佳实践是不够的——承运商还需要建立一种方法，将这些最佳实践与理算员的日常索赔处理流程联系起来. 要做到这一点，最有效的方法之一就是使用责任和伤害评估技术系统. 这种类型的技术收集有关索赔的信息，并提供责任和一般损害赔偿建议，然后公司可以使用这些建议来达成索赔和解.
What liability and evaluation recommendation model is right for you? 通过米切尔的简单易用的指南找到答案. Go to Guide >
3. Provide Automation, Technology and Partnerships that Allow Adjusters to Focus on Their Core Tasks
Third party adjusters are often tasked with a wide variety of assignments, from dealing with complex bodily injury claims to studying police reports and demand documents. 除了他们的核心索赔解决职责, adjusters in many claim organizations also are required to manage many administrative tasks. 在他们的工作中有相互竞争的优先级, some best practices in claim handling may suffer or go unaddressed, 影响结算精度. 每个亚博真人官方版APP的目标应该是让他们的第三方理算员专注于他们最擅长的事情——评估和解决索赔. 为了做到这一点, 运营商应该考虑在他们的工作流程中加入以下一些基本元素:
- 将需求排序外包给值得信赖的合作伙伴，以消除理算员无休止地对文档进行排序和查找所需索赔信息的需要.
- Automation and technology that surface the most important claim insights, 例如, 当提交的医疗账单超出了预期的治疗时间时，会显示, so adjusters can make informed decisions at the right time.
- 一个医疗账单审查平台，通过应用自定义业务规则和在谈判期间考虑的价格调整，自动化部分医疗特殊评估流程.
- 促进自动分类，将特定类型的索赔分配给特定理算员的技术, ensuring claims are routed right from the start and helping promote specialization for adjusters (i.e. 高额美元索赔).
4. Create an Efficient, Integrated Claim Workflow for Adjusters
正如前面提到的 above, adjusters are busy and third party claim processing can be especially complex. Carriers can set their adjusters up for success by providing an integrated, end-to-end third party evaluation solution that makes it easier for adjusters to accomplish their jobs. 以下是每个承运商在为其调度员建立高效工作流程时应该建立的一些最重要的基本元素:
- Technology systems that surface the right information for adjusters exactly when they need it.
- 标准化数据导出, making sure adjusters not only receive the facts they need, but also ensure it is automatically delivered in the right format every time, 减少所需的任何行政工作.
- 综合和存储数据的系统可以被运营商用来评估调节器的性能.
- 通过在整个索赔过程中提供关键发现和指导，鼓励理算员批判性思维的工作流程和界面.
- Platforms that provide a responsive, modern and easy-to-use user experience for adjusters.
5. 使用报告和管理工具获得清晰的见解
没有适当的报告工具, 确定异常值或识别有问题的索赔类型就像大海捞针一样. Establishing foundational reporting and management practices is essential to 成功的第三方索赔处理. 应用上面提到的一些技术系统的好处之一是，这些类型的平台还将生成报告所需的数据，使管理人员和其他决策者能够在多个层面上清楚地了解他们的第三方绩效. For example, carriers can use operational reports to help ensure 遵守法规 or easily identify gaps in performance and coaching opportunities at an adjuster or team level. Other types of reports can show carriers' medical specials and generals trends, allowing them to focus on specific areas like a certain county or injury group. 将报告工具作为组织身体伤害流程的常规部分，可以帮助索赔经理在问题恶化之前发现潜在的问题区域, 实时做出改变和改进，并轻松找到帮助员工发挥潜力的方法.
建立基础
Securing the right foundations first is crucial to long-term third party claim success. 在米切尔, we’d like to encourage every third party claim organization to take a step back and ask themselves, which of the five most foundational elements do they have in place today, 他们的机会在哪里? Initiating each of these five elements in their programs can help carriers establish consistent, 准确和有效的索赔处理方法, 为现在和未来的成功做好准备.
Mitchell can help you establish a solid foundation for your third party claim program. Find Out How Now >