1900 West Park Drive
Suite 280
Westborough, MA 01581
Phone: (508) 366-9203
Fax: (707) 276-3833
7760 France Avenue South
Suite 1100
Edina, MN 55435
Claims Management
Claims management is a critical core process to any insurance company and most importantly a large driver of your bottom line business results. Our focus is to work with you to create a holistic view of the claims management process with focus on key decision points.
Claims Workflow
The key to effective claims management is to understand the entire process and recognize the individual decision points that change the rights and liabilities of the parties. A “claim” is not a single event. It is a series of small decisions that move the claim toward resolution. For example, once coverage is confirmed, liability is normally the next key decision point. Definition of liability will drive the next steps in the claim management process. Once you have accurately broken down the process into its natural segments, you can design your workflow to achieve the best outcome at each decision point.
Claims Triage
Each claim contains a different set of issues and risks. Because of this, not all claims should follow the same claim workflow process. Do you effectively identify and manage your new claims to get the right skill sets applied to the right claims at the right time? Do your current employee’s skill sets match your claim complexity?
Claims Determination
The single most important determination made in the life of a claim is the decision surrounding whether you have any liability. Coverage evaluations and compensability decisions should be given the highest priority. Protecting you and your insured’s’ financial resources by paying only the claims you owe results in increased customer satisfaction and improved bottom-line results.
McDonald Consulting Group has the experience and knowledge to help you document a world class claims process and define the key decision points within it. We can then assist you by improving the decision making around your claims determination. Our expertise has been proven through delivering improved bottom line results repeatedly for our clients. Let us help your staff implement a sound workflow and make improved decisions regarding claim compensability.
Litigation management
Balancing the need for counsel with prudent expense management is a challenge faced by all claim professionals. How well does your company manage this issue?Focus should include assignment criteria, clear definition of the roles and responsibilities between the claim adjuster and the attorney, negotiation and settlement strategies, and trial preparation.
McDonald Consulting Group staff includes consultants that have redesigned litigation management programs for many clients. We can offer first-hand experience from managing an in-house legal department to managing a national program with outside counsel. Our knowledge and experience delivers proven results including claims expense savings.
Adjuster Staffing
Your claims managers are too important and too busy trying to meet their service, timeliness, expense and other standards not to have the right tools. One of these essential management tools is an interactive staffing model. This tool tells them, and you, how many and what type of positions are needed to get the work done.
To be effective, these models must be customized to the unique way you do business. The models are designed around your specific workflows and adjust for variables such as internal versus field adjusters thus ensuring you are staffing to your business model. While these models help you today they also become a predictive modeling tool as you grow to effectively forecast staffing for budgeting as well.
McDonald Consulting Group has been a pioneer in developing staffing models and building in analyzers to make them most effective. Our consultants can develop a set of very powerful tools for you then train you on their maintenance so you can use them into the future.
