高性能第三方索赔工作流的最常见特征

虽然每个承运人的确切工作流程和索赔处理技术是不同的, most claim professionals across the third party liability industry operate with the same goals in mind—settle claims accurately, 高效和一致. But sometimes, the complexity of third party claim processing can cloud these seemingly simple objectives.

通过使用数据组合, technology and expertise—and putting a special focus on the foundations of third party claims processing—third party carriers can overcome a myriad of barriers that can make it challenging to achieve their goals. 那么，如何确定您的程序是否准备成功呢? In addition, 如果您正在寻找新的技术或服务合作伙伴, 你怎么能确定它是合适的? Below, Mitchell has created a guide based on our work with high-performing claim organizations that go beyond the fundamentals and highlights what we believe to be the most important characteristics your third-party claim program should embody in order to excel.

Processes & 程序层次的特点

可用于索赔处理的工具并不缺乏. While it may be tempting to provide adjusters with the largest possible set of tools at their disposal and leave them to process claims their way, the top-performing third party carriers take the time to focus on setting up their foundations in a way that allows adjusters to work smarter. 在程序层面上, 这意味着致力于开发和遵循流程, and collecting and evaluating data to learn how they can continuously improve their workflow and overall programs. By establishing best practices and connecting those management goals to adjuster day-to-day activities, 运营商可以开发一致的, 准确和高效的索赔处理流程, 为短期和长期的成功做好准备. Here’s a checklist of the program-level characteristics every third party carrier should strive for:

• 承诺建立并遵循一套最佳实践.
• Dedication to a data-driven approach to evaluating performance and continuous improvement.
• Focus on establishing the foundations of third party claim processing so that adjusters realize maximum benefit from new tools and technologies.

您的项目在索赔生命周期的每个阶段需要什么

一旦你承诺为你的第三方工作流奠定正确的基础, 下一步是评估索赔流程的每个步骤. Below, we’ve included a checklist for all of the characteristics that a top-performing third party organization should possess, 无论是你目前的项目，还是你正在与外部合作伙伴评估的项目.

Investigation

在索赔的早期阶段, 至关重要的是，您的程序可以帮助调整人员在正确的时间收集正确的数据, and supports them by collecting the most important information for a specific loss scenario. 以下是我们认为调查阶段的关键因素:

1. Clear investigation standards to ensure adjusters across the company gather consistent information about each loss based on best practices.
2. 为调整员提供指导，使他们能够明确遵守这些标准, 同时还提供了根据具体场景做出决策的灵活性.
3. 理赔系统集成, 进站和出站, 确保你的理算员在他们需要的时候总是有他们需要的信息.
4. 收集正确的数据并根据损失情况对其进行优先排序的能力.
    

Liability

在责任阶段, carriers should focus on helping adjusters use best practices in their evaluations for accuracy and consistency. 以下是我们建议您在负债阶段执行的事项:

1. Clear liability evaluation best practices and standards that utilizes data already collected during FNOL 和调查.
2. A liability evaluation recommendation tool that helps apply those best practices throughout the organization, 所以你的调度员可以在他们的指尖上得到一致评估的指导.
3. 您可以配置特定于每种损失类型的侵权责任框架.
4. 通过一致和可重复的索赔评估方法减少周期时间 管理器分析仪表板 这有助于确定需要改进周期时间的领域.
    

损伤评估

In order to make sure your organization thoroughly evaluates claims consistently and accurately, the injury evaluation stage should not only be comprehensive but also fully integrated with all data streams for the claim, 包括调查和需求包审查. Here’s how we believe your company can achieve optimal injury evaluations across the board:

1. 明确基于公司最佳实践的工伤评估标准.
2. A services partner that has extensive bill review and third party experience that is backed by industry-leading technology to not only manage documents but also manage your bill review process.
3. 一个行业领先的 账单审核平台 that presents billing adjustments in a way that adjusters can clearly understand and utilize in the negotiation stage.
4. Deep integration with the investigation and liability stages to ensure your adjusters have the data they need, 他们需要的地方.
    

Negotiation

在谈判阶段, 承运人应专注于为理算员提供清晰的信息, 容易解释的事实, so they are fully prepared with all of the information they need to negotiate with attorneys or claimants. We recommend that carriers understand and incorporate the following items that may help improve the negotiation process:

1. A negotiation module that includes fact-based information using artifacts from the entire evaluation, 包括负债比例、特殊和一般金额.
2. The tools to help adjusters develop a clearly documented strategy with a clear line of sight back to key points documented during liability and injury evaluations.
    

让你的第三方项目获得成功

The right organizational processes and solid claim processing foundations combined with best practices at each stage of the claim lifecycle can help your organization succeed. Mitchell’s end-to-end third party solution addresses each of these areas individually and holistically. 欲了解更多信息，请访问 http://rirw.ngskmc-eis.net/solutions/casualty/third-party-liability-solutions.