How We Simplify the Process to Ensure Quality Claim Outcomes

All claims professionals know the six steps to securing a quality claim experience and outcome, but what measures does your business have in place to ensure you’re alerted when a claim veers off track? 

There are many points at which a claim can start to attract higher costs and poorer outcomes, from the initial communication to evaluation, action and documentation. By stepping out of the claim journey, you can plan a roadmap for delivering consistent results, every time.

When I think of quality, I really think about going back to the basics. If we do the right thing at the right time on the file, we get the right result. Quality starts at this simple point—we identify the necessary elements within the claim file and tie each of them to an advantageous outcome in six key categories:

  1. Communication/Contact 
  2. Investigation
  3. Evaluation/Assessment
  4. Plan of Action
  5. Action
  6. Documentation

Anyone in claims will tell you that the focus on these six categories has been in place a long time. But one additional step—one that is potentially the most important—is new: visibility.

How does the Resolution Manager/Supervisor and team know when an element is missing? In our everyday lives, we experience these alerts in lots of contexts. When we leave the refrigerator door open, there is a noise to remind us. When the laundry machine has completed its cycle, we hear a buzzer. If we try to lock the car door with the keys still in the car, we hear a warning. 

In the claims management world, once we are comfortable with the blueprint of the file, how do we achieve visibility on anything missing or when an action needs to be done quickly enough for the team to make a timely correction and keep the file on track?   

Our answer is ROSCO—Real-Time Opportunities for Superior Claim Outcomes

ROSCO provides the Supervisor with a real-time view and feedback to point them to the element of the file that needs to be addressed. Utilizing this tool to review highlighted files, the Supervisor can target missing elements and communicate next steps to their team. ROSCO is set up to ask the right questions at the right time to assure that the file is on track and moving forward. It’s like a claim file version of a car’s safety and crash avoidance technology, which allows the driver to course correct in real-time. ROSCO empowers our Resolution Managers to course correct in real time! 

Over time, we have learned that everyone wants to do the right thing—from the resolution manager working the file to the driver not wanting to open the car door with the keys in the ignition. It helps to know that there are measures in place that can let us know that something is missing early enough that we can address the issue and keep the file on the right track. Connecting the use of the six foundational elements with ROSCO is a great way to establish and maintain quality in each and every GB claim file, while empowering our team to execute at a high level.

This level of transparency enables our claim professionals and client service managers to have full visibility of claim financials, claim notes, contacts, plans of action, and key information, to ensure they are confident the basics are being done exceedingly well. This allows our claims team to focus their time and energy on claim strategy.

For more information about how ROSCO can enable better outcomes for your business, connect with our team today.

Jon Stambaugh

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