By: Derrick Amato,
Vice President, Workers’ Compensation Sales & Strategy, MultiPlan
Previous Leaders Speak segments have dealt with; RFPs, medical fee schedules, opiate influence on case costs and outcomes and varied definitions of evidence based medicine. Each of these topics is timely and from my point of view creates residual influential need for re-defining best practice standards in many an aspect of WC claims management.
Often overlooked, or perhaps better said, not addressed with as much significance and influential importance is what’s happening at the claims professional level and how, or if, the industry has positioned these technicians to be truly successful in achieving meaningful case outcomes.
Today such influences as office consolidation and regionalization of claim staff means adjusters likely are juggling high caseloads and/or required to work within multiple jurisdictions, all at a time when meaningful training has taken a back seat to positioning these hard working professionals for greater success and job satisfaction. The aging adjuster workforce could also be setting the stage for a “cliff event” where a mountain of knowledge exits the industry.
Successful claims professionals must have the right tools and learned skills to be equipped to deliver superior case results. The complexities of injury management can’t be process driven. They must be front ended, thoughtful and targeted with strategic and tactical action plans.
WC claims industry leaders are in the best place to measure their own organizations’ commitment and efforts to keep a “dying” vocation alive, and most importantly, “well”!
At a time when national stats are showing claims frequency is down and severity is up, the need for industry confidence and commitment to support multi-dimensional skill set training should be high.
Those organizations that embrace talent and skill set advancement will stand apart and more importantly, get one step closer to making the right decisions early on in a claims life cycle . . . and in turn yield better outcomes!
There is a cause and effect at play here. Very little is being done to grow new adjusters, and its uncertain on my part how much investment the WC industry is making in keeping pace with the need for improving medical and RTW skill improvements at the adjuster level. The days of road adjusting has all but died in the WC environment and the lessons learned in the field are events few adjusters today are likely to be able to say they have even experienced. Additionally the ever increasing added complexities to successfully managing claims requires claims staff to contend with such advances issues as: opiates usage, complex claims ,chronic pain and medical advancements including implants.
The value of skilled adjusting has seemingly lost its importance in the marketplace at the purchaser level and has been driven to a commodity type purchase (wrongfully) so has the talent pool diminished.
Many of today’s adjusters have risen through the ranks of the “claims” department and forced into a processing mode vs. managing and impacting the outcomes of claims.
Gone are the days of single state adjusting. To be a good claims professional one needs to be proficient in multi juris regulations -the model of claim office centralization and requiring a single adjuster to manage many claims in too many jurisdictions only serves to further dilute the art and science of adjusting.
To those carriers and TPA’s that have kept the bar of performance obtainable by limiting caseload size , aligning complexity with skill set and spend time teaching their adjusting staff, my sincere thanks for holding firm in the proposition quality in equals quality out.
Many adjusters lead stressful day to day existences and have few personal career highs!
There are two things that must get more attention in the adjusting industry in general.
First, supporting the principle that claims excellence comes from developing skill sets that are the foundation for building good claims professionals. Secondly the purchasers of adjusting services should place the right level of importance on the value skilled adjusting brings to art of total loss cost mitigation. Judging all claims services in large part by the per claim charge is short sighted. As a payor “you do get what you pay for “..cheap claims fees usually downstream can translate into costly claim outcomes. Incenting your claims service partner to have established outcome goals is an excellent way to align expectations and deliverables.
Good claims management is part science and an art .Many have set aside both these principals for the sake of being the “low cost service provider”. In the end who pays the price from this lopsided model? The answer is clear.
Too all those adjusters who spend countless productive hours behind the desks and on the phones of the organizations they work for and who take pride in what they do..I commend you for staying the course!
Its time the industry takes a hard look at itself and get back to basics. To the buyers of such services, as needed, rethink what you should be paying for and how you can incent your claims partner in a way that creates a win/win scenario which is ultimately the best possible total loss outcome.
That’s what I think!
About Derrick Amato
Derrick Amato currently serves as Vice President, Workers’ Compensation Sales and Strategy for MultiPlan, Inc., the nation’s oldest and largest independent PPO network. Amato previously served in a senior level role for the Accident Fund Insurance Company of America, one of the nation’s leading workers compensation insurers with more than $3 billion in assets. Prior to joining the Accident Fund, Amato served as Chief Operating Officer for Coventry Workers’ Compensation Services clinical management service operations. Amato has 32 years of claims related experience in both the workers compensation and managed care fields. Amato began his career with Aetna where he learned workers compensation claims and managed a workers’ compensation claims unit.
MultiPlan, Inc. is the industry’s most comprehensive provider of healthcare cost management solutions. The company provides a single gateway to a host of primary, complementary and out-of-network strategies for managing the financial risks associated with healthcare claims. Clients include large and mid-sized insurers, third party administrators, self-funded plans, HMOs and other entities that pay claims on behalf of health plans. MultiPlan is owned by BC Partners, a leading international private equity firm, and Silver Lake, the world’s largest private investor in technology.