Claims Triage - How to Do It Well

Claims TriageHow to Do It Well

Phil Reynolds CEO / Founder BriteCore

Triage: /trēˈäZH,ˈtrēˌäZH/“to assign degrees of urgency”.

French word trier ‘separate out or sort by nature.’

Developed by military physicians.

Claims Triage is the process of sorting and

responding to incoming losses.

Triage may be necessary

following a high volume claims event.

Plan Ahead

“Before anything else, preparation is the key to success.”

-Alexander Graham Bell

“By failing to prepare, you are preparing to fail.”

-Benjamin Franklin

“Success is where preparation and opportunity meet.”

-Bobby Unser

Don’t bury your head in the sand!

Hope for the best. Plan for the Worst.

Complex Planning

Not great when drowning.

People tend to panic in a crisis.

Panic is a survival

mechanism for the brain.

Amygdala Sends Alarm Triggering Fight or Flight Response

Effects Panic1. Suppresses Pre Frontal Cortex, Inhibiting Rationality

• Emotional Outbursts

2. Reduces our Ability to Make Decisions • Analysis Paralysis or Self-Destructive Behavior

3. Hyper Awareness of Threat-Related Information • Exaggeration and Paranoia

4. Negative Bias Toward Ambiguous Stimuli • False Conclusions and Red Herrings

Freak Out!

Staff under high Pressure.

Staff under high Pressure.• Working Under Increased Volume

• Unfamiliar Procedures and Job Roles

• Extra Hours and Responsibilities

• Ratings Downgrade

• Forced Liquidation of Assets

• Insolvency

Customers experienced Loss

Customers experienced Loss• Lost valuables, keepsakes, memories

• Lost loved ones

• Where do I live? What do I wear? How do I eat?

• How will I replace everything?

• Can I hold down a job and manage all this?

• Is the insurance company going to take care of me?

Perfect storm to divide people.

You

Customers

Teamwork and

Cooperation

Show Concern and Empathy

Can’t Rely on Willpower!Our ability to exercise judgement is limited when we feel panicked.

Willpower is Like a Muscle

Willpower Experiment

8 minutes 19 minutes

Willpower Experiment

Performance Follows Practice

Practice Forms Habits

Cue

HabitReward

The Habit Loop

Smoking Habit

Eating Habit

Habits Can Be Shaped

Willpower Becomes Automatic

Triage Planning

Carriers should devise a Triage Plan that can be executed consistently

under high pressure.

Prioritizes and sorts losses.

Reduces unnecessary loss expense.

Increases customer satisfaction.

Lay a solid foundation.

Triage Planning

1. Communication

2. Loss Notice

3. Response Team

4. Adjusting Losses

5. Risk Management

Triage Planning

1. Communication

Triage Planning

• Build Awareness

• Show Concern and Empathy

• Proactively Advocate

• Set Expectations

GOALS

Awareness plays a critical role in preparing

for unfortunate claims events.

How do you build awareness among policyholders, staff, and agents?

Educate before, during, and after events.

i. Contact Management

ii. Outbound Messaging

iii. Notification Channels

Communication

i. Contact Management

At the vary least, you need to be collecting name, risk address, mailing address, email, phone number, and

preferred method(s) of contact.

Deploy a centralized CRM

Hubspot• Manage contacts (syncs with Gmail or Outlook)

• Create, automate, measure, and optimize online marketing

• Publish search-friendly blog posts

• Build landing pages without IT

USE CASE: Contact Management, Agent and Insured Communication

ii. Outbound Messaging

Communication should be sent to customers when a

threat is known.

• How to prepare for a natural disaster (each type)

• Disaster recovery locations and instructions for customers

• Periodic updates with recommendations

• How to seek assistance and file a claim

Outbound Examples


Dashboards

Website

Email

Push Notifications

Social Media


Channel - Dashboards

Consider All AudiencesPolicyholders

Adjusters Agents

Admin Staff

Channel - Website

Set up a landing page that can either take over your company’s home page during a disaster or direct traffic flow

to a specific task page.

Page Purpose: To help claimant’s quickly and efficiently file claims directly following a catastrophe.

SquareSpace• Quick WebSites from Beautiful Templates

• Fully Managed Deployment

• Business User Can Build and Edit

• Optimized for SEO, Search, Usability, etc.

USE CASE: Landing Pages

Channel - Email

Email Campaigns

Email is a great way to send frequent communication that drives traffic to other

landing pages and dashboards.

Once you’ve created content on your website or blog, you can easily paste it into

an email to send to your customer base.

Recycle Content

Mail Chimp• Email Communications

• Stock and Customizable Templates

• List Management

• Analytics

USE CASE: Agent and Insured Communication, Warnings, Alerts

Channel - Push Notifications

Percentage Opened

2%

98%

Opened within 3 min

10%

90%

https://www.txt180.com/article/insurance-agents-mobile-marketing/

Texts and Push Notification

Texts and Push Notification

A disaster warning has been issued in

your area. If you experience a loss, file

a claim at www.britecore.com/losses.

Text STOP to 17568 to unsubscribe

from notifications.

http://www.britecore.com/losses

Automated Call Systems

“A disaster warning has been

issued in your area. For tips on

how to prepare for a disaster,

please visit our website

www.britecore.com/disaster."

http://www.britecore.com

Plum Voice (IVR)• Easily launch campaigns

• Completely cloud-based

• Decision trees with business logic

• Simple opt out options

• Integration with policy and claims systems

USE CASE: Automated phone campaigns

Channel - Social Platforms

Social PlatformsPolicyholders / Community

You should already have an established Social Media

presence and actively connect with customers via Facebook,

Instagram, Twitter, Youtube, etc.

Buffer• Share to All Social Media Platforms Equally

• Schedule Posts For Peak Times

• Promote Consistent Messaging

• Reduce Administrative Overhead

USE CASE: Facebook, Twitter, Linked In, Instagram, Google+, Pintrest

YouTube• Channel for Your Company

• Playlists Per Project

• General and Personalized Training

• Allow People to Learn Onsite

USE CASE: Agency Training, Insured How Tos, General Promotions

Company-Wide Disaster Training

2. Loss Notice

Triage Planning

Develop a Script

To effectively assign levels of priority to incoming claims, you’ll need to develop a

standard script to use at FNOL.

Ask policyholders 5-10 questions to determine how

quickly they need your assistance.

How Urgent is the Claim?

Example Questionnaire

Major Weather Event

1. What are the names, current or temporary addresses, and phone numbers for each policyholder?


2. What is the extent and severity of the loss?


3. Is your home livable? Do you have a place to stay?


4. Is there any property damage that might worsen if left untreated?


5. Did you lose personal property?


6. If so, do you have a way to purchase replacement items until the company can reimburse based on policy coverages?


7. Are you planning to return to work? If so, what is best time to

reach you?


8. What else can we do to make your family more comfortable?


Rank Losses

To make the best use of available resources, sort claims by severity.

Prioritization takes an overwhelming number of claims and classifies them into

manageable groups.

Going from this…

… to this.

Carriers can use a 3 Level Model to help determine which policyholders need

assistance first.

Involve conditions that are likely to deteriorate or change, or the scope of the loss requires

an adjuster’s immediate attention.

Level 1 Claims

Require field inspection but the conditions of the claim aren’t immediately urgent.

Level 2 Claims

Field inspection for these claims

could be scheduled out further without

significantly impacting the

outcome.

Can easily be handled in the office and do not require an adjuster’s field inspection.

Level 3 Claims

Digital Assistant

Instant Message

Mobile App

Web Form

Phone

You should offer many convenient channels for a policy hold to file a first notice of loss.

1

2

3

4

5

1. Phone• Call center / CSRs

• BPO providers can assist

• VoIP systems

• IVR for automated screening

Plum Voice (IVR)• Self-service phone interactions

• Speech recognition

• Interactive dialogues with rules engines

• Integration with Policy and Claims Admin Systems

USE CASE: Loss Notices, Ranking, and Routing.

2. Web Form

Create web form that can automatically post to your claims system. Setup

workflows to notify staff when a FNOL is filed from the web.

SquareSpace• Quick WebSites from Beautiful Templates

• Fully Managed Deployment

• Business User Can Build and Edit

• Optimized for SEO, Search, Usability, etc.

USE CASE: Landing Pages

Dedicated FNOL Vendors

• Complex rules engines

• Connected to other service providers

• Frequently include a BPO service as well

• File a claim directly from your policyholder app

• Leverage phone features such as gps, and camera

• Post directly into your claims management system

3. Mobile App

4. Instant Message

I want to file a claim. >>

I want to view coverage. >>

I want to add coverage. >>

I want to pay my bill. >>

Automated chat assistants can be added to your customer apps or portals to help policyholders quickly find answers to questions.

5. Digital AssistantServices like Amazon Alexa allow

customers to file a claim by talking to a digital assistant.

3. Response Team

Triage Planning

Help staff prepare. Create a company-wide First Response Plan that outlines responsibilities.

COMPONENTS

A. Notify Team

B. Dispatch Responders

C. Set Up a Crisis Center

A. Notify Team

Triage Planning > Response Team

Who should be contacted when help is needed?

Notification Tree• Company Directory

• Assigned Order

• Response Team

• Notification System

• Signal v. Noise

Channels

Direct Messages

Threads

Integrations

Alerts

Search

VoIP

Screen Share

B. Dispatch Responders


Activate those with designated responsibilities to ensure all functions of the Triage Plan are carried out as quickly and efficiently as possible.

Dispatch Key Responders

Key Responders

• Home Office Administrators

• Claims Director

• Claims Assistant

• Marketing / Communications

• Department Managers

• Catastrophe Response Team

• Triage Team Directors

• Triage Team Members

• Adjusters

• BPO Providers

C. Setup Crisis Center


• Secure a facility for triage, media, and housing.

• Secure a lease if needed for the remote site.

• Transport and setup supplies and equipment.

Setup a Mobile Office

Mobile Office

Will you rent or buy chairs, desks, computers, etc?

Necessary Supplies

• Emergency Supply Kits

• Emergency Vehicles

• Power Tools

• Company Signage

Hardware Needs

• Computers / Devices

• Phones

• Printers

• Chargers

• Internet

Software Needs

• Communications

• Claims Management

• Payment Systems

• Productivity Suite

• Expense Tracking

Ring Central• VoIP, Conferences, Video Chat, Messaging

• Includes PBX Features (Forwarding, Voicemail, Extensions, etc)

• Supports All Desktop and Mobile Devices

• Very High Quality

USE CASE: Call forwarding, Automated Voice Alerts, Remote Access

Web-Based Claims Admin• Accessible from anywhere

• Supported from a wide range of devices

• Minimal infrastructure requirements

• Team-based interaction

USE CASE: All software systems, mobility, accessibility.

Google Docs• Accessible from Anywhere

• Replaces Microsoft Office

• Realtime Collaboration

• Advanced Permissions

USE CASE: Documents, Spreadsheets, Slides, Forms, Diagrams

Amazon Workspaces• Virtual Windows Workstations

• Centrally Managed Environments

• Mobile Device Access!

• Integrates with Work Docs

USE CASE: Mobile,Temp Employees, Remote Workers, Tech Partners

Expensify• Expense tracking in the cloud

• Per Diem allotments

• Image recognition with auto-categorization

• Auto generates receipts below $75!!!

USE CASE: Expense Tracking, Expense Reports, Audits

4. Settle Claims

Triage Planning

A) Independent Adjusters

B) Web Software

C) Mobile Apps

D) Drones

E) Electronic Signature

F) Electronic Funds Transfer

Settling Claims

A) Independent Adjusters

Use independent adjuster networks for overflow capacity

during high claims generating events.

How do you build great relationships with independent adjusters?

You will receive better service from independent adjusters

if you are working to build relationships with them on a regular basis and not just during an emergency.

Regular contact maintains a healthy working relationship.

Engage Often

Kindess Wins Loyalty

Be Nice!

Make jobs a piece of

• Write good estimates using accurate measurements.

• Include detailed explanations as much as possible.

• Submit all pertinent pictures for adjuster’s file.

• Make timely submissions with few supplements.

Support your adjusters in front of policyholders whenever you possibly can.

Be Supportive

Resolve customer issues.

Happy customers make for happy adjusters.

Give adjuster a heads up on customer complaints.

Notify the adjuster of action plan with customer.

Send updates to adjuster regarding issue.

B) Web Software

• Accessible from Any Location

• Desktop and Mobile Support

• Managed and Dependable

• Connected to Data Sources

C) Mobile Apps

• Accessible without an internet connection

• Process claims on the go, upload data later

• Utilize device features such as camera and gps

D) Drones

• Review damage quickly

• Take photos and measurements easily

• Limit risk of adjuster injury

• FPV goggles make it very easy to fly

Not This!!!

This

E) E-Signature

• Review and settle onsite

• Reduce processing and turn around time

• Encrypted and secure

• Legally binding

F) Electronic Funds Transfer

• Remit Payment Immediately

• Requires simple account information

• Encrypted and secure

• Close many claims in the field

Questions?How to Contact Me

www.britecore.com [email protected]

(417)299-1119

Phil Reynolds CEO / Founder BriteCore