During a recent quality audit being conducted for a large autoinsurer, a question was posed about the lackluster results. Afterall, severities were down and profitability was good. This wascertainly a fair question, and one that is probably ponderedthroughout the insurance industry.

In this particular case, pricing was the catalyst to beingprofitable. While this was essentially subsidizing the poor claimshandling, it won't always be the case; giving way to the needfor improved blocking and tackling on the claims front.

Properly adjusting insurance claims takes a delicate balance ofinvestigation, negotiations, and thinking outside of the box. Justas a football play is designed to go a certain way, the fluidity ofthe process often leads to alternate routes and big gains. The sameholds true in the claims process.

During the closing meeting of this recent audit, an example ofan opportunity was shared. In this particular case, the adjusterwas following a script during a recorded interview with theclaimant:

Adjuster: Tell me how the accidenthappened?

Claimant: I was making a left onto190th Street. I was finishing up a call for my 1 p.m. appointmentto let them know that I was running late. I saw cars coming, butthought I had enough time to make it across the lanes of oncomingtraffic.

The adjuster proceeded to ask questions about the weatherconditions, emergency response, and damage to the car, but neveronce followed up on a variety of possibilities that could haveplaced negligence on the claimant.

While I'd like to say that this was an atypical example of apoor investigation, it was not. Poor investigative skills oftenhamper the claims investigation process, which belies thechallenges facing claims organizations seeking to improve.

ReadMore of Chris Tidball's Blog Posts at Blocking &Tackling

There are often several reasons underlying poor investigations,including poor training, improper hiring, or the unintendedconsequences of a push to achieve other metrics. Having managed avariety of claims organizations, I can state with a fair degree ofcertainty that it is a combination of all of the above.

When it comes to training, it is imperative that carriers havemanagers, mentors, and executives who have walked the walked. It isvery tough to develop an adjusting staff if the fundamentalblocking and tackling of insurance claims isn't understood.

While training departments and procedure manuals play a valuablerole in the process, there is no substitute for a line manager whocan turn a novice into a pro.

But beyond training comes the need to hire the right people.Insurance claims careers are not for everyone, yet often anyone ishired. While it can be a very rewarding career, it can also bewrought with challenges and demands not for the faint at heart.

Like a coach on draft day looking for the best player on theboard, my philosophy has always been to hire the best availablecandidate. More often than not, best doesn't equate withexperience. In fact, many of my best hires have had no insuranceexperience whatsoever!

Rather, my focus has been on personality, vision, and demeanor.Technical details can be taught, and often the best students arethose without preconceived notions or bad habits. At the end of theday, an organization will be driven by not only the quality of thepeople who they hire, but the positive influences within theorganization as negativity begets negativity. As discussed in mybook, Kicked to the Curb, negative influences are thesingle biggest contributor to organizational dysfunction.

Complicating matters can be the unintended consequences ofputting too much emphasis on certain metrics. There is no end tothe various metrics measured by organizations, many of which play acritical role in productivity and profitability. From contacts andinspections to liability decisions and closing ratios, adjustersare faced with a myriad of competing priorities.

At the end of the day, what truly matters is quality, which isan all-encompassing measure that takes every aspect of the claimsprocess into account. What is the point of a 24-hour contact ifnothing more than a message was left on a machine? What about aninspection where the adjuster snapped a photo over the tow yardfence? How about the 100 percent closing ratio with a 50 percentsupplement rate? These are all situations that can beaddressed with an improved quality assurance process that measuresevery aspect of the end-to-end claims process.

By focusing on hiring the best and the brightest, teaching basicblocking and tackling skills, and developing key quality assurancemetrics, claims organizations can assure themselves of acompetitive edge in the marketplace.

Like a coach drafting for the future, hiring for quality createsa foundation upon which a dynasty can be built.