Home
Flashcards
Preview
Study 1
Home
Get App
Take Quiz
Create
Define
Claims Management
An
inclusive
term incompassing both the following:
Handeling
individual claims
Department claims
processess and procedures
Claims Managment on a
broader
department baisis includes:
Establishing
procedures
Providing
administrative
support
Establishing a system of
record keeping
Ensuring
budget
compliance
Aligning operations to overall corporate and
vision staratagy
Insurance compliance
Staffing and education
Mission Statements
must align with the companies:
Core Strength
Values
Culture
Delivering a claims
indemnity
payments is accomplished in a way that
preserves
the insurance company's:
Reputation
Integrity
Ability to sustain a business
Utmost good faith
is associated with:
Honesty
Fairness
integrity
respect
for the insured.
What
adjectives
have been used by the courts to describe insurer conduct that warrents
judicial punishment
Harsh
Vindictive
Rerehensible
High-handed
Oppressive
Malicious
For
successful
stratagies
goals
should be:
Specific
challenging
cabable of being measured
What
factors
influence how a claims operation is
organized
Size
of operation
Whether operation is
regional, national
or
international
Lines
of business it services
Levels
of expertise requires
What are the 3
systems
of
organizations
:
Centralized
Decentralized
Hybrid
Define
Centralized Claims Operation
Handels claim from
one main location
Decicion-making
controls in one location
One major office rather than a series of offices
Define
Decentralized Claims Operation
Has a
regional
claims offices with
varying levels
to deal with the complexity claim handeling.
Head office
staffed w/ senior technical examiners ready to assist regional offices
Define
Hybrid Claims Operation
Has
elements
from
both
systems
Negative and positve effects of both structires are
balanced
against each other
Name 2
management structures
Hierarchical
Flat
Define
Hierarchical
Has
layers
of managment resembling a
many-tired wedding cake
Groups of Claim handelers report to their
supervisors
who report to their
managers
and so on.
More employees than smaller organizations.
Define
Flat
Is like a
single layer cake
Fewer designated managers
Cuts out the middle management
layer
Generally
everyone reports to one
supervisor or manager.
Author
Anonymous
ID
76455
Card Set
Study 1
Description
Introduction to Claims MAnagement
Updated
2011-03-31T19:36:21Z
Home
Flashcards
Preview