Study 1

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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.

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Card Set

Study 1

Description

Introduction to Claims MAnagement

Updated

2011-03-31T19:36:21Z

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