Casualty Claims Examiner

Title: Casualty Claims Examiner (WORD version ) (Customer diagram)

Industry: Insurance

Function: Customer Service

Value-Added Results/Weights Performance Standards

Settled claims (35%)
• Payments

• Explanations of decisions

• Approvals
• District Casualty Claims Manager (DCCM) is satisfied with the Examiner’s claims decisions based on the following:
• The file documentation supports and explains the decision made by the Examiner.

• The description of how the decision was made follows corporate guidelines and fair claims practices.

• The examiner achieved a 90%—95% claim closure rate over a 6-month period.

• 80%—90% of initial contacts were made within 24 hours of receipt of claim.

• Average time to make a decision is 15—30 days.

Serviced policyholders and claimants (30%)
• Explanation of procedures and claims process and answers to questions
• No more than 2—3 justified complaints/year.
• 70%—80% customers rate the Examiner 3.0 or higher on the random district customer survey.

• An average rating of 3.0—3.5 on the random district customer survey.

• 80% of DCCM quarterly audits contain no recommendations for improving customer contacts.

Completed investigations and documentation (20%) • No more than 3—4 of 15 audited files show major or repetitive findings for improving investigations or documentation.

Trained agents, staff and claims employees (10%) • Manager who requested the training is satisfied that:
• The information was presented clearly.

• It helped the agents, staff and claims employees to do their jobs.

• The training was worth the time they spent.

• Manager hears agents saying they were satisfied with the training provided.

Risk information to underwriting (5%) • Underwriters/agents say the data in the Risk Review screen is verifiable, accurate, concise and identifies the potential risk.

Customer Diagram: Casualty Claims Examiner

Value-Added Results/Weights	Performance Standards
Settled claims (35%) • Payments • Explanations of decisions • Approvals	• District Casualty Claims Manager (DCCM) is satisfied with the Examiner’s claims decisions based on the following: • The file documentation supports and explains the decision made by the Examiner. • The description of how the decision was made follows corporate guidelines and fair claims practices. • The examiner achieved a 90%—95% claim closure rate over a 6-month period. • 80%—90% of initial contacts were made within 24 hours of receipt of claim. • Average time to make a decision is 15—30 days.
Serviced policyholders and claimants (30%) • Explanation of procedures and claims process and answers to questions	• No more than 2—3 justified complaints/year. • 70%—80% customers rate the Examiner 3.0 or higher on the random district customer survey. • An average rating of 3.0—3.5 on the random district customer survey. • 80% of DCCM quarterly audits contain no recommendations for improving customer contacts.
Completed investigations and documentation (20%)	• No more than 3—4 of 15 audited files show major or repetitive findings for improving investigations or documentation.
Trained agents, staff and claims employees (10%)	• Manager who requested the training is satisfied that: • The information was presented clearly. • It helped the agents, staff and claims employees to do their jobs. • The training was worth the time they spent. • Manager hears agents saying they were satisfied with the training provided.
Risk information to underwriting (5%)	• Underwriters/agents say the data in the Risk Review screen is verifiable, accurate, concise and identifies the potential risk.