Claims Processor

Title: Claims Processor (WORD version ) (Customer diagram)

Industry: Insurance

Function: Customer Service

Value-Added Results/Weights Performance Standards

More productive adjusters (35%)
• Sorted mail

• Phone messages

• Located files

• Policy information

• Documented files
• Adjusters say they are more productive because of the Claims Processor’s work:
• They know which mail is high priority and which mail can wait.

• They have the correct file for each piece of mail and phone message.

• Their suspense files are available to process.

• They can find files when they need them.

• The Claims Processor handles urgent matters immediately.

• Claims Processor responds to requests by the time needed.

• Exceeds = The above standards are written at the "exceeds" level.

Organized files (30%)
• Open/closed files
• Adjusters are satisfied that:
• They can find files quickly when the Claims Processor isn’t there.

• They can find the file in the first place they look.

Information input into computer (20%)
• Quick pays

• Credits

• Glass payments

• Field drafts
• No more than 3—5 errors/month are spotted by someone "downstream."
• Quick pays and field drafts are entered the same day they are received.

• Glass payments are entered by the end of the quarter.

• Credits are entered within 48 hours of receipt and by end of month.

Backup coverage (10%)
• Other units

• Own unit

• Customer service
• When backing up Claims units:
• Adjusters in the other unit say the backup Claims Processor meets the same standards as above.

• For Customer Service backup, supervisor observes calls and hears the Claims Processor:

• Speaking politely to callers.

• Giving accurate information.

• Referring callers to the right person.

• Not placing callers on hold for more than 2—3 minutes.

• Calming down irate customers.

• The supervisor receives no more than 2 complaints/year from customers who say they were treated rudely.

Calls referred to the right person (5%) • Supervisor overhears Claims Processor:
• Giving claim number, adjuster’s name and extension.

• Giving caller a choice between leaving voice mail or getting another live person.

• When the call is transferred, the Claims Processor waits until the next person is on the line before releasing the call.

Customer Diagram: Claims Processor

Value-Added Results/Weights	Performance Standards
More productive adjusters (35%) • Sorted mail • Phone messages • Located files • Policy information • Documented files	• Adjusters say they are more productive because of the Claims Processor’s work: • They know which mail is high priority and which mail can wait. • They have the correct file for each piece of mail and phone message. • Their suspense files are available to process. • They can find files when they need them. • The Claims Processor handles urgent matters immediately. • Claims Processor responds to requests by the time needed. • Exceeds = The above standards are written at the "exceeds" level.
Organized files (30%) • Open/closed files	• Adjusters are satisfied that: • They can find files quickly when the Claims Processor isn’t there. • They can find the file in the first place they look.
Information input into computer (20%) • Quick pays • Credits • Glass payments • Field drafts	• No more than 3—5 errors/month are spotted by someone "downstream." • Quick pays and field drafts are entered the same day they are received. • Glass payments are entered by the end of the quarter. • Credits are entered within 48 hours of receipt and by end of month.
Backup coverage (10%) • Other units • Own unit • Customer service	• When backing up Claims units: • Adjusters in the other unit say the backup Claims Processor meets the same standards as above. • For Customer Service backup, supervisor observes calls and hears the Claims Processor: • Speaking politely to callers. • Giving accurate information. • Referring callers to the right person. • Not placing callers on hold for more than 2—3 minutes. • Calming down irate customers. • The supervisor receives no more than 2 complaints/year from customers who say they were treated rudely.
Calls referred to the right person (5%)	• Supervisor overhears Claims Processor: • Giving claim number, adjuster’s name and extension. • Giving caller a choice between leaving voice mail or getting another live person. • When the call is transferred, the Claims Processor waits until the next person is on the line before releasing the call.