The insurance industry especially the claims handling part of the business has been office based. Supervision was present and claims handling expertise was available to help solve any problem that was beyond the training and expertise of the adjuster. There was a backup system to take telephone calls and messages for the adjuster. The clerical assistance was present to perform tasks in the adjuster’s absence.
The majority of adjuster’s today work from their home and principally from their car. The communication options have been advanced. The cell phones and lap tops are able to access the web from anywhere in the world. The new training has produced an adjuster who is able to operate independently. The communication between the adjuster and the vendors necessary to close claim files has suffered.
SECURITY
The reason for the decline in the communication with vendors is security. The industries deep concern about leaking the insured’s personal information that may be used by an unscrupulous third party is a real threat. It is a potential law suit that the industry cannot win.
THE SOLUTION
CLAIMS ADJUSTER SYSTEM. (CAS)
CAS recognizes the current workflow between the adjuster and their vendors is wrought with inefficiencies. The CAS solutions offers the adjuster and the vendor a wide range of enhancements over the current inefficient process of emails, faxes, phone calls, voice mails, overnight mail and the U.S. post. CAS offers a safe and secure environment to work and communicate in. If the adjuster and the vendor can get to the web you can communicate. Imagine the CAS environment as a fortress (web site). Only the vendors that the adjuster chooses are allowed to enter this fortress. The vendors are given user identification and a password. Inside there are standardized formats and protocols. The standardization gives the reports the same look regardless of the type of assignment, type of report or which vendor office completes the report. The format does not change the vendor’s product. Engineers and contractors reports are more efficiently displayed and understood by the adjuster. To further understand the concept. Each adjuster and vendor is given his own desk (Portal). Adjuster and vendor can freely communicate within this fortress (web site) without fear of the leaking of their insured’s confidential information. The final report can be down loaded when a paper file is needed. The adjuster can leave all vendor files on the website, eliminating the necessity of the adjuster carrying paper files or using space on the adjuster’s laptop. The adjuster can still use, for non secure information, phone, fax and email as a choice but not as a necessity. The vendor has the same efficiencies of storage. The vendor has the ease and convenience of entering documentation directly into the web site using CAS protocols for the findings, analysis and conclusions. Photos and attachments are easily uploaded and stored on the secure server. The attachments can be of any scanned image, such as diagrams, blueprints or receipts The file that the vendor creates becomes one concise file of conclusions along with photo’s and attachments. Because of strict adherence to the CAS protocols and standardized report generation process the reports are user friendly, consistent in format and easily accessible. To further address the problem of security and communications each claim has a message thread attached. The message thread allows for a secure ongoing email like discussion between the claims adjuster and vendor. Since the online discussion is located directly on the CAS server (fortress) security is guaranteed. CAS has created a highly secure web based communication platform.
CASE STUDY OF HOW THE CLAIMS ADJUSTR SYSTE SYSTEM WORKS
The adjuster receives notice of a claim. The adjuster arrives at the insured’s property to settle the loss. There is evidence present that could result in a denial of claim. The adjuster goes to the website enters the user code and password and proceeds to the adjusters designated web portal. The adjuster completes an assignment form ordering an engineer to investigate the claim. The adjuster can choose the engineering firm from a list that displays the disciplines and skills of the firm. The alternative is to let the computer choose the firm based on proximity to the insured and discipline needed. The investigation is ordered.
The engineer completes the investigation using the CAS format. The adjuster is able to “look over the engineers shoulder” while he completes the report. Assuming that the “event” is a covered peril, the adjuster, still in the web portal orders a contractor to scope and price the insured’s claim. No faxes, telephone calls or emails the claim is settled using the secure information platform created by CAS.
Choosing a vendor