Claims Management

Our Claim Manager, Chris Smith has over 25 years of premier national carrier experience.  She has personally managed Workers Compensation, General Liability, Automobile, and Property claims desks and has been a leader of claim staff, including adjusters and nurse case managers.  Mrs. Smith understands insurance carrier initiatives and claim management approach and speaks the special language of claims.  Our professional team approach bridges any gap between the carrier and our clients. 

What makes us different?

We are our client’s claim advocate from cradle to grave.  Our competition may have claim staff, but they engage when claims go bad, they attempt to get the claim back on course and then they disengage.  

We want your experience to feel like our claim professional is your part time claim manager.  Our claim management approach is a hands-on, team approach with our clients to improve results.  By engaging at claim inception, we ensure that only valid claims are accepted.  We look for “exits” from the freeway to close a claim consistently.  There are more frequent freeway exits early in the life of a claim, but distance between exits expands quickly in very short duration resulting in elevated claims cost.

We understand the various issues that can lead to reactive versus proactive claims management resulting in negative claim outcomes.  Carrier claims caseloads continue to rise in the U.S., as many carriers require more and more from their claim adjusters every day.  Our solid carrier claims staff relationships enable us to swiftly navigate and communicate.

We believe in communicating with our clients, insurance carriers and TPAs on an ongoing basis, many times on a daily basis, as claims are happening and developing.  We make strategic recommendations to carriers and TPAs to move claims to resolution as expeditiously as possible.  We ensure the adjuster is aware of and utilizes resources, programs and/or processes that help reduce claims costs.

In addition to our ongoing communication and team approach on claims, other available services include:

  • Education and mentoring of client staff on effective claim management techniques
  • Coordination of timely and strategic Claim Reviews
  • Claim reporting to insurance carriers and TPAs
  • Assistance with handling claims within our client’s retention (i.e. deductible)
  • Identifying superior medical clinics for injured workers
  • Assistance with establishing protocols at medical clinics
  • Provide guidance on the implementation of a highly effective transition work program
  • Evaluation and analysis of claim history/trends
  • Tracking and ongoing communication of financial data (reserves and payments)
  • Communication of claim results
  • Ongoing recommendations to help reduce claims costs

The benefits to our clients include:

  • More positive claim outcomes
  • Improved customer service from the insurance carriers and TPAs
  • Lower cost per claim
  • Timely claim closures
  • Improvement to e-mod
  • Time savings and positive public perception by having experienced claim person assisting with claims within client retention

Key Claims Services

  • Claims advocate, results focused
  • Mentoring and development of client staff
  • Facilitator of carrier communication
  • Efficient reporting approaches
  • Strategic claims management
  • Medical provider selection
  • Transitional return to work programs
  • Carrier/TPA resource management
  • Experience Modification Rate Analysis
  • Claims analysis
  • Meaningful claims reviews
  • Claim closure strategies
  • Contractual review and feedback 

We believe that there are lessons to learn from past claims and we take this knowledge and share it with our clients to improve future results.  Our team is recognized and rewarded based upon client satisfaction.