Until now, measuring quality related to claims administration has reportedly been time consuming, labor intensive, and completely subjective.
Now, Atlanta-based Crawford & Company can objectively measure quality in 100 percent of its Risk Management Services claim files with the system known as QOps on a daily basis.
“You wouldn’t measure your financials only every six months – you always want to know where you stand. Why wouldn’t you always want to know how your claims operation is doing as well?” said Bob Kulbick, senior vice president, Risk Management Services. “Traditionally, quality has been measured by performing full file audits on a small sampling of cases per claim handler. Not only is this time consuming, but you may miss a lot because you can’t look at enough files necessary to perform statistically valid trend analysis. Since QOps looks at each claim file every month, we are able to identify trends such as consistent step reserving or file inactivity. By measuring every file systematically, QOps ensures quality.”
Crawford’s QOps measures performance based on progress notes that adjusters enter into the company’s claims system. The system then analyzes the data and determines whether all the performance measurements are being met. Five different performance indicators are reviewed for every file created to ensure a consistent level of compliance. The performance indicators include initial futurity, ongoing futurity, initial contacts, initial report, and status reporting.
Crawford’s QOps System also gauges 11 different diagnostic indicators via an established threshold of acceptance for different operational behaviors.
For example, the company looks at the percentage of files with diary messages to ensure that adjusters are using the diary to manage their claims. The QOps System measures diagnostic indicators at every level of the administrative process.
For more information on Crawford’s QOps system, contact Susan Koblasz at: email@example.com.
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