Outsourcing First Notice Of Loss – FNOL Call Overflow To Optimize Call Center Effectiveness

Many healthcare and insurance related companies have experienced high ASA times (Average Speed of Answer) and problematic Call Handling Times (CHT). Others have experienced challenges with ABN (Average Time to Abandonment) and ATB (All Trunks Busy). A company’s call center is the often the first contact, the critical initial claims intake responsible for customers when problems or losses occur. As with most call centers, there are times when in-house occupancy rates are at 90% – and no one is available to answer the phone.

A company call center could certainly return the call an hour later or the next day, but that may be too late, as the customer may have already contacted an attorney or progressed down a more problematic or costly path than necessary. For claims related issues, industry experts agree that a cycle time delays can increase the cost of your claims dramatically and will simultaneously reduce the effectiveness and level of customer service provided by your organization. This is why many of today’s contact centers employ outsourced call centers for overflow, nights and weekends. The around the clock claims professional staffing with overflow capacity offers improved call center responsiveness and enhances the overall customer experience.

By leveraging a contact center for overflow, nights, weekends and holidays, companies can improve organizational by as much as 40% while enhancing the customer experience. All of these things can positively impact the bottom line of many if not most organizations. Today, many high quality call centers outsource FNOL (First Notice of Loss) for overflow and non-peak times, while some outsource their entire operation. JD Power and Associates has stated that insurers with longer than average cycle times of 14.8 days are rated in the bottom 50% in terms of customer satisfaction.

At 80% or greater call center occupancy in-house staff is extremely busy, turnover often increases due to burnout, customer service is adversely impacted and many calls go unanswered. At 50% occupancy staff has flexibility with down time, customer service levels are often very good, and most calls are answered. At 20% occupancy, essentially every call is answered, ASA times are short, customer service is superb; however efficiency is low and the cost per claim is astronomical. Finding the right balance with outsourced first notice of loss (FNOL) solutions can allow call centers to improve efficiency and reach optimum effectiveness.



Debunking The Health Insurance Claims Process

Health  insurance  is no different to most other types of  insurance  – having the policy is one thing, but what happens if you need to file a  claim ? There’s no one answer to this question. That’s because just about every type of health  insurance  plan has its own method for dealing with  claims . Stop for a minute and think about how many health  insurance  companies there are, then multiply that by the number of policies each company offers, and you start to realize why giving advice on how to file a  claim  can be so difficult.

This may sound obvious, but if you’re not sure how to go about filing a health  insurance   claim , and even if you’re not sure whether it’s covered by your policy, the best thing to do is ring your health  insurance  company. If you look at their paperwork or website, they will usually have a toll-free number that’s staffed during business hours to assist customers. Some bigger companies may even offer extended contact hours. You’ll need to have information about your policy on hand, including the policy or group number, and the name of primary person insurance by the policy. Once you’ve provided those details, the customer service person can look your policy up on their computer and give you specific advice about how to proceed with your claim.

Filing a claim for a covered benefit under a Managed Care Plan is usually quite simple. Quite often the front office staff at the medical facility you visit will take care of the necessary paperwork for you, so you won’t need to file a claim. They know all the proper medical codes that apply to the service rendered, and will forward the correct paperwork to your health insurance company. If there’s a co-payment required, you pay that at the time of your appointment, so there’s nothing else for you to do until you receive the paperwork back from your insurance company. This paperwork will show you what percentage the insurance company paid, what amount was applied to the deductible, and if there is any balance due to be paid by you.

Indemnity Plans used to be quite difficult to deal with when it came to filing a claim. Usually you had to pay for the medical service up front, and then you’d fill out a lengthy  claim  form and send it to your health  insurance  company. You would then have to wait anything up to a couple of weeks to receive a reimbursement. Nowadays, it’s more common for the front office staff to directly bill the insurance company for the medical service you received. Then, once they find out what percentage of the bill will be paid by the insurance company, they will bill the remainder directly to you. If there’s a dispute then the medical services provider will bill you directly, and you are obliged to pay. It’s then up to you to contact your health insurance company and sort it out.

Now that computerization is so advanced, the medical billing process is much more streamlined, and generally as a patient your only cost upfront is your co-payment. Even if you need to pay the deductible first, the paperwork goes to the insurance company to determine the correct amounts, so there’s a delay before you need to pay. This also means the health insurance company can keep your policy usage and payment history up to date. Considering the sheer volume of paperwork these companies deal with every day, most claims still get settled reasonably quickly.



Car Accident Advice

Car Accident Claim Advice

Being in a car accident can be very stressful for all involved. It can be hard to know what to do when you have been involved in a road traffic accident.

But if you have been involved in a car accident through no fault of your own you’re entitled to claim compensation for injuries that occurred due to the accident. Even if you have gained injuries through being a passenger in a car that was at fault you are entitled to claim against the drivers insurers for compensation.

Filing a Car Accident or Road Traffic Accident claim can be stressful. Follow our advice to ensure your claim is not rejected and you get the compensation you are entitled to.

• Do not leave the scene.

• Check all persons for injuries. If required call for medical help instantly.

• Call the police to attend the scene immediately.

• Speak to the other driver only to get their details which should include- Name, address, telephone number, registration, make and model of car, colour of car, insurance details i.e. policy no. and company name.

• Do not admit liability, or allow yourself to be bullied into thinking you caused the accident if this was not the case.

• Do not be abusive to the other driver in any way.

• If possible while take photos of the scene, make sure you capture the surroundings in the pictures so that they cannot be argued at a later stage. Include photos of damage to both cars and remember always include surroundings.

• Get numbers of any witnesses.

• When given your statement of the accident, try not to contradict yourself. As this might affect your claim later on.

• Remember that adrenalin can affect your ability to feel pain and the extent of your injuries might not come through till hours or days after the accident.

• An accident must be reported to your insurers within three months of it happening, but remember it will be easier to claim if done immediately.

• Take note of any dates that you went to the GP’s or hospital to get treatment for injuries caused by accident.

In the UK you can claim on a ‘no win, no fee’ basis, and most companies retrieve costs from the other side so that you get 100% of the compensation. Claims Management Companies ensure that you always get your full compensation.

The amount of compensation a successful claimant will receive depends on a variety of things

• Extent of injury or disability

• Pain past and present

• Income lost due to accident past and present

• Any disadvantage in the job market

• Loss of life amenities

• Any reasonably expenses you incurred while injured

Sometimes after an accident people are unaware how to make a claim for compensation. Many websites have forms that you can fill in online. Other sites have instant chat links on their pages so that you can discuss your accident with an advisor immediately.

It can be hard to know which company to choose after the accident.

But you should take into account what you need. For example

• A replacement vehicle

• Vehicle Recovery

• Personal Injury claim

• Rehabilitation after the accident

Obviously you can get all these things through separate companies but companies such as Claims National offer a complete service and are available 24 Hours a day 7 days a week.



Who Files More Auto Insurance Claims?

Men claim that they are better drivers and women argue back that they are the superior driving gender. But who in fact is correct? Well…women do have cheaper insurance premiums than men do. Does that mean that they are better drivers? It would surely indicate that women are safer drivers if you consider that insurance companies calculate risk.

Insurance is a number crunching and statistics driven industry. This makes it tough to argue with  insurance  companies that state clearly that women also file fewer auto  insurance   claims . So now it is evident that it would be fair to say that women are safer drivers which results in fewer claims. But, does that mean that they are better drivers?

 Insurance  companies are able to predict to a certain degree the chances that a driver will file a future  claim . This is all part of the number calculating process.  Insurance  companies  claim  that women are also more cautious when they drive than men are. Being a more cautious driver would likely also result in fewer accidents and therefore, less claims.

Another thing that insurance companies have discovered about women drivers is that they have a tendency to buy the right cars. This means that they, as a rule, will purchase a vehicle that is safer to drive and that has more safety options. This also reduces the cost of premiums. Insurance companies have also determined that it is women who drive fewer miles than men do. This is another reason for women being offered cheaper auto insurance rates. But, does all of this point to women being better drivers or just safer drivers? That is for you to decide!

Interestingly enough, the number system that insurance companies use has tipped the scales a bit in favor of the guys. This is because more women are demonstrating more aggressive driving behaviors recently. Unfortunately, the scales have not been tipped quite enough to change the fact that women pay less for insurance than men do.

There is no immediate indication that the insurance companies have any intention of evening up the playing field between men and women. Men are presumed to show more risk while women are still seen as more passive drivers. Until these changes are made, there will be no change in men paying more for auto insurance than women do.



Getting the Paperwork Right With Self Insurance

Paperwork may not make the world go round, but it can use up a lot of time and patience. For busy people, paperwork needs to be pinned down, and an efficient management system needs to be in place to do it. There are a few ways of doing this, internally and externally. The “admin factor” in self insurance requires a level of expertise, and management needs to decide the best fit for its operations.

Doing your paperwork in house issues

The main issues with self insurance administration are twofold:

  • Administration costs and efficiencies: There’s an obvious dichotomy for business in terms of administration costs in specialised areas. The work must be done, but it’s also resource intensive in some cases, particularly when the work is undertaken by in-house professionals whose jobs are designed to cope with workloads generated by the business. In house management may or may not be cost efficient, based on the requirements of the workload.
  • Accounts and financial management issues: Self insurance is a financial management issue, and it is necessary for the business to conduct its self insurance operations according to statutory requirements. Input from financial managers is required, and in-house reporting systems are involved. However, the justification of costs in terms of additional resources committed to paperwork is also a potential issue.

External support- A working option

External support eliminates any additional requirements on internal administration, while retaining the valuable reporting functions of the self insurance management scheme. External services provide all the information required for financial management, allowing the financial managers to deal with issues without the added burden of administrative costs and resource issues.

Expert assistance from risk management consultants also provides a very useful administrative backup for managers who need to deal with the sometimes complex issues raised by self insurance. The external support approach covers all angles seamlessly, creating a good ongoing management methodology.

Figuring out the best approach

Best practice for self insurance administration consists of several stages of development and related options:

  • Consultants are engaged to set up the self insurance programs and systems. They provide a full operational schematic. These consultants also provide a full range of monitoring and safety management system support service.
  • Businesses may administer these operations themselves, or retain the consultants for both administrative and advisory purposes.
  • Businesses that administer their own self insurance engage consultants as required to upgrade their safety management systems and undertake safety audits.

Option 1 is basically an outsourcing approach, eliminating the administrative costs and creating a working management system.

Option 2 may be appropriate for businesses which are able to manage the administrative issues but still require support and advisory services.

Option 3 is a compliance-based approach, ensuring both reporting and proper conduct of self insurance administration on a needs basis.

The best options are chosen for cost-effectiveness and a good fit with the administrative and financial management needs of businesses. External services improve self insurance management efficiency greatly, whichever option is preferred.



Filing a Title Insurance Claim

Although it is not likely, in some rare instances a person who has purchased a Tampa real estate ends up facing a problem with the title to the home. Unfortunately, in a very small number of cases, that title blemish ends up being found after the closing has occurred and after the purchaser has taken ownership and possession of the residence in question.

If you have found yourself facing a problem with the title to your home after you have closed on the purchase of that property, you will need to file a claim with the title insurance company that did the title search on the property in the first instance and that issued a policy of title insurance to cover that property and its title in the event of a problem. Through this blog posting you are provided with some basic information that you will need to keep in mind as you go about filing and then pursuing a title insurance claim.

As with any other type of insurance, the first step that you will have to take if there ends up being a title problem is the filling out of a claim form itself. Generally speaking, these claim forms are not that complicated to complete. Moreover, a representative of the title insurance company itself – in most instance the title insurance agent that wrote the policy in the first instance – will assist you in preparing the claim form in the first instance if you do find that some help in this regard would be useful to you.

Once the claim is submitted, the title insurance company, through its retained legal team, will work to resolve the title defect or problem with all deliberate speed. The reality is, of course, that you likely discovered the defect in the title at a point in time at which you are trying to sell the real estate in question. Therefore, time really will be of the essence. The bottom line is that if the title insurance company is not able to resolve the title defect within a reasonable time, within the amount of time that is necessary to allow you to close you deal (for example), the title insurance company will be responsible for paying for any losses that you may sustain as a result of the title defect they insured against or for a sale that you may lose because of the title defect.

You do need to keep in mind that in most instances when a previously undiscovered title defect does arise that defect will end up being rather minor. In most instances the title defect in question will end up being able to be resolved in a short period of time and without causing you to suffer any loss or problem.



The Process of Accounts Receivable Management

Accounts receivable management is the art of keeping track of how much credit the company has given its customers, and when the company can expect it back. Usually these involve an amount that a customer owes to the company regarding the sale of any product or service. Doctors provide patients with the best care possible and expect to be paid for their services from the insurance company and patients. The healthcare insurance system works in a curious way where the provider delivers service and is re-imbursed at a much later stage.

Whether we like it or not, the insurance model is here to stay and it is imperative for both small providers like doctors offices and physician groups and large providers like big hospitals to diligently follow up on payments that are due. The accounts receivable management has developed in to the most significant department in these organizations as they help in recovering the money from patients and insurance companies and help to keep the business running.

The task of accounts receivable management has evolved from a mere departmental activity to a specialized skill center by itself and requires professionals so that doctors can focus on delivering the best care to their patients. This activity has become an important and integral part of the overall billing services that are offered by medical billing companies. The process of accounts receivable follow up is preceded by charge entry, verification, and claim posting. The process of entering the charge codes into the healthcare claim sheet is called charge entry. This involves determining the procedure codes and diagnosis codes based on the treatment performed by the doctor. There are specific rules defined by the insurance companies on what constitutes a valid claim and there are hundreds of rules some simple and others complex to determine the validity of a claim. The audit team typically reviews the claim based on the rules and approves the claim for submission. This is a very important step as this significantly lowers the risk of claim denials. The claims are then submitted to the insurance company for processing. The insurance company processes the claim and sends a payment remittance to the billing company but the response time is unpredictable and hence the requirement of an exclusive accounts receivable team. The AR team takes over the claim and follows up with the insurance company for payments.

The AR team analyzes the claim for denials, partial payments and non-payments and if the claim has been filed incorrectly, the claim is corrected and re-submitted. The AR team develops a constant communication mechanism with the insurance company, patient and the medical office and meticulously follows up to ensure quick and complete payment. The skill sets and qualities expected from members of the accounts receivable management team are good analytical skills, attention to detail, diligence and above all, patience. Team members with these qualities are valuable assets to the organization and will ensure that the medical office receives their payments promptly.

The aging report is the most common tool to measure the efficiency of the accounts receivable team. This shows the amount that is due to the provider and is broken down into different periods – 0 to 30 days, 31 to 60 days, 61 to 90 days and more than 90 days. An aging report that has less than 5% of total amount pending for more than 30 days is considered very efficient.

In conclusion, the accounts receivable management is THE most important service offered by medical billing companies and the effectiveness of this team will determine the financial health of the billing company as well as the medical practice. If you have any questions regarding accounts receivable and how to receive prompt payments from insurance companies.



Insurance Claims After a Chimney Fire – Basic Guide To Ensure Your Claim Is Approved

When it comes to insurance claims after a chimney fire, you want to be sure that you handle the entire process smoothly and efficiently. After all, experiencing the chimney fire itself was traumatic enough; you don’t need to add the hassle of paperwork, frustration and financial worry on top of all that.

If you’re unsure of how insurance claims after a chimney fire work, then this article will provide you with a basic guide on how you can ensure that your claim is approved. By following these steps, you’ll save yourself a great deal of hassle when working with insurance companies – not to mention the headache!

Document Everything. Because chimneys are considered part of the home, your homeowners insurance will cover damage incurred by a fire that’s deemed to be accidental. Like with any other insurance claim, it’s vitally important to document anything and everything that’s damaged by the fire. Make sure you use a camera that imprints dates on the photograph (digital cameras automatically do this) and leave no stone unturned.

Recruit The Help of a Professional. Many insurance companies won’t approve a claim unless an inspection has been carried out by a member of the insurance company or a certified chimney inspector. If you opt for the latter choice, make sure your inspector is part of the Chimney Safety Institute of America, as many insurance companies will reject inspections carried out by professionals who aren’t associated with this prestigious organization.

Be Prepared For the Unexpected. If your chimney was struck by lightning or any other fluke was found to be the cause of the fire, an insurance company will generally approve the claim and fund your repairs. However, if the insurance inspectors find evidence of chimney neglect (such as a clogged flue), then they won’t approve the claim, as the fire and resulting damage was caused by negligence. If you’ve been keeping up with your chimney cleanings and inspections, you should have nothing to worry about; otherwise, it’s best to prepare yourself for a not-so-favorable decision from your home insurance company.

When it comes to insurance claims after chimney fires, you’ll want an expert by your side to ensure the process runs smoothly and efficiently. That’s why you should call a CSIA certified chimney inspector today. A CSIA certified inspectors and cleaners will help you process your insurance claims, so you can get your life back on track faster.



Business Transaction Management – The Next Generation Of Systems Management

Why a new generation? What’s wrong with the old one?

Traditional systems management tools focused on monitoring the health of individual components. Tools like IBM Tivoli, BMC patrol, CA Unicenter, and HP Openview, initially focused on management of servers, services, and resources. In those days, the equation was relatively simple – 100% cpu utilization = bad, 10% cpu utilization = good. However, the increasing complexity of applications introduced numerous new enterprise application components including databases, connection pools, webservers, application servers, load balancing routers, and middleware. The business service management industry followed shortly after, and began offering tools for database management , monitoring of network traffic, mining application metrics, and analyzing webserver access logs. Each of these business service management tools “speaks” a different language – database management tools speak in “SQL statements”, network traffic tools use “packets”, while systems monitoring report in “CPU and disk usage”.

So what happens when the application crashes or hangs?

What do you do if a single transaction suffers slow response times?

In comes the “war room”

To cope with the proliferation of information sources, enterprises came up with the notion of the “war room”. Whenever slow response times or poor performance of critical applications is detected, relevant personnel are grouped together into a room for brainstorming and joint monitoring. This involves a large amount of professionals, since a single transaction may flow through several infrastructure components. For example, a financial transaction will trigger an HTTP request to an apache webserver installed on top of Redhat Enterprise linux, which in turns calls a Websphere application server on a windows machine, flowing through an MQSeries queue, eventually querying an Oracle database. Members of the “war room” typically include Java and J2EE performance experts, Microsoft windows system managers, Unix (Linux, Solaris, HP-UX, etc.) system managers, database administrators (DBAs), Network sysadmins, and proxy specialists, just to name a few. This is a lengthy process that can take thousands of man hours to complete.

The new paradigm – Business Transaction Monitoring

The “new generation” of systems monitoring and management tools, widely referred to as Business Transaction Management (or BTM), offer a new approach. Instead of monitoring SQL statements, tcp/ip packets, and CPU utilization, Transaction Management tools view everything from an application perspective. In the world of transaction management , an application is considered as a collection of transactions and events, each triggering actions on the infrastructure. The goal is to track every transaction end to end and correlate to the information collected from the infrastructure. Such an end-to-end view enables to quickly isolate and troubleshoot the root cause of performance problems and start tuning proactively. This application-centric information base enables a group of professionals working together to “speak” the same language and focus on facts, rather than guesswork.

According to IDC (Business Transaction Management – Another Step in the Evolution of IT Management ), BTM (Business Transaction Management ) will likely become a core offering of established IT system management vendors, since it can contribute to almost every aspect of IT management – ranging from performance management , SLA (Service Level Agreement) management , capacity planning, to change and configuration management (CMDB).



Filing a Homeowner’s Insurance Claim

I have had several questions about how to go about filing for a homeowner’s insurance claim after we have provided our services to the client. I will attempt to answer this here:

1. Promptly notify your insurance company or agent of your loss.

2. Make a detailed list and description of damage, including photographs if possible.

3. Collect your cancelled checks, receipts and other documents to help the adjuster set a value on damaged or destroyed property.

4. Review your coverage. You might not be aware that your homeowners or renter policy pays for debris removal and for emergency housing and living expenses if your loss forces you to move temporarily. If you can’t find your policy, ask your agent or insurance company for a copy.

5. Do not make permanent repairs before an insurance adjuster inspects your home.

6. Make only temporary repairs to protect your home from looting or further damage. The insurance company might deny your claim if you make any permanent repairs before the adjuster inspects the damage.

7. If possible be present during the insurance adjuster’s inspection and take notes on the discussion. You might want your own contractor/builder present to represent your interests.

8. Keep good notes on all contact with your insurance company and adjuster. Your chance of getting a satisfactory settlement improves when you are well prepared with the facts.

9. Write down names, dates, and who said what. Remember, good records help your cause if you want to complain to the Department of Insurance about an insurance company’s decision of contest in court.

10. Don’t agree to a final claim settlement until you are satisfied that it is fair. You’re entitled to obtain independent estimates if you wish.

11. Get more than one bid for construction or repair work. Try to use a local contractor with a good reputation. Large claims events like storms often attract fly-by-night operators who do shoddy work or skip town after receiving advance payments.

These are just some simple rules or steps to go by when you do need to make an insurance claim.