Risks are inherent to running a business. These include financial and economic risks that come with market fluctuations, security and fraud risks, compliance risks, and perhaps most seriously, safety risks to workers. Incidents or accidents that harm workers or compromise workplace safety have company-wide implications, including compliance issues (for example, with OSHA) and financial liabilities.
An effective risk management program can mitigate the risk, of course. But some accidents are unavoidable, and their financial consequences are managed only by the appropriate insurance coverage. Some insurance policies such as workers’ compensation are required for compliance with regulations.Yet others — such as general liability insurance, warehouse claims, etc. — depend on the industry and size of your business.
When an incident does occur, you may need to manage multiple insurance claims, often under different insurance companies. Setting up a robust claims management process helps you handle the different claims processes smoothly. An essential aspect of claims management is claims administration, which involves all the administrative aspects of the claims process, such as documentation and paperwork. It also includes cooperating with claims administrators or claims adjusters and keeping them in the loop.
Since the claims administration process is a vital part of the claims management process, this article will highlight the responsibilities of a claims administrator. We will also outline some best practices for working with an administrator to benefit your business and workers alike.
A Claims Administrator’s Responsibilities
The people responsible for performing the administrative duties related to insurance claims are claims administrators. They coordinate between the claimants (in this case, the company) and the insurance company to analyze the claims and calculate the insurance company’s liability. Insurance claims can take a long time to resolve. But if the claims administrator is efficient and if the company cooperates fully with them, the process can be faster.
The claims administrator reviews documents related to billing, the claims process, the insurance provider, and others. They check that all documentation is in order for a prompt payout. For workers’ compensation claims, they maintain the files — including claim forms, workers’ healthcare bills, indemnity documents, and more — of all injured employees, reviewing them to determine their payout.
In case of any dispute or issues arising in the claims documents, they also perform investigations and adjudication as required. This involves reviewing medical treatment documents and bills to audit pricing, and making adjustments and benefits recalculations if necessary. They also maintain open communication with all related stakeholders.
Claims Administration Best Practices
The vital role of the claims administrator in getting insurance claims processed underscores the importance of full cooperation with them. But claims administration involves more than just coordination. If your claims documents are in good order, it makes everyone’s work easier and your payout that much faster. Here are five things you can do to ensure smooth insurance claims processing:
1. Itemize Claims and Calculate Cost Buildup
This step is critical if the incident not only harmed your workers but also damaged multiple items on your worksite, such as equipment or infrastructure. Prepare a systematic list of every item to include in the claim, adding in the estimated cost of repair or replacement (or, in case of workers’ compensation, medical cost).
Include evidence in the form of pictures of damaged equipment, medical bills, or cost estimates from professionals to strengthen your case. You can also add related costs the company faces during the event that may be eligible for reimbursement. Finally, aggregate these costs and record a total estimate for your claim.
2. Protect Your Assets
Ensure that the after-effects of the incident don’t cause further damage to already damaged items or damage other assets. For example, if a pipeline leak caused the incident, equipment may be damaged by fluids after the incident. Move the items to a dry location to prevent such damage or document why this is not possible. In the absence of such steps, insurance companies may pay only for the damage sustained during the incident.
3. Investigate the Incident
When an incident occurs, it is your responsibility to investigate it, find its cause, and take steps to prevent it from happening again. In addition, a prompt incident investigation shows insurance providers and claims adjusters your proactive interest in workplace safety. A detailed incident investigation report also provides documented evidence of the incident and the steps you have taken to prevent recurrence, making your insurance claim stronger.
4. Make the Necessary Notifications
Before taking any of the above steps, you must notify the insurance companies, and a claims administrator would then be assigned to your case. Keeping them aware of whatever actions you take is crucial as they play an adjudicating role in case of any dispute over your claim. In addition, you also need to notify the people in your company who may need to record the losses and, if relevant, inform senior management and investors about the situation.
5. Monitor the Process Closely
The time after an incident is usually hectic, and claims management may get neglected in the process. Make certain that everything is in order, that claims are accurate and submitted on time, and that payouts for these submissions happen as quickly as possible. So, communications with your claims administrator should involve verifying that the process is going smoothly.
Make Administrative Work Less Tedious With Automation
Administrative and documentation work can be tedious and prone to errors. With claims administration, these issues are more pronounced and can impact the financial gains made by accurate but quick work — both for your employees and potentially your business.
The process may be further complicated if major incidents require claims from multiple insurance companies. While prior planning, a good claims administrator, and a strong case backed by evidence certainly help, the process of documentation isn’t any easier. Hiring third-party claims services may help streamline the process, but human errors are still possible.
The best way forward is automation. Claims administration software such as Pulpstream can minimize paperwork by integrating all your claims and policies into a single platform. Automate your workflows, including collection and storage of evidence and regular communications with insurers, administrators, and other stakeholders, and eliminate the risk of inefficiencies and errors. Further strengthen your claim with sophisticated data analysis that can help you create trend reports, arrive at the root cause of your incident, and more.
Make your claims management team happy with Pulpstream. Book a free demo today!