3 Ways to Improve Claim Intake with Enhanced Call Center Customer Service Practices

Posted on

July 23rd, 2018

shutterstock_138016598 - Copy When customers call their insurance provider to make a claim or discuss an existing claim, the experience isn’t always smooth. After wending their way through a phone tree, customers often just want to speak to a knowledgeable person about their claim. Many of these interactions flow through a call center, which represents a prime opportunity to improve customer retention. The following are several ways to boost customers’ experiences with insurance claim call centers.

Give representatives the tools and training they need. Customer service representatives (CSRs) need to feel confident that they can help any customer that calls. The best way to do this is a blend of quick thinking and expertise with systems and tools of the trade. Skimping on training or forcing representatives to work with outdated tools will yield average results at best, which isn’t a great start for improving customer satisfaction or retention rates.
Foster a positive working environment. Unhappy customers need fast resolutions to keep them from searching for new providers. However, representatives often take the brunt of customers’ anger. Insurers need to make sure they’re taking care of their people as well as their customers. Keeping CSRs in good spirits is vital to processing claims without complaints or delays. Some ideas to boost the office mood include providing snacks in the cafeteria free of charge, raffling off free movie tickets, recognizing performance-based achievements, etc.
Focus on soft skills. Most customers are hesitant to contact call centers because they don’t want to interact with a robotic CSR. Soft skills such as communication, adaptability, conflict resolution, and more are all vital to successful claims resolution. Call simulations or listening to recorded calls can help CSRs learn how to handle angry or upset customers without losing their cool or coming across as unfeeling.

Many insurers focus on closing cases as fast as possible, and they can sometimes lose sight of the customers on the other side of the claims. By investing in a quality claim reporting solution, insurers can spend less time on redundancies and focus their efforts on customer satisfaction, retention, and claims resolution instead. To learn more about claim reporting and outsourcing, contact the experts at Actec.

How to Curb Summertime Blues and Improve Attendance

Posted on

July 18th, 2018

Andrew

shutterstock_252811903 - Copy Sunny days can entice employees to fake a sick day. There isn’t anything unusual about waking up on a beautiful day and wishing to spend it lounging by the ocean than in an office. However, more and more people are giving into this impulse and calling out of work. This is a challenge for employers as it‘s difficult to determine who is ill and who is spending the day at the beach.
Economic authorities refer to the moment when employees decide to call out of work to enjoy a sunny day the bliss point. One expert found the exact statistics to trigger the bliss point are:

81 degrees Fahrenheit including humidity (27.2 degrees Celsius)
Clear skies
A gentle breeze (9 mph or 14.7 km/h)

Most workplaces blame stress for why workers misuse their sick leave, but it’s worth looking at the weather as a possible motivator.

How to Reduce Weather-Induced Absences

Compounding the problem, the employees most likely to call out of work to enjoy the weather are the ones who can least afford it. For example, new employees or at-will employees are on tentative grounds as their employers can fire them with relative ease. While remaining gainfully employed should be reason enough, employers plagued by absenteeism may need to provide another incentive.
Offering flexible hours, such as arriving earlier in the day to be able to leave earlier and still enjoy the weather may be enough to tip the scales. Employers could also consider allowing employees to work an extra hour Monday-Thursday so they can take off half a day on Fridays.
Businesses also need to consider the work environment they provide for their staff. If the building is lacking sufficient natural light, stuffy, or otherwise uncomfortable during the summer months, employees will actively want to avoid it. Providing simple but fun summer activities can help as well such as offering popsicles in the break room. Getting employees outside can reduce the impulse to call out of work as well. Companies can achieve this by encouraging employees to go for a walk during their lunch, eat outdoors, or hold walking meetings.
If your business is struggling with summertime absenteeism, Actec can help. Our absence reporting system can help employers reduce the frequency and duration of absences as well as improve employee productivity. Contact us to learn more.

Avoid These 5 Mistakes for Better Claims Results

Posted on

July 12th, 2018

Andrew

shutterstock_306793247 - Copy Medical coding is a complex process that varies for every procedure, patient, and insurance provider. While no billing department is immune to claim denials, they can avoid several common mistakes to reduce the frequency of them. These include:

Missing information. Claims need to be as specific as possible to avoid a denial. Any missing piece of data can result in a rejection. However, the most common missing details are the date of the medical crisis, the date of onset, or the date of the accident. Avoid this mistake by examining the claim for any missing fields.
Incorrect patient information. Similar to missing data, incorrect patient data can result in a claim denial. The most common examples of incorrect information include misspelled names, inaccurate date of birth, sex, insurance provider, and policy number. Double-checking the patient’s information for accuracy can avoid this kind of claim denial.
Referral required. Some insurance providers require patients to receive a referral or prior authorization before receiving certain medical services. If a primary care doctor sends a patient to another physician for advanced medical tests or specialized treatment, he or she may have to issue a referral while the payer issues a prior authorization. However, receiving prior authorization doesn’t guarantee coverage. If the payer determines the services weren’t medically necessary or if the claim wasn’t filed on time, the payer may still reject it.
Claim filed too late. Continuing with the above, providers must submit claims within a certain window. For Medicare patients, this is of particular importance. The Affordable Care Act reduced the claims submittal period from 15-27 months down to one calendar year. This means from the date of service (the from date on the claim), providers have one year to ensure the payer receives the claim. This means if the provider submits the claim before the end of the calendar year, but the payer receives it after the one year date, the payer can deny it.
Eligibility issues. Insurance terms and coverage change often, so it’s vital to verify eligibility before receiving a service. For example, a patient may be eligible to receive physical therapy following an accident, but only for 12 weeks. If the patient meets their maximum benefit, the payer can deny any claims extending beyond that amount.

Keeping errors to a minimum is critical for successful claims management. If your claims management system is causing several errors and delays, contact the experts at Actec. Our full cycle claim and incident reporting solutions can help you close claims quickly and efficiently.

How to Help a Sick or Injured Employee Return to Work

Posted on

June 26th, 2018

Andrew

woman in wheelchair When an employee is absent for an extended period due to an illness or injury, how their employer handles their return to work is critical. Mismanagement of an employee’s recovery process can lead to a delayed return and relapses. Employees may be anxious about returning to work or feel worried about falling ill again. How an employer communicates with the employee during an extended absence can make or break the employee’s return to work.

The Employer’s Responsibility to the Employee

Employers may think their job is done when they finish processing a worker’s compensation claim, but that’s not the case. Employers need to work with the employee and the employee’s doctor to develop a successful treatment plan. Part of that plan should include:

An overall assessment of the employee’s work setting
What available support exists for the employee
If transitional work is an option
How to adapt the employee’s job if possible

By addressing the above, employers can know what to expect when the employee returns. The employer can also help facilitate a safe return with a suitable timeframe.

Establish Frequent and Open Lines of Communication

Sick or injured employees are often afraid to return to work full time. If the last time they spoke to their boss was their first day off work, their anxiety will likely be through the roof. Employers should touch base with sick or injured employees often to keep up to date with their progress as well as any setbacks they encountered. Employers should also work with the sick or injured employee’s direct supervisor to make sure he or she understands the employee’s needs when returning to work.

Flexibility is of the Essence

When a sick or injured employee returns to the workplace, they aren’t likely to be at the top of their game. Expecting them to be at 100% of their previous productivity is unrealistic and likely to result in a setback. Some examples of return-to-work flexibility include allowing the employee to return on a reduced schedule, decreasing the employee’s number of duties, or allowing the employee to work from home a certain number of days per week. That being said, while it’s important for employers to support the employee as they return to work, they shouldn’t let the employee walk all over them either. Employees returning to work should be able to make measurable strides toward resuming their original workload.
Establishing a unique return-to-work plan for a sick or injured employee can help set the employee up for success and diminish the likelihood of a relapse. If your company’s return-to-work policy is lacking, Actec can help. Contact us to learn more about managing employee absences.

How to Improve Claims Customer Service

Posted on

June 19th, 2018

Andrew

shutterstock_138016598 - Copy Insurance claim adjusters have a difficult job. They take the brunt of angry client phone calls while managing a workload of dozens if not hundreds of claims at any given time. However, while customer service is part of the job, there are several ways to improve the experience to cut down on the number of complaints. Improving the customer experience isn’t just about resolving complaints either. Twenty percent of customers never complain at all; they let their wallet do the talking and find insurance elsewhere. The following suggestions can help improve the customer’s experience and loyalty.

Follow up often until settlement. Unlike sales calls, customers always want to hear from their claim adjuster. Adjusters should call more often at the onset of a claim when the customer is most upset and in need of guidance. By maintaining frequent contact, the customer isn’t left wondering about the status of their claim or what steps they should take next.
Provide emotional support. One of the most common customer complaints is that their insurance provider doesn’t care about them. While there isn’t enough time in the day for a claim adjuster to provide the amount of emotional support every single customer needs after an accident, showing even a little compassion goes a long way.
Handle complaints with grace. Most of the time, a customer just wants someone to listen to them and apologize for the poor experience. While no adjuster like to listen to criticism, validating a customer’s frustration helps retention rates.
Promote rapid action. Most customer complaints center on delays and lengthy claims processes. However, customers are the root cause for most of these delays. Pointing this out to the customer isn’t likely to yield a positive outcome; instead, the adjuster should encourage the customer to supply necessary documents as soon as possible.

Even when certain tasks are out of the adjusters’ hands, they can influence the outcome of a claim. If your company is struggling with customer retention rates, Actec can help. Contact us to learn more about improving your claims management processes.

Employee Rate of Absenteeism Formula & Calculator

Posted on

June 11th, 2018

Andrew

chart-2785902_1920 Employees miss work for a number of legitimate reasons. Vacation time, holidays, and approved leave don’t count toward the overall absenteeism rate since employers can plan for these absences. It’s the unexpected time off from work that has a significant effect on productivity, workplace morale, and profits. Employers need to gain a measure of their overall staff absenteeism rate before they can ascertain if there is a problem or take steps to rectify it. Employers should use the following formulas to calculate their quarterly employee absenteeism rate.

Determine the average number of employees during the given quarter. There are a few ways to determine this number. The easiest way is to take the sum of the total number of employees at the start of the quarter and the end of the quarter, then divide that number by two. Employers could also take the total sum of employees at the end of each month of the quarter then divide it by three. A third approach is to total up the payroll deposits for each pay period during the quarter then divide that number by the number of payroll periods. For this example, let’s assume there is an average of 50 employees for the quarter.
Compute the total number of workdays in the quarter. This number should exclude legal holidays. However, it should include odd days such as additional days when a quarter starts or ends during the middle of the week. Next, employers should multiply the total number of weeks in the quarter by five since there are only five workdays to a week. Then, employers should add the total number of odd days and subtract the holidays. This will provide the total number of workdays during a quarter.
1. Example: (12 weeks in a quarter x 5 workdays per week) + 4 odd days – 1 holiday = 63 workdays
Find the total number of available workdays. Employers can do this by multiplying the average number of employees by the number of workdays determined in steps one and two.
1. Example: 50 employees x 63 workdays = 3150 available workdays
Determine how many days the company loses to absenteeism. Employers can do this by using a standard 8-hour workday to factor in fractions of a day. Let’s say an employer’s absence reporting system indicates employees called out sick once per quarter and missed an additional 3 hours per quarter outside of pre-approved vacations days and holidays. Employers would then use the following equation to determine their total number of days lost to unplanned absences.
1. Example: (50 employees x 1 sick day) + (50 employees X 3/8 hours missed) = 68.75 workdays lost to absenteeism
Calculate the quarter’s rate of absenteeism. To determine this number, employers should take the total number of days lost to unplanned absences and divide it by the total number of available workdays then express it as a fraction.
1. Example: 68.75 workdays lost / 3150 available workdays = 2.18%

Once employers establish a baseline for absences, they can easily and swiftly notice a steady or sudden increase in attendance problems. Employers can then investigate if the absenteeism problem is company-wide or department-specific. Employers can use such insights to make management changes, redesign tasks, or implement steps to reduce workplace stress. To learn more about reducing the employee absenteeism rate in your business, contact the experts at Actec.

How to Improve Claims Management Workflow in 3 Simple Steps

Posted on

June 5th, 2018

Andrew

shutterstock_251707783 sm There are only so many hours in a day, but clients don’t care about their insurer’s workflow problems. They want answers to their questions, rapid resolutions for their claims, and quick payouts for settlements. While insurance companies can’t make the day any longer, they can optimize their existing procedures to improve efficiency. The following are several ways to improve the claims management workflow.

Consolidate and Share Data

Insurers that rely solely on spreadsheets limit their service abilities. When insurance agents and adjusters need to access information about a claim, a massive excel spreadsheet is not the most efficient method. Storing data on several databases also makes it difficult to find all of the relevant information, which slows down the claims resolution process. By storing all data in one location and granting access to all relevant employees, insurers can speed up the claims management cycle.

Prepare for Emergencies

Many businesses operate well enough until they are hit with an emergency. They don’t have the ability to take on the additional work, so their day-to-day tasks sit on the sidelines until they can resolve the problem. This creates a looming disaster, as the sheer volume of backlogged work will swiftly overwhelm employees. If insurance companies consolidate their data as suggested above, adjusters and agents can access the information they need much faster, which better enables them to handle emergency situations.

Look for Trends

When data is easier to access and view, insurers can identify trends much faster. For example, an insurance company may notice certain natural disasters provoke more fraudulent claims than others do. They can then look at those false claims and search for commonalities to red flag similar claims going forward. This can save hours of time otherwise spent working on a case that may or may not be duplicitous.
Resolving bottlenecks in the claims management process doesn’t always have to be complicated. Sometimes, it’s as simple as revamping an existing system to make it work better. If your claims management process is causing headaches, contact the experts at Actec to learn how we can help.

How to Reduce Summer Seasonal Absences

Posted on

May 28th, 2018

Andrew

shutterstock_174875483 The lure of the sun, beaches, and time with family grows stronger with each passing week of summer. Employees will want to take advantage of their vacation time, and so long as employers manage the schedule, it shouldn’t be a problem. What is an issue, however, is unscheduled or frequent absences. Employees who always call out on Monday or seem to fall ill every Friday take their toll on the rest of the staff’s morale as well as their productivity. The following are several methods employers can use to manage summertime absenteeism.

Remind employees of their current sick leave, vacation time, or overall paid time off (PTO). Employees who take a day here or there may not realize how much time off they actually have. Remind employees to check their leave bank so they remain aware of the time they are burning. This may curb the urge to call out on Monday if the employee realizes he or she won’t have enough time off to take their long-awaited vacation.
Balance remaining employees’ workload when staff members go on vacation. Everyone deserves a break, but it shouldn’t come at the expense of the remaining employees at the office. Stressed employees are more likely to call out themselves, exacerbating the workload problem. Managers should spread load the absent employee’s work so as not to overwhelm the remaining staff.
Provide incentives for perfect attendance. For example, every employee who has perfect attendance for a week gets his or her name entered into a drawing. At the end of the month, their employee will pick a name and give that employee a reward such as free movie tickets, a gift card, etc. This encourages employees to come to work on time every day to have their name entered as many times as possible to increase their odds of winning.
Keep track of attendance. Companies that don’t have a system for tracking absences will quickly have an attendance problem on their hands. Implementing a system that allows employers to see patterns in absences gives them the opportunity to address attendance problems before they get out of control.

If you suspect that your business has a summertime absenteeism problem, Actec can help. Our absence reporting system can track casual absences, FML, and disability. Our system helps businesses reduce absenteeism while complying with federal and state laws regarding leave. Contact us to learn more.

How to Ensure Customer Satisfaction During Insurance Claims

Posted on

May 21st, 2018

Andrew

shutterstock_138016598 - Copy Insurance companies run any number of ads to try to lure new customers; however, retaining customers is just as critical for success. The best way to keep customers loyal is during the claims process. When a customer files a claim, they are often in a vulnerable state. They likely experienced a loss of some kind (i.e. car accident, theft, etc.) and need their insurance company to help them through the process. If their experience is less than satisfactory, customers may begin looking for a new insurer.

First Notice of Loss

First notice of loss (FNOL) is one of the greatest opportunities for insurers to guarantee customer satisfaction. This period of time is when the client is most upset as they are filing a claim right after an accident or loss. Insurers can improve their customers’ satisfaction during this phase by minimizing the amount of effort the client has to put forth. However, while FNOL plays a pivotal role in customer satisfaction, it presents less of an opportunity to improve the overall claim experience.

Acting in the Client’s Best Interest

While many insurers know that FNOL is vital to customer satisfaction, not as many realize that customers place a higher premium on their insurance company acting in their best interest. This part of the claims process can improve customer satisfaction and the overall claims experience. Factors affecting this include:

Managing the client’s expectations
Minimizing or eliminating surprises by supplying the client with solid information
Resolving the client’s issues the first time

Dialing in the Claim

Insurance adjuster can use a few additional approaches to improve the claims process. While they do not do much to improve the customer’s overall satisfaction, they do affect customer retention. These include:

Knowing the client’s personal information
Providing a personalized experience
Finding the client’s preferred contractor for repairs

Insurance companies that focus on the above can improve their customers’ satisfaction as well as their overall claims process. These two factors are vital to improving customer retention. If you’re losing customers to the competition, it may be time to overhaul your claims process. Contact the experts at Actec to learn how we can help.

What Do Chronic Employee Absences Say About Your Organization?

Posted on

May 14th, 2018

Andrew

shutterstock_252811903 - Copy An employee calling out from time to time is not cause for concern. Even numerous employees calling out in quick succession can have a plausible explanation, such as the flu making its way through the office. However, excessive absences that remain unchecked can have significant consequences for businesses. Absences cost money, impede efficiency, and can hurt office morale.

Interpreting the Message

If a company notices patterns surrounding employee absences, they need to determine the root cause. Absences almost always have meaning. The following represent the most common explanations for continuing employee attendance issues.

Unclear attendance policies or limited enforcement. If the employee handbook does not underscore the importance of adhering to arrival and departure times, employees are likely to believe their hours are flexible. The handbook also needs to clarify the leave request policy so employees know how to report sick days.
The attendance policy is unreasonable. Employers need to take a hard look at their workforce when setting start and stop times. For example, many retail jobs rely on high school students. However, if employers demand their student employees arrive to work minutes after school lets out, they are asking for failure. Refusing to allow vacation or personal leave can also cause numerous sick leave requests. Attendance policies need to take into account employees’ work-life balance. Everyone needs time off work for personal matters, and attendance policies should reflect this.
Personal problems. If employers notice the same employee calls out on a regular basis or always leaves early on Fridays, there may be a personal issue at play. Employers should schedule a time to talk with the employee to determine the issue. For example, the employee may be taking night classes on Fridays and needs to leave early to get to class on time. One solution for this scenario is to allow the employee to begin and leave work earlier on Fridays to meet their work schedule and school schedule needs.

Employers may not notice an attendance problem until it is out of control. By implementing absence reporting and tracking programs, managers and employers may notice trends regarding employee absences. This allows them to take action right away to contain the absences. If your office is struggling with absenteeism, Actec can help. Contact us today to learn more about our absence reporting program.