This is the second in a two-part blog series involving the day-to-day role of a claims adjuster at the average P&C insurance carrier and how Flagship Services Group can make that day easier and more rewarding. In the last post, we looked at some potential pitfalls the average claims adjuster does not want to deal with. In this post, we’ll discuss how these pitfalls are avoided.
As we noted in the previous post, the average claims adjuster at a mid-size to large P&C insurance carrier has a heavy case load and a lot of stringent requirements and KPIs keeping them on their toes.
We were introduced to Bob, a P&C staff claims adjuster who just opened up a new file to find it’s one of those dreaded Medicare reimbursement cases. The claimant is a Medicare beneficiary who was injured in a motor vehicle accident and was in the hospital for several days. In addition, he has ongoing physical therapy and follow-up medical bills in the mix. Medicare has already paid for the hospitalization and a Conditional Payment Letter is on its way.
Now, Bob only sees one or two of these types of claims every month, in among as many as 200 claims he may touch in that same amount of time. As a result, he’s not completely comfortable with all the regulations involved, and he knows it’s going to take a lot of time to research it and get that all straight before he can proceed with confidence.