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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.  

The trouble is, Bob’s success and failure are defined by three key ingredients:

  • Cycle times
  • Paid costs
  • Reserves

And these Medicare claims can easily push all three past the thresholds Bob and his supervisor want to see.  So, this leaves Bob in a difficult and dangerous position. 

Does he somehow set aside the multiple hours necessary to relearn how to properly report, process, and pay this claim every time it pops up?  Does he leave it to the claimant’s attorney to handle it, hoping he’s as knowledgeable as he claims to be?  Does he rush through it himself and just pay whatever he has to get it closed?

Unfortunately, none of these choices are optimal.  And some of them are downright foolish. But, there is a way to help Bob.

How to Save Bob – and his Employer – Time, Money, and Job Security

lori-0005535439-smallwwwLet’s leave Bob there with his head in his hands again for a few moments because the solution he’s struggling to reach actually has to come from above.

No, not from heaven, but from the C-suite.  It’s a matter of smart management and strategic decision-making.

The solution Bob needs does exist. It will take these difficult and problematic Medicare claims off his hands while ensuring his employer they’ll be settled efficiently, at the lowest defensible cost, and completely compliant to current Medicare law.

What’s more, using this solution will lower cycle times, paid costs, and reserves on all Medicare-related personal injury claims.  The carrier will be able to comfortably enjoy 100% Medicare compliance, meaning no exposure down the road to additional reimbursement demands, unidentified liens, bad faith litigation, or referrals to other government agencies.

As soon as Bob identifies a Medicare beneficiary, he can hand over the letter of loss and continue working on his other claims. As he manages his case load and stays in line with the company’s KPI’s, the Medicare claim will be moving through the appropriate channels in the background.  After a final reimbursement amount is negotiated, Bob will receive a Case Closure Letter with a big grin and sigh of relief.

The solution is Flagship Services Group’s end-to-end Conditional Payment Management Program.  If it were up to Bob, he’d hire Flagship.  Plus, we never charge you more than we save you, meaning you really don’t have to worry about these potentially problematic claims at all. 

So what are you waiting for?


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