In today’s terms, insurance claims handlers are really not “specialists”, but are considered bottom rung glorified Administrative Assistants, hired for the sole purpose of chasing paperwork and routing files back and forth among resources.
Claims handlers do not have autonomy to make claims decisions, which are left up to claims managers who are as equally uninformed as their direct reports. The primary purpose of a claims handler is to shield and buffer the real decision-makers from the general public.
In fact, claims handlers who can shield their managers from irate insureds, and can contribute significantly to “shareholder value” (profits) are valued and quickly promoted more so than others working the unit. Managers depend on the skills of their employees to bolster their reputations with executive management.
All claims handlers are required to “tote the corporate line”, working through the directed claims process, as communicated by senior management. “The process” per se, is determined during multiple weekend “offsites” attended by claims management. In general, claims handlers are required to only do what they are told, think inside the box, and blindly support claim denials even when they know the decisions are inappropriate.
What I am writing about is never openly admitted by claims handlers as evidenced by many depositions I’ve read over time. The most popular answer is “I don’t know” – a deliberate result prompted by management resulting from the “dumbing down” of employees, who really don’t know much about the adjudication of Plans and policies.
Claims handlers are held accountable for rolling in financial objectives, making managers look good to the executive branch. Since managers “manipulate” claims decisions in accordance with financial reserve highs and lows, claims handlers are highly depended on to produce “proof” of deniability when its needed.
As a result, claims handlers are hired as “Type A Personalities” viewed as a personality type less likely to “give away the farm.” Allowing sympathy or compassion to influence claim decisions is a deliberate no-no, and handlers who show weakness for the typical “sob-story” are quickly removed from claims.
Claims handlers are also required to sign letters they don’t write. All insurance letters are mostly management approved “templates” inserted into letters constructed by handlers. This is why insurance letters contain so many “provision repeats”; the letter is a parody of templates, most of which don’t even pertain to each person’s unique set of circumstances.
Bottom line here is that insureds and claimants are wasting their time arguing, or trying to convince claims handlers their claims are credible. What insureds say goes mostly out the window, and although it is somewhat documented, is never read again. A claims handler is only the bottom ladder rung in a process that chases paper and only says or does what it is told. It is a waste of time, ranting to a claims handler who does not have the authority to make it count.
Claims handlers can be very nice, or rude, or contentious, which surprises me since they have no real authority to make claims decisions. This is another reason why DCS, Inc. supports all communications in writing – it only makes sense given the fact that claims handlers are, for the most part, clerks.
It is suggested that insureds remember who it is they are dealing with when contacting claims handlers. Every communication should be sent in writing so that it becomes an official part of the record to be seen by some manager somewhere before claims decisions are made.
