Study 1

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Author:
Anonymous
ID:
76455
Filename:
Study 1
Updated:
2011-03-31 15:36:21
Tags:
Claims Management nprocess nprocedures
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Description:
Introduction to Claims MAnagement
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  1. Define
    Claims Management
    An inclusive term incompassing both the following:

    • Handeling individual claims
    • Department claims processess and procedures
  2. Claims Managment on a broader department baisis includes:
    • Establishing procedures
    • Providing administrative support
    • Establishing a system of record keeping
    • Ensuring budget compliance
    • Aligning operations to overall corporate and vision staratagy
    • Insurance compliance
    • Staffing and education
  3. Mission Statements must align with the companies:
  4. Core Strength
    • Values
    • Culture
  5. Delivering a claims indemnity payments is accomplished in a way that preserves the insurance company's:
    • Reputation
    • Integrity
    • Ability to sustain a business
  6. Utmost good faith is associated with:
    • Honesty
    • Fairness
    • integrity
    • respect for the insured.
  7. What adjectives have been used by the courts to describe insurer conduct that warrents judicial punishment
    • Harsh
    • Vindictive
    • Rerehensible
    • High-handed
    • Oppressive
    • Malicious
  8. For successful stratagies goals should be:
    • Specific
    • challenging
    • cabable of being measured
  9. What factors influence how a claims operation is organized
    • Size of operation
    • Whether operation is regional, national or international
    • Lines of business it services
    • Levels of expertise requires
  10. What are the 3 systems of organizations:
    • Centralized
    • Decentralized
    • Hybrid
  11. Define
    Centralized Claims Operation
    • Handels claim from one main location
    • Decicion-making controls in one location
    • One major office rather than a series of offices
  12. Define
    Decentralized Claims Operation
    • Has a regional claims offices with varying levels to deal with the complexity claim handeling.
    • Head office staffed w/ senior technical examiners ready to assist regional offices
  13. Define
    Hybrid Claims Operation
    • Has elements from both systems
    • Negative and positve effects of both structires are balanced against each other
  14. Name 2 management structures
    • Hierarchical
    • Flat
  15. Define
    Hierarchical
    • Has layers of managment resembling a many-tired wedding cake
    • Groups of Claim handelers report to their supervisors who report to their managers and so on.
    • More employees than smaller organizations.
  16. Define
    Flat
    • Is like a single layer cake
    • Fewer designated managers
    • Cuts out the middle management layer
    • Generally everyone reports to one supervisor or manager.

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