3 Ways to Make Your Claims Review Meetings More Meaningful

Claims review meetings are critical in identifying high-cost claims, streamlining claims processes, establishing proactive risk assessments, and potentially resolving claims faster. Efforts to meet these goals, though, require a certain level of collaboration from all stakeholders, including claims adjusters, employers, carriers, and, when necessary, legal counsel.

“For the results of a claims review meeting to reach reasonable expectations, the goal should be to assess high-risk claims, work through questions and details, and leave with an action plan,” said Tanya Parker, Assistant Vice President – Client Engagement at Safety National. “There should not be any surprises during these meetings unless there have been very recent changes. Otherwise, these occurrences may be indicative of a larger problem.”

These tips may offer a better approach to make your next meeting more successful.

1. Set guidelines to determine which claims will be reviewed.

Many file reviews are set at a dollar threshold for determining priority, but some of those claims may be more straightforward and not necessarily need a review. Setting cost parameters could deprive other claims of attention, like those where reserves have not been met, garnering questions and creating a potential to explode in cost. A more deliberate approach may include reviewing claims that are open longer than a year or focusing solely on litigated claims.

Setting distinct guidelines helps TPAs narrow the list to those claims needing attention. Furthermore, if TPAs can provide this list to all stakeholders 30-40 days prior to a claims review, it may help eliminate claims in good standing, allowing more time to review high-priority claims.

2. Be prepared with a schedule for all stakeholders.

Before the claims review meeting, a TPA pre-file review may be beneficial, ensuring all status reports are organized, accurate, and up to date, including adequate and appropriate reserves. Additionally, supervisors should prepare to be included in review meetings, especially when an adjuster is new to an account, company, or file.

To best use the meeting time, each file should have a set time limit to ensure all files are discussed. Communicating this schedule in advance allows all stakeholders to contact additional parties and collaborate. For example, an organization may want to invite HR managers who oversee specific locations, allowing a TPA to coordinate adjuster scheduling for those particular claims. Assigning time limits prevents every adjuster from attending the entirety of a lengthy review meeting.

3. Leave with an action plan.

Typically, a TPA will keep a detailed meeting summary covering action plans to discuss during the next meeting. For timely actions to be taken by the TPA, they must be trackable. Many TPAs still issue status reports, but these can be time-consuming and detract attention from the day-to-day responsibilities of adjusters. Sharing accessible reports via spreadsheets can serve as a point of reference for each concurrent file review.

Provided that all stakeholders are assigned specific responsibilities with designated timelines for completion, the next meeting should set itself up for success, allowing an emphasis on difficult claims resolutions. If previous meetings have not involved your carrier, consider including them. They can provide additional knowledge and experience, even on claims that are not necessarily near their coverage layer. Their expertise can also identify patterns they might have seen with previous clients, offering a collaborative approach to resolving complex claims.