Data Science & Claims Handling - Claims Tips over Jazz & Coffee

Moments of re-discovery, are often moments of catalyst I find, so back towards the end of my career as a claims handler, while it was often vastly misunderstood as to my methods, the first thing I would do at the start of my shift, was sit down, and analyse the entire spread of data that was relevant to my department for the day.

Most people, simply obtain their list of data, and then dive into it, and go top to bottom, or bottom to top, or working as a team, some strategy variation thereof, which, is great, it’s a strategy and it’s a method of teamwork and it is certainly better than just plodding along.

However for myself, probably due to the tenure of time I was in the industry, as you can imagine, being exposed to so many different scenarios, competitions, methods, management ideas, to say nothing of materials I was exposed to in my own personal life, as one can imagine you develop the ability, or drive, to think about things in a different way.

More or less, while I was doing market data analysis, the concept, behind my day-to-day work modality you could almost argue was entry level data science to be perfectly honest.

Now, in my personal life, I am trying to essentially apply, that method, to me new business plans, since my first business failed, which is fine, happens to most people I am of the understanding statistically, but what you give up? Of course not, frankly, I know to much now to go back to any of those kind of roles and if I am going to achieve at least half the things I set out to do, I’m going to need time, which I wont have, if I am stuck in an office 9 – 5, 5 days a week now will I ? pretty logical.

Anyway, lets give you the good stuff, shall we? Perhaps you can improve on it.

So, if you are a claims handler, what I always did, is you first analyse the entire spread of data, and you leave notes, personal comment notes, essentially noting what needs to be done to convert the file, or finalize the case to the next part of the process, whatever it happens to be.

Now, the challenge you will face, if you are a new claims handler, is that the easiest way I can say it, is if you actually need to ask your Team Leader or Senior a question, this method wont work for you, you wont know enough.

When I was in the industry I used a software product called Proclaim, which, has a function called quick, view, without going into any specific details, because the individual nuances would most likely not be relevant to you, I would look at, the liability screen, and quickly consider

• Do we have an insurance company listed?
• Do we have the name of the TP
• Do we have the address? If no, what state is it
  o Do we have the Rego? – if you have the rego, you can obtain addresses with paid mercantile services in certain states of Australia

All this calculation, you need to do, in about 1 second.

Then, you flip backwards, to the Accident type, eyeball It, the loss location, and description, you need to be able to instantly, look at an accident description, and more or less instantly, or in a very short amount of time, be able to know, based on experience, what outcome, the insurer should, determine, if they follow standard practice, meaning, you will know, what they are going to do, long before they even do it, and you need to be as close, to 100% accuracy on that decision, and you need to be able to do that, at a glance, or, after a very short, brief read, and when I say brief, I mean, like, under 20 seconds.

Then, you look at the Client screen, which, for the most part, is all mainly irrelevant to whether the claim is GTG or not to be honest, as the logistics department could always sort that out directly with the customer, and likewise, you probably have other departments that can sort that out, if its your clients details, essentially, don’t miss a sales opportunity simply because you were missing some arbitrary piece of information, yes on the one hand, by the by, your Senior or Team Leader are going to be obligated to give you feedback or something on it, but its like, ok, I didn’t get the email address, but I also made you 5k, what do you want from me manager guy ?

And you do that enough, trust me, thinking outside the box, you start to accumulate your stats very quickly, I think I might actually have an old template about it actually.

But yeah, I would put on some music, whatever the mood was I was in at the time, or the energy I felt I needed for the situation I was in, as we all know, some days are chill, other days are pretty full on, do data science on the segment of data, you “snipe” the easy wins along the way, then, you do the intermediate ones, and yeah, you leave the hard ones for last.

I know some people have that mentality of “eat the toad” which is like, do the hard stuff first, personally? In my experience I have found that to be not efficient to flow, because, you get tilted, get off balance, end up in a bad mood, and at least in a claims department sense, you end up in a situation which is metaphorically like tripping over at the start of a race yeah? Sure, you can catch up, but it’s a lot harder.

Now, this does require a lot of pre-requisite knowledge, quite a considerable amount, and the people that teach you that, are your “enemy” so your managers, are going to try and install this us and them mentality in you, total nonsense in my opinion, and I will tell you why.

The Insurance Company, is not, the enemy of credit hire, nor are they the bad guy, in fact, if you actually zoom all the way out for a moment and think about it, they are the ones that pay you, because they are the ones that you recover from don’t you? So if they didn’t exist, you wouldn’t exist, because you would have no one to litigate.

Which as an amusing aside I always then philosophically considered, that there for means, that the entire multi billion dollar industry that motor insurance is, and all the good work that comes, from the money earnt and paid in wages, pretty much just all boils down to people making mistakes yeah? Or just like “having a moment” which is pretty deep if you think about it.

Anyway so yeah if, I not only did this on my own work, I also did this on everyone elses work, and then, when I was done, I would do it on the rest of the departments work, and then I would be officially off the clock, because I finished at 6:00pm, and then that’s when the fun really started, would hit up our UK Team Manager (great team and manager by the way) ask for a refreshed list, and now this is great, coz now theirs no rules right? Coz im off the clock, can basically do whatever I want, so yeah, would have a drink, have a smoke, listen to music, watch television, and just basically work until I was either bored, or, I felt there was no ROI for the day in continuing, wrap up with your final drink, have a smoke, say goodnight to UK team, or the “Claims Minister” as I called her, and then yeah, wakeup and do it all over again.

Yeah … sometimes I was late logging in, but you know, when your doing that level of work, and analysis, its kind of like? Seriously? Your gonna pick hairs about a dude logging in 5 – 10 minutes late after that level of workload output? Of course not, then they are just going to start resenting workplace conditions and start looking elsewhere, and then all the training and knowledge they learnt under your tenure now end up coming back against your own market share, which is just a daft decision, you treat people well, the last thing honestly you ever want to do is have them leave your company, pay them well, look after them well, invest in them well.

But yeah, that’s how you used applied data analytics to do planning segmentation, increase your efficiency and increases your stats, and the smarter you are, the more you know, the more you learn from the insurers, the more over time, you will know, what outcome they are going to determine, because you have literally had a chat with them about it like a billion times at a certain point, and this is why, I consider them my friends, in my career trust me, the insurers were the people who were nice to me, the people I worked with, very rarely, approached me at all, I went years, and years, without anyone even stopping to talk to me, or come and see me, aside from a fine gentleman from Shanghai, and a funny fellow from Cookie Mountain.

It eventually reached a point where it was like, hmmm, these insurers have deep and meaningful intellectual conversations about legal matters, and, everyone around me, is talking about … well, not that I assure you, in fact I would not even know, because they never would speak with me.

And of course you cant get up and go and speak to others can you? Because, you need to be working, and if you get up, your team leader is going to instantly observe this behaviour and think “why is that person not working” so you might get in trouble yeah? Ipso facto, it was never an option, for me to get up and walk around and talk to people face to face, your team leader may reprimand you, or your manager, and that could affect your livelihood, which then has knock on ramifications, so you learn ways to get around it, and rapport building with insurers, it teaches you things, they teach you, by kicking your ass, or, either having their tail kicked, but yeah, don’t be gruff with them, truly, bit of diplomacy goes a long way.

I always used to say, those times when you go full on teeth over something trivial, sure you win today, but then like, that person remembers, and then next however any claims, locks it up on you, or maybe they get promoted and then come back to really mess you about somehow, or, instead, your nice, when you can be nice, firm, but nice, watch the difference you get on your recovery and watch your debtor days come down rapidly, as suddenly, they want to actually talk to you when your POL lands in their inbox, as opposed to hmmm, lets put that at the bottom of the list coz I don’t like that guy.

Anyway, I best get on with my day, hope that helps you all out there in Claims land, no matter whether you’re on the claimant or defendant side of the fence, was listening to Medeski, Martin & Wood – Tonic, sipping a coffee and smoking a cigarette while writing this, feeling a bit Jazzy this morning.

Written by Kashmir_Z