DMA's first priority is to produce the best possible loss results for our client. We accomplish this by:
Claims Systems and Reports
DMA Claims Services uses FileHandler by JW Software. This system is web-enabled, and all your data is available to you via a web browser.
The system is very flexible and, in addition to capturing all the normal claims data, it can easily be programmed with client-specific fields to record data tailored to a specific book or type of risk. This flexibility permits the capture and accumulation of data vital to the management of an insurance program. FileHandler can also be set up in tiers to segregate data by insured, geographical area, etc.
FileHandler's standard reports are usually more than adequate, but customized reporting is also available.
We can and do use a client's system when this is desirable. With a CIO and fulltime IT staff, DMA is a strong partner in making information technology work.
Data-Driven Processes and Claims Management
To produce a superior claims result, two elements are vital:
1) Measure performance - We use metrics that measure key elements of the claims process tailored to the type of program. We utilize baseline numbers from prior years when available, to develop benchmarks which we then work to exceed. In the absence of baseline data, we use our experience on similar programs to develop the benchmarks.
2) Manage the numbers to achieve superior results. This includes weekly management reviews and reporting the metrics to the client monthly along with the specific actions being taken to improve results.
Because the metrics used are comprehensive and cover the entire claims process, with the emphasis on quality of claims handling rather than volume alone, we base compensation of Claims Reps and Managers on the results reflected in these numbers.
Limitations on Adjuster and Supervisor Work Loads
Two of the key metrics gathered, managed and reported to a client are the number of files in a Claims Rep's pending and the number of new files received. These figures monitor Claims Rep workloads and enable management to ensure overload never occurs. We establish benchmarks ("not to exceed" numbers) that will vary based on the type of claim being handled. The actual numbers are reported to our client monthly along with the rest of the performance numbers.
We also limit the workload of the Supervisors, establishing a maximum Rep to Supervisor ratio and monitoring the number of Reps he or she manages.
Claims Rep load is critical to optimum claims performance, which is why this number is so closely monitored by DMA management.
Dedicated Subrogation Unit to Maximize Client Recovery
Claims units that leave subrogation responsibility in the hands of the front line Claims Rep will leave potential recoveries in the files uncollected. Front line Reps cannot produce an acceptable level of recovery while carrying a full caseload.
Our subrogation specialists handle only recovery. They review ALL files and do not leave it to the Rep to determine if subrogation potential exists. All potential recovery is aggressively pursued, resulting in numbers higher than industry standards.
Fraud is a fact of life in all lines of insurance and there are indications that fraud networks tend to attack insurance programs that lack sufficient safeguards to detect, document and deny fraudulent claims.
DMA has for many years had a Special Investigations Unit (SIU) headed by an investigator with decades of experience. This unit operates as the Designated SIU for several national carriers (references available upon request) and is quite familiar with DOI requirements. Cases referred for prosecution over the years have resulted in excellent relationships with law enforcement.
Our SIU has access to experienced investigators in all DMA field offices across the country. In locations outside our own service areas we utilize a network of investigators with proven results.
A TPA Responsive to Client Needs
Some companies complain of finding themselves in the hands of a TPA that doesn't seem to know they exist. If their volume of claims is not large, they may not make it onto the TPA's radar screen.
DMA Claims Services has its roots in the independent adjusting business where any assignment received could be the last one you ever get from that client - if you fail to give the client the attention required and complete each and every assignment on time.
This tradition of service extends to our TPA business. We provide dedicated account managers to ensure that each client's needs are met and that optimum claims results are achieved. Our clients are very important to us.
Seven reasons why DMA will get you the best possible loss results:
For the best loss results your program is capable of producing, call the quality claims administration solution:
DMA Claims Services