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In the claims industry the word “quality” has become synonymous with the exercise of box checking. I see that as a problem. We all know that complying to basic requirements is important, but isn’t that just one aspect of quality that should be deployed and measured?

I believe that the definition of “quality” should include a combination of performance and traditional compliance measurements. That is why Sedgwick has taken a new approach to quality, called Performance 360. The primary enhancement is a shift to outcomes-focused reviews versus compliance-based audits only.

As many know, the established industry standard for compliance auditing consists of a retrospective review of claims handling activity. But in the fast-paced claims industry, to be able to effectively impact the outcome of a claim, we believe work needs to be evaluated as close as possible to when it is performed. And the right files need to be selected for team lead review.

In an industry that has not changed the definition of quality for literally decades, industry supervisors are expected to review many files regardless of the potential severity of claims, and the schedule is often based on arbitrary timeframes. Besides the obvious concerns with this random approach, another issue is that the number of audits required takes supervisors away from their primary responsibilities.

At Sedgwick, our team leads are charged with providing continuous guidance and training to our examiners, not just through the evaluation of files, but through daily interactions and coaching. And by utilizing predictive analytics our team leads can determine when to review files to drive quality outcomes versus random selection. They can also identify and employ necessary interventions to ensure our clients get the best possible outcome.

Our tiered approach targets real-time behavioral changes and ensures examiners learn from current claims so they can better impact the next life phase of the file. Sedgwick actively evaluates work processes to ensure examiners focus their energy on tasks that add the most value to our clients.

Sedgwick’s approach stresses operational speed, as well as quality. By frequently reviewing key claim segments, Sedgwick ensures a faster resolution while giving clients and ourselves the best opportunity for successful outcomes. This includes auditing via a three-tiered approach to evaluate performance in relevant claim lifecycles: initial development, mid-claim management and resolution.

I’m excited that Sedgwick has taken the initiative to check the boxes and check the outcomes too!

Darrell Brown, Chief Performance Officer

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2 Responses to Redefining quality

  1. Earnest says:

    Keep on working, great job!

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