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Put empathy to work in managing workplace DI claims

Jim McGovern

Although I come from a humble background, I know many people have had a more difficult walk than me, so I take seriously the blessing of leading a business line that goes to the very heart of securing the financial future for so many working Americans, at all income levels.

(Editor’s note: Author Jim McGovern is SVP, Employee Benefits at OneAmerica.)

In the employee benefits world, policyholders count on what we do for paycheck protection ─ to ensure they can maintain their standard of living for themselves and on behalf of their families.

While eliminating frustrating and needless aggravations is the surest way to go about demonstrating this mindset (an example would be getting the customer’s bill correct the first time) and is your greatest opportunity to keep the customer and win more business from our broker, I’d argue there’s a more foundational philosophy you need to adhere to. On a larger scale, empathy – difficult to quantify or measure – is even more worthwhile as an opportunity.

Jim McGovern
Jim McGovern

I’ve pooled together some guidance, having talked with disability claims front-liners who live out these values each day – an associate in operations, a long-term disability claims examiner, and a veteran short-term disability analyst.

Empathy starts with your own team. Your staff or support personnel are essential to your journey; you can’t do it without them.

Treat policyholders like people. There’s a point in which someone who has for years reliably “paid in” via payroll deduction. When they least expect it, they are a “pay out.” Because of the suddenness of an injury, nobody expects to go out on disability. Claims team members understand that the process can be confusing for them.

Remember: If someone is upset, you acknowledge that and just listen. A claimant could be you, your mother, or your sister.

Know your stuff. It takes special people to work with disability claimants. When people file a disability claim, they’re scared. They might be in an emotional state when they call. That’s why every one of your hires should go through hours of empathy and compassion training.

One claims operations professional where I work tells me: “Listening can make or break where a claim goes. We ask claimants to tell us what’s going on in their own words. We also listen for cues. Sometimes what people aren’t saying is just as important as what they do say.”

For example, the sound of children in the background might trigger a query about childcare needs and Employee Assistance Program benefits. On top of that, claims examiners must know each policy. They have to understand finance, know what to investigate and have good customer service and all-around people skills. They need to be timely and accurate. Working in claims isn’t just a job; it’s a career.

Be honest and fair. When you’re serving claimants, honesty works best, one of our short-term disability analysts told me. Sometimes, her honest approach leads this analyst to advocate for claimants. When you build a relationship with claimants, you understand their circumstances, which leads to a high level of service, she explained.

“I recently had a claim where I wasn’t in agreement with the medical staff, so I asked them to look at the case more carefully,” the analyst told me. “We have to feel good about our decisions.”

Honesty extends to keeping claimants informed of potential outcomes, whatever they may be, and don’t make promises that you can’t keep. Our analyst has received thank-you notes from customers even after delivering difficult messages. When you care, listen, and call people back, you get peace of mind. If the determination is approval, that’s great, you can help manage their claim. If the news is not so good, they understand why: It’s a provision in the policy.

Do that, and you might not ever have to process a claim where a person feels upset because they didn’t understand why your company did what we did. They get it.

View each claim as unique. One of the most difficult aspects of managing claims is the fact that every policy and every claim is different. You can have two people with the same disabling condition, but their policies might be night-and-day or their treatment could be totally different.

There are no shortcuts to providing exceptional customer service. It takes time, whether it’s that extra step reviewing records or just talking to a person. Where I work, we don’t read off a set of pat answers like it’s a script. Claimants may not always like the final decision, but they do like the way they’re treated throughout the process.

Work as a team. One surprising aspect of claims management is the degree of teamwork involved. It really takes a partnership. Claimants, medical professionals, employers, intake specialists, benefit assistants, claim examiners, vocational consultants, Social Security advocates and even brokers play a part in ensuring each claim gets processed the right way at the right time.

For our claims team, teamwork and compassion come together to consistently serve customers. “We all have an eclectic background, and although we each have an individual job and manage our own set of claims, we are very much a team – from the claims professionals to the clinicians and vocational staff,” says our claims operations director. “We want to make sure every determination is the right one.

Our real power is realized together, not in silos. Mother Teresa expresses it best as, “I can do things you cannot, you can do things I cannot; together we can do great things.”

And compassionate claims are a great thing to strive for.

Jim McGovern is senior vice president, Employee Benefits at Indianapolis-based OneAmerica.



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