Claims Administration
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"Service to others is the rent you pay for your room here on earth."  -Mohammed Ali

cqiclmsadm.jpg (19201 bytes)ClaimQuest was formed in July 1995 to provide an exceptional full service claims administration program to clients desiring a top quality program. Service is limited to Workers’ Compensation, General Liability, Automobile Liability, and Product Liability programs, with the emphasis being on self-insured organizations.

 

 

1. Philosophy. ClaimQuest has developed a philosophy that guides our conduct in everything we do. The following text describes this philosophy which has been segmented into four separate categories:

Integrity and Ethics.

Communication.

Responsibility.

Spirit and Attitude.

 

Integrity and Ethics.

 

ClaimQuest will maintain the highest level of integrity and ethics, based not only on the legalities of an issue, but right and wrong.

We will always put ourselves in the other person’s shoes, treating them as we would want to be treated.

Our verbal statements are commitments, and will be treated as if they were written contracts.

Our honesty with our co-workers, clients, vendors, and above all ourselves, will strengthen our integrity. If we have erred, we will admit it, taking quick corrective action without cost to others.

 

Communication.

 

We foster and promote open and honest communication within our company structure and urge clients to treat ClaimQuest as an extension of their organization.

Communication is more than relaying information to others; it requires the ability and desire to listen and understand what others are conveying. We must always be willing to actively listen and understand the needs of others, and not make assumptions.

We will always encourage our clients to contact us regarding any issue or concern, so it may be resolved expediently.

If we disagree with the opinions of others, we will always explain our position in a calm and positive manner, without criticizing the other person’s position.

We must always keep in mind that everyone has valid and important information to contribute, regardless of the position held.

 

Responsibility.

 

We accept responsibility for completing our duties in a timely and accurate manner, putting forth our best effort at all times.

We, as individuals, are willing to accept any additional responsibility for tasks and commitments that fall outside our immediate scope of responsibility, when the responsible person is unavailable; thus assuring each task or commitment is properly fulfilled.

Everyone is expected to give their complete attention to their duties while on the job, and is encouraged to excel in their position.

ClaimQuest will recognize and/or reward those who do excel, assisting all who put forth their best effort in an attempt to improve their contribution to the company.

 

Spirit and Attitude.

 

ClaimQuest is committed to promoting a positive image and attitude in everything we do for our clients, co-workers and community.

We will offer the best possible working environment. This commitment not only encompasses the physical necessities for optimum employee comfort, but a relaxed and productive atmosphere conducive to promoting camaraderie and loyalty.

We will offer the opportunity to grow professionally, without limit

Our relationship with each client shall serve to enhance their image and reputation.

Everyone at ClaimQuest is encouraged to make a positive contribution to the community, and will be supported by ClaimQuest in all such efforts.

 

2. Goals. ClaimQuest has developed a set of goals that provide a general statement of our commitment to high service levels, and the attainment of client expectations. These goals are outlined below:

Superior Service. ClaimQuest will provide a level of service that exceeds the level the client could obtain from their own internal staff, or from any other Third Party Administrator. We must never lose a client because they did not receive the expected level of service.

We will always be conscious of the need to effectively communicate with each client, listening to and understanding their concerns, needs and goals.

ClaimQuest shall provide a depth and breadth of claims administration service that cannot be matched by other Third Party Administrators. The approach we have developed is Total Claims Management (TCM).

The ClaimQuest Partnership approach enables us to maintain long term business relationships. Together with each client we will meet all risk management objectives.

 Program Cost Containment. Controlling and minimizing the overall costs of each client’s claims program, on both a short and long term basis will involve the following:

TCM is a proactive program, implemented and operated by the client and ClaimQuest together.

TCM includes prompt three point contact, prompt and effective investigation, quality managed care, early return to work, aggressive litigation control, medical bill review, prompt and accurate benefit payment, and loss prevention analysis.

Analysis of loss data, with corresponding recommendations, will permit each client to take proactive Safety program steps to improve their work environment, and in turn reduce loss frequency and severity.

 3. Objectives. ClaimQuest has developed a set of objectives that provide a detailed statement of the particular tasks that comprise the essence of quality service. This is not an exhaustive list, but represents the basic elements of an effective administration program. It does, however, set the tenor of what shall be done in all areas of administration.

Additional information about the service objectives will be found in the ClaimQuest Procedure Manual, which outlines in further detail the steps that will be taken in order to achieve the required results.

Establish prompt contact with the injured worker, relieving him/her of any anxiety, thus reducing the possibility of litigation.

Timely contact the employer verifying the reported facts, to eliminate any possibility of incorrect information.

Prompt contact with the medical provider, clarifying the medical status and needs of the injured worker.

Rapidly conduct and complete the required investigation to resolve any pending AOE/COE issues.

Coordinate the services of Quality Medical Specialists to insure proper medical care.

Focus on early Return to Work or Modified Work with the client, so the injured worker can remain productive.

Review all medical expenses for reasonableness, adjusting any inappropriate or excessive charges.

Controlling Counsel’s involvement in the handling of all cases, by reaching an action plan with Counsel on the services required.

Review all litigation expenses, insuring that billing is reflective of services provided, and services requested.

Provide loss analysis information and recommendations that will permit each client to take proactive steps to improve their work environment, reducing claims frequency and severity.

Provide timely and accurate benefit payments, while avoiding over payments and penalties.

Assist each client in developing and/or improving their claims program.

Assist each client in training their management staff with the proper reporting and handling of an injured worker.

Assist the client by training their management staff how to evaluate and interpret the various management information reports they receive.

For additional information on ClaimQuest's claims administration services, please call our sales staff at 909.594.9400.

 

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