Group Captive Program
This Captive program was rapidly expanding during extremely soft market conditions. They had developed an impressive safety and loss control program, and the policyholders were pleased. But the Captive was facing challenges in one area–claim administration. They had partnered with a large national third-party administrator (TPA) to provide these services. And initially, they were thrilled with the capabilities that TPA had to offer. However, they quickly realized that the TPA suffered from staggering levels of employee turnover. In fact, the primary adjuster dedicated to their business changed four times within the first year. Not surprisingly, poor claim handling and general neglect of claim files led to rapid deterioration in the Captive results.
The program manager decided it was time to transition their claims away from the TPA, and contacted their fronting for a list of approved TPAs. They soon turned to Athens, and we agreed to take on the clean-up project, as well as ongoing claim administration for the program.
Because we knew the claims we were about to inherit would be in poor condition, our first step was to bring together a powerhouse team. We then moved forward with a formal action plan, assuring that no time was lost during the program transition. We immediately attacked the files, assessing each individual claim. Major areas the team examined during the takeover initiative included:
As the takeover initiative progressed, we also began converting all of the legacy paper claim files into digital files. Once in place, the paperless system allowed for greater day-to-day efficiencies in claims handling.
In addition to attacking the takeover claims, we also established definitive claim-handling guidelines and communication standards to be followed by the Athens staff that would be assigned to the program. The goal: to ensure that the Captive manager was comfortable, confident and secure with how their program was being managed.
The program has experienced a number of positive outcomes since the transition: