Presentation is loading. Please wait.

Presentation is loading. Please wait.

TMK1536 011211Agent training only. Not for sales use. Claims Dawn Mitchell Senior Vice President Policy Benefits TMK1536 011211Agent training only. Not.

Similar presentations


Presentation on theme: "TMK1536 011211Agent training only. Not for sales use. Claims Dawn Mitchell Senior Vice President Policy Benefits TMK1536 011211Agent training only. Not."— Presentation transcript:

1 TMK1536 011211Agent training only. Not for sales use. Claims Dawn Mitchell Senior Vice President Policy Benefits TMK1536 011211Agent training only. Not for sales use.

2 TMK1536 011211Agent training only. Not for sales use. Claims Policy Benefits Overview Liberty cancer/critical illness/other health claims statistics Liberty life claims statistics Resources for Claims Questions Procedure for Claims Inquiries Branch Manager/Agent Involvement in Claim What you should not do How you can assist the claimant

3 TMK1536 011211Agent training only. Not for sales use. Liberty Cancer/Critical Illness/ Other Health Claims 700 - 750 claims processed/week  Liberty Cancer claims are the most difficult of all claims to process $1+ million paid on a weekly basis for Liberty cancer/critical illness/other health claims 9 examiners dedicated to paying these claims

4 TMK1536 011211Agent training only. Not for sales use. Turnaround time for Liberty Cancer/Critical Illness/Other Health Claims 2007 turnaround – 13.9 calendar days 2008 turnaround – 8.3 calendar days 2009 turnaround - 7.5 calendar days

5 TMK1536 011211Agent training only. Not for sales use. Liberty Life Claims 700 Liberty life claims processed/week $3.5+ million paid/week for Liberty life claims In Q1 2010, 99% of Liberty life claims received were incontestable and only 1% were contestable 7 examiners process incontestable life claims 9 examiners process contestable life claims 2 medical reviewers read and summarize medical records

6 TMK1536 011211Agent training only. Not for sales use. Turnaround Time for Liberty Life Claims Turnaround time for Life includes both contestable and incontestable claims 2007 – 11.5 calendar days 2008 – 10.4 calendar days 2009 – 7.8 calendar days

7 TMK1536 011211Agent training only. Not for sales use. Resources for Claims Questions TMK1536 0510Agent training only. Not for sales use.

8 TMK1536 011211Agent training only. Not for sales use. Filing Liberty Claims Download from www.libnat.com Online Forms, Customer Servicewww.libnat.com

9 TMK1536 011211Agent training only. Not for sales use. Filing Liberty Claims Claims procedures are explained in the Agent Instruction Guide (Form 59)

10 TMK1536 011211Agent training only. Not for sales use. Procedures for Claims Inquires TMK1536 0510Agent training only. Not for sales use.

11 TMK1536 011211Agent training only. Not for sales use. Procedure for Claim Inquiries - Claimant Claimant should contact Liberty Customer Service for claim questions or status inquiries  Customer can call 205-325-4979  Customer can send written correspondence to PO Box 8080 McKinney, TX 75070-8080  Customer can inquire via email through Customer Service Express (click on “contact us” in website)

12 TMK1536 011211Agent training only. Not for sales use. Procedure for Claim Inquiries – Branch Manager/Agent Branch Manager should contact Liberty Customer Service for claim questions or status inquiries  Branch Manager can send email inquiries to custserv@libnat.com  Customer Service answers inquiries within 48 hours  If Customer Service can’t answer the question, it is forwarded to Claims Dept. through an internal messaging system (still work to meet the 48 hour turnaround)  This is best and fastest way to ensure a response

13 TMK1536 011211Agent training only. Not for sales use. Procedure for Claim Inquiries – Branch Manager/Agent Branch Manager inquiries sent to Customer Service should include  Policy number and insured name (telephone number is also helpful) Branch Manager inquiries should not be sent directly to Claims Department

14 TMK1536 011211Agent training only. Not for sales use. Procedure for Claim Inquiries One of the most common inquiries is “Have you received the information that I sent in?”  Mail or faxes are not “logged in” as received until the claim reaches an examiner  On many occasions Customer Service will tell a claimant/Branch Manager that the system doesn’t show the claim information as received (in most cases, an appropriate amount of time has not elapsed to allow the information to reach a claims examiner) which causes frustration on the part of the claimant/Agent and duplicate claims to be sent in

15 TMK1536 011211Agent training only. Not for sales use. Procedure for Claim Inquiries  The Claims Department processes claims in date received order so if our turnaround time is running 7 days, the claims information will not be logged into the system for approximately 7 days from the date the information was received by the company  The Claims Department works off of claim images instead of paper documents; need to allow adequate time for us to scan in the documents and put in a work queue for an examiner

16 TMK1536 011211Agent training only. Not for sales use. Branch Manager/Agent Involvement in Claims TMK1536 0510Agent training only. Not for sales use.

17 TMK1536 011211Agent training only. Not for sales use. Branch Manager/Agent Involvement in Claim – What you should not do !!!Branch Manager/Agent should not express an opinion on whether or not a claim will be paid!!!  Benefits will be paid according to the policy provisions Agent should not indicate to whom a claim payment will be made  There could be an assignment or other situation of which the Agent is not aware

18 TMK1536 011211Agent training only. Not for sales use. Branch Manager/Agent Involvement in Claim – What you should not do Branch Manager/Agent should not guarantee when claim payment will be made  Can set expectations when a contestable claim is involved; processing time is increased due to conducting a claims investigation.  Majority of investigations are complete within 90 days but can take longer if we don’t get cooperation from provider/facility or if insured/beneficiary does not return information requested from Claims Dept

19 TMK1536 011211Agent training only. Not for sales use. Branch Manager/Agent Involvement in Claim – What you should not do Agent should not promise a claim payment to be sent “overnight” to an insured  Claim payments sent “overnight” occur infrequently and are only sent in unusual circumstances  Once a claim is processed, the claim check is not generated until the following day; once generated (at our printing facility in OKC) the check will not be released for a couple of days (printing facility must go through their audit and balancing process)

20 TMK1536 011211Agent training only. Not for sales use. Branch Manager/Agent Involvement in Claim – What you should not do Agent and claimant should allow adequate time for an insured/beneficiary to receive a check before requesting reissue of a check  Claim Department policy is to not reissue a check for 30 days (exception exists if the check was sent to an incorrect address)

21 TMK1536 011211Agent training only. Not for sales use. Branch Manager/Agent Involvement in Claim – Assisting Claimant  Claimant/Agent can submit claim paperwork o If cancer claim, should send to PO Box 8080 McKinney, TX 75070-8080 o If life claim, should send to PO Box 8066 McKinney, TX 75070-8066

22 TMK1536 011211Agent training only. Not for sales use. Branch Manager/Agent Involvement in Claim – Assisting Claimant  Or, claim can be sent in via fax (if original documents are not required); these are the fax numbers that belong to the Claims Dept. o If cancer claim, should fax to 214-544-5336 o If life claim, should fax to 405-270-1496

23 TMK1536 011211Agent training only. Not for sales use. Branch Manager/Agent Involvement in Claim – Assisting Claimant  Never express an opinion on whether or not a claim will be paid  Track claims through custserv@libnat.com  Claim forms and procedures found on www.libnat.com


Download ppt "TMK1536 011211Agent training only. Not for sales use. Claims Dawn Mitchell Senior Vice President Policy Benefits TMK1536 011211Agent training only. Not."

Similar presentations


Ads by Google