Claims Quality Measures Up

Atlanta-based Crawford & Company introduced QOps, a quality system that objectively measures quality in the company's Risk Management Services claims files on a daily basis, the claims management solutions provider says. Traditionally, claims quality has been measured by performing full file audits on small samplings of cases per claim handler, according to Crawford & Co. QOps, however, examines each claim file.

QOps measures performance based on adjusters' progress notes in Crawford & Co.'s claims system. The system then analyzes the data and determines whether all the performance measurements are being met. Five performance indicators are reviewed for every file to ensure compliance, including initial futurity, ongoing futurity, initial contacts, initial report and status reporting. The QOps system also gauges 11 diagnostic indicators via an established threshold of acceptance for operational behaviors. For example, it looks at the percentage of files with diary messages to ensure that adjusters are using the function to manage their claims. The QOps system measures diagnostic indicators at every level of the administrative process.