Soft Skills of a Good Claim Manager

SOFT SKILLS ARE WHAT MAKES A FIRST-RATE DISABILITY CASE MANAGER.

“I am very happy with the way my claim has been handled!” As an outside
consultant who gets it straight from the claimant’s mouth, I often hear many comments
like this about the people who are making the decisions on their claims. One interesting
aspect of my job as a Field Representative is that I deal with many different adjudicators
from various companies. Not only do I get some perspective on the adjudicators’ habits
and abilities myself, I also quite frequently get unsolicited comments and feedback from
the claimants. These comments are mostly positive ones.

Negative comments (which I really don’t want to dwell upon) are usually as a
result of poor contact and communication with the claimant. I often note that the
simplest of actions can make such a difference on relationships with case managers
and claimants with very little extra effort. Even if the decision about the claim itself
might be disappointing, claimants will at least understand the decision and accept it
even if they don’t like it. They respect the person and organization they represent and
understand why a decision is made. Generally (and there are always exceptions),
above average communication and communication skills with claimants render good
relationships, less adversarial situations and therefore less litigation. Little things like
picking up the phone and keeping claimants up to date on the progress of their claim,
goes a very long way especially if the decision is delayed for any reason. Doing phone
interviews may seem like extra work however, it is proven repeatedly that doing a little
bit of extra work initially will ultimately mean successful closure rates, better early
intervention and return to work success and less legal costs.

When contemplating this article, I wanted to solicit a few expert opinions from
colleagues I respect and admire in the Life and Health world. I began by asking them
what they felt were the best qualities of what makes a good claims case manager. I
didn’t want the usual jargon on formal education, past work experience and grammar
skills, but I wanted the personality traits and characteristics of successful case
managers. I wanted that “sixth sense” such experts have and what makes them
successful.

I asked this long winded question to Roula Sahyoun who I used to work with at
Unum Canada in the mid 1990’s and who is now at Munich Reinsurance, and Marg
Browne, Manager of Living Benefits Claims at Manulife Financial. When discussing this
with Roula, she noted that these qualities were the “Soft Skills” of a successful case
manager. On that premise, both Marg and Roula gave me what they thought made up
these qualities.

Marg has been a manager with Manulife for 12 years and has worked with many adjudicators
in a supervisory role. She also has over 20 years experience in the claims
business having handled her own block of claims for her first 8 years in the industry.
During my phone interview with Marg, she provided her take on these “soft Skills”:

“You want to be the nicest person you ever meet with a strong ability to say no!
The best adjudicators don’t necessarily need to have a lot of formal education. What I
like are people who have street smarts. I would prefer to have a street smarts person
over someone with only a formal education. I can teach the adjudicator formal skills like
understanding policies, medical information and accounting details, but I can’t teach
them insight and common sense.

I am looking for someone who has the ability to deal with the general public and
cope with all types of people and their personalities. The characteristics that make up a
good police officer are also common with the characteristics that make a good case
manager. They need to be compassionate at times, as well as inquisitive and have an
ability to ask themselves, “Does this make sense?” I want someone who has insight
about whether someone is telling the truth or not. It also doesn’t hurt to have a bit of a
mean streak!

As far as the formal qualities, I can teach them medical issues and we have in
house medical consultants as well. I can teach them about policy provisions
contractually and we have a team of lawyers to help if needed. I can teach them about
financial issues using our accounting consultants. But I cannot teach them insight and
common sense. The ability to look at a file and claim and recognize that something
might just not make sense or is not right. We have resources in place for the formal
things but not for the soft skills.

As a manager, I would encourage all adjudicators to always use fairness in
claims adjudication. Understand what it is like to be in their shoes (the claimants). Most
of the claimants you deal with don’t know or understand this process…”

MARG BROWNE
Manager Living Benefits Claims
Manulife Financial

Further to Marg sharing her thoughts on the subject, I had the opportunity to
speak with Roula, who provided her perspective Roula joined Munich Re in January
1998. Her responsibilities include overseeing a team of Account Managers and Claims
Litigation Director, performing regular claims reviews, producing analytical reports &
recommendations, consultation services and relationship management. Roula brings
20 years of experience in disability claims management.

Here is what she wrote:

Disability Claim Specialist’s Key Soft Skills

“* Self-awareness: maturity, understanding who you are, why you do things a certain
way, how you reach decisions and choices…
* Creativity, positivity
* Action and goal orientation
* Excellent communication (written and verbal)
* Critical thinking and negotiation skills
* Strong analytical skills and attention to detail and accuracy
* Sound prioritizing skills to deal with evolving tasks
* Drive for results with successful collaborations and team work
* Insight/Perception, Empathy
* Conciliation: non-confrontational, non-provocative
* Decision-maker
* Proactive leadership that can balance multiple stakeholder demands and energize the
team
* Return on investment mindset and bottom line focus

As the saying goes:
“Experience is inevitable, learning is not”
Rather than rely just on years of experience, a focus on soft skills is important. A
learning mindset and a thirst to always think critically but with empathy may be the
unique ingredients that make up the successful Disability Claims Specialist.”

ROULA SAHYOUN
Assistant Vice President, Disability Claims
Munich Reinsurance
Toronto, Ont.

I note a lot of common characteristics in both of these well respected individuals’
comments when offering what they feel are the “Soft Skills” of a good case manager.
As far as my observations, I couldn’t agree more! I am hopeful that these insights might
help you as you continue to manage claims in what can be challenging circumstances.
I welcome your comments, feedback and encourage you to send in any suggestions
you might have about the article or the position itself.