Claims management has always been a combination of art and science. The science part tends to be fairly easy to understand, at least at a conceptual level. After all, insurers base a great many of their decisions on statistics and probability.
They search for anomalies, applying filters to discern which conditions fall outside of acceptable boundaries. If something unexpected turns up, they flag it for follow-up.
The art of claims management is quite a different story, though. What makes a great claims professional is his or her ability to read through detailed accident reports, medical notes and legal documents to determine which elements are meaningful and which ones simply constitute background noise.
In many respects, the claims professional’s role is to take in very large amounts of analog information and distill it into a form that can be understood through a more analytical, scientific lens.
This is difficult enough, just on the face of it. It calls for an understanding of medical terminology and practice and legalese and the ability to decipher accident and medical reports. And it requires a knack for retaining and synthesizing information from multiple sources.