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CSR SPR CRITERIA - FILE MAINTENANCE

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mcvonbraun's version from 2015-06-17 21:49

Section 1

Question Answer
SUPERVISOR INVOLVEMENT
What does this subcategory measure?The supervisor's direct involvement in the case and their influence on the file handler's final work product.
What does failure to give needed direction initially or at any other supervisory review result in? This will downgrade the category if the reviewer thinks that direction was needed to place the file back on track.
How should the reviewer evaluate the claim file? As prompted by the Timed Reserve Review
What other questions should the reviewer ask?1. Did the supervisor provide incorrect information and/or instructions?
2. Was the Timed Reserve Review completed accurately and timely?
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Section 2

Question Answer
WORKPLAN MAINTENANCE
What are the questions the reviewer should ask regarding this category?1. As Atlas acitivties is a critical component of effective file handling - was it used and updated properly?
2. Are there appropriate entries that address the status of the claim, or any outstanding issues?
3. If there were any misrouted documents, how were they handled?
4. Was the activity worked proactively and at appropriate intervals?
5. Were there inappropriate gaps in handling?
How should CSR level file diaries be handled compared to other claims levels?CSR level files should have a tighter diary when compared to other claims levels due to their shorter case life (days versus months).
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Section 3

Question Answer
CSR LACK OF INTEREST HANDLING GUIDELINES
What are the objectives of this section?CSRs will follow standardized handlign for follow-up on pending activities in an effort to reduce unnecessary phone calls.
What are examples of pending activities under which the CSR Lack of Interest Handling Guidelines apply (including but not limited to)?1. VNI/VNM/VNP
2. Rule out car seats
3. Scheduling repair appointments
4. First contact
5. Rule out treatment for injuries
ATTEMPT 1 GUIDELINES
When should the first attempt to reach a customer follow-up be made?As soon as possible after the loss is reported to GEICO. If after hours, the CSR should attempt contact the next day.
What actions should be made on attempt 1?1. Call all numbers on file for the customer and leave a detailed message asking the customer to contact GEICO regarding the additional information needed.
2. Email NEED GENERAL CONTACT LETTER or FREEFORM LETTER with specifics
3. If no email address on file, send regular mail
4. Change Workplan Activity Title to: PEND - (ITEM NEEDED) ATTEMPT 1
Note: when documenting the voicemail in call driver, CSR will document which attempt they are completing in call driver.
Note: it's possible that the CSR will be pending items from multiple parties on one claim. In that situation, the workplan activity title should be as follows: PEND - CLMT (ITEM NEEDED) ATTEMPT 1/ INSD (ITEM NEEDED) ATTEMPT 1
ATTEMPT 2 GUIDELINES
What is the procedure for attempt 2?Call all numbers on file for the customer and leave a message indicating GEICO will make no further attempts to reach them for the needed information. Remove workplan activity if nothing further is needed. Set HC in certain circumstances. Send PD SOL or BI SOL if warranted (state specific)
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Section 4

Question Answer
DOCUMENTATION
What questions should the reviewer look for regarding documentation?1. Were customer contacts and actions properly documented in Notes?
2. Are the notes logical and concise?
3. Are the notes appropriate in content and professional?
4. If double insured loss, are notes documentations proper?
5. In the event of a companion claim, if the file documentation independent and respective for each claim file?
6. Was accurate and complete information entered into Atlas?
7. Was the information updated timely?
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Section 5

Question Answer
KEYING QUALITY
What questions should the reviewer look for regarding keying quality?1. Was accurate and complete information entered into Parties Involved? Was it updated timely?
2. Was the correct loss description code/type of loss used?
3. If the investigation revealed a different loss description, was the code updated timely and correctly?
4. Was the negligence indicator appropriate?
5. For long form FNOL, were interested parties added appropriately, including unknown IPs? Even non-vehicle interested parties (except concrete items) that did not sustain damage should be added.
5. Was the correct % negligence keyed?
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Section 6

Question Answer
FILE MAINTENANCE CRITICAL ERRORS
What are the file maintenance critical errors?1. Failure to follow supervisor instructions
2. Supervisor involvement lacking
3. Improper notes documentation
4. Incorrect LDC
5. No/Incorrect % negligence
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