Project Management & Workflow Flashcards

When an adjuster receives a high-volume catastrophe assignment, what is the FIRST workflow step?

Answer: Triage incoming claims by severity and coverage type

Triage allows adjusters to prioritize critical losses and allocate time efficiently during catastrophe events.

Which project management technique helps an adjuster visualize overlapping tasks and deadlines across multiple open claims?

Answer: Gantt chart

A Gantt chart displays tasks on a timeline, making it easy to see parallel activities and key deadlines.

An adjuster's investigation reveals a potential subrogation opportunity. What workflow action should follow immediately?

Answer: Preserve evidence and document the third-party liability basis

Early evidence preservation protects the insurer's right to recover from liable third parties.

Under California claims regulations, what is the maximum number of days an insurer has to acknowledge receipt of a claim?

Answer: 15 days

California Insurance Code regulations require acknowledgment of a claim within 15 days of receipt.

An adjuster manages 60 open claims. Which metric best indicates that the workload is unmanageable?

Answer: Average claim age exceeds 45 days

Excessive average claim age signals that files are aging beyond acceptable resolution windows, indicating overload.

What does 'round-tripping' refer to in claims workflow management?

Answer: Sending a claim back and forth between departments without resolution

Round-tripping wastes time and resources; workflow design should minimize unnecessary handoffs.

Which of the following best describes a 'closed with payment' versus a 'closed without payment' claim disposition?

Answer: Closed with payment means the claim was settled; closed without payment means no covered loss was found

These two dispositions are standard workflow outcomes distinguishing covered losses from non-covered or invalid claims.