Managerial Authority, Turnover Intention and Medical Insurance Claims Adjusters’ Recommendations for Claim Payments

Although it is acknowledged that the final decision of whether to accept or reject a medical claim application is determined by medical insurance claims adjusters, very little research on insurance fraud has considered the factors that contribute to the unjustified claim decisions made by these professionals. The purpose of this study is to examine the impacts of managerial authority and moral intensity on medical insurance claims adjusters’ decision-making in the claims handling process. Whether or not a medical insurance claims adjuster with higher turnover intention will propose more lenient recommendations for claim payments is also addressed. The research hypotheses were tested by using a survey. One hundred and thirty full-time Taiwanese medical insurance claims adjusters participated in the investigation. The results show that managerial authority is the strongest predictor of the medical insurance claims adjusters’ final recommendation for insurance claim payment.