Service Provider Performance Evaluation - WC Claims Consultant
    Please rate the effectiveness of service provided by the contractor listed below. If you have no opinion, or do not recall using or receiving the service, indicate not applicable (N/A).
 
1.
Contractor Company:
2.
Contact Person:
3.
Contract Anniversary:
4.
Service Provided to SELF:
       
    Activity Rating
      Poor -- 1 -- 2 -- 3 -- 4 -- 5 -- N/A -- Excellent
    CONTRACT TASKS  
5.
Evaluate claim reserves, including on-site reviews of claims when directed by the Executive Director.
 1   2   3   4   5   N/A  
6.
Prepare written report of evaluations.
 1   2   3   4   5   N/A
7.
Report findings to the SELF Board and make recommendations to protect SELF’s interests. Prepare written reports to SELF on rate, coverage or insurance carrier related issues.
 1   2   3   4   5   N/A
       
    COMMUNICATION  
8.
Ability to communicate thoughts and ideas orally and in written form, and have them understood by others; ability to carefully listen, observe, understand and respond to what is communicated by others; skill in preparing written documents in a thorough and professional manner; skill in preparing, articulating and presenting material in a public meeting.
 1   2   3   4   5   N/A
       
    INTERPERSONAL SKILLS  
9.
Ability to deal with people; skill in maintaining cooperative, friendly relations with the Board and members; skill in handling conflict and confrontation; skill in inspiring confidence in others.
 1   2   3   4   5   N/A
       
    FOLLOW THROUGH  
10.
Ability to not just accomplish goals and objectives as stated, but to provide additional value for members.
 1   2   3   4   5   N/A
       
11.
Specific examples or comments: