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“Summer’s Here And I’m For That” With 2 Ideas To Improve Your Claims Operations

Don’t Let The Hazy Lazy Days Of Summer Prevent You From Making Some Real Improvements

Let’s face it, no one wants to work in the summer. It is OK you can admit it. Vacations are being taken and it’s just not that easy to get work done. People are away and it’s harder to schedule meetings and get calls returned. Offices receive less claims and courts close down often resulting in a small chance to catch up with the work piling up.

Because of this, summer can also be a great time to look inward and focus on refining your organization.  Last year I wrote about 3 Suggestions To Beat The Summer Slow Down In Claims.  In that article I suggested ways for Claim Handlers, Managers and Claims Executives to productively use summer slow downs to improve operations.  Those suggestions still hold true and can be a valuable way to improve your group.

This year, 2 ideas come to mind as a way to put your organization in the right position to improve quality and productivity long past the summer.

Improve Your Claim Review Process

Are you conducting internal or external claims audits?  If not, then you really need to consider them.  As W. Edwards Deming, famed management consultant said, “you can only expect what you inspect”. If you are not inspecting then you really have no way of predicting quality or productivity and your results will most certainly vary or deteriorate. In order to plan, to stay ahead of the curve, and to be competitive, you must conduct regular claim file reviews to check for quality and ensure expectations are being met.

Doing reviews are a good thing as long as they go beyond the need to dot an “I” or cross a “T”.  Audits are a great way to see what is is going on and make improvements.  Successful reviews are looked at as a positive, not negative, event and are always done in an organized consistent manner.

If you are doing reviews then how would you answer these questions:

  • Do you have a process in place for conducting reviews?
  • Are you getting any value from these reviews or are they just another requirement that needs to be done?
  • Are you producing consistent reports from review to review or are all reviews different?
  • Are you able to look at data in different ways, or are you just receiving what is provided in an anecdotal narrative report?
  • How long does it take you to produce a report?
  • Can you provide immediate feedback, or does it take time to produce results?

Reviews can have such value when done in an organized consistent fashion.  Take a look at your review process and ask yourself the questions above.  It may be time to put an audit process in place and build more structure around your claim reviews.

Improve your process by establishing best practices which includes information on file selection, review criteria and an easily defined rating system. Get the most out of your reviews by collecting data not just commentary. It’s 2011 and it’s time to get away from the handwritten forms for conducting a review. Data is key and using a system like The Audit Portal™ will create a structure around the review and provide information not previously available.

Conduct A Workflow Audit

I have often referred to Seth Godin who writes a wonderful blog on leadership,  marketing, change and productivity. In a recent post, Seth described  conducting a Workflow Audit.  In it he wrote:

Go find a geek. Someone who understands gmail, Outlook, Excel and other basic tools.

Pay her to sit next to you for an hour and watch you work.

Then say, “tell me five ways I can save an hour a day.”

Whatever you need to pay for this service, it will pay for itself in a week.

I think this is one of the best ideas I have heard in a long time that would go a long way to saving time and money.  I cannot tell you how many times I would sit in a room with a colleague watching them struggle with the most basic Excel or Word skills. There is so much power in the basic tools and people are only using a small percentage of features making their jobs more difficult.  Have you ever had to reformat the work of another person because they didn’t know how to indent a paragraph and used the space bar instead?  Enough said.

This type of workflow audit does not have to be limited to the “office” suite of tools either. Let your best claims processor go around and sit and watch how other claims handlers use the system. I bet you will find that there are hours being wasted because of inefficient use of your systems.

What Are Your Summer Improvement Plans?

Posted in Best Practices, SPOT on Issues.

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One Response

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  1. Mark Daoust says

    Very interesting article … as W. Edwards Deming would note, the claim review process is where you “gather your data”. A review is retrospective in nature and in its basic application is a form of inspection … To achieve “excellence in operational management” we must take that retrospective data, analyze it and successfully use it to improve our systems, processes and outcomes … How you analyze the data is the key … The Deming Method provides a road map to move from compliance auditing to “excellence in operational management”.

    For an introduction to the Deming Method see:

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