Most workers compensation carriers have hundreds of business-related processes within their Claims, Policy and Billing operations. Many times, the supporting systems do not interface with each other creating additional workflows and bottlenecks. The insurance industry process includes different complex workflows combining interaction with many stakeholders including insureds, brokers, claimants, providers, internal staff and regulatory bodies.
For example, in Claims administration, these business-related processes can include: initial intake, triage, policy coverage verification, fraud assessment, case assignment, establishing reserves, employer / physician / employee contact, medical case management, wage determination, regulatory filings, payment processing, possible litigation and settlements.
For Policy administration, processes include broker / agent submissions, assignment, underwriting, binding, billing, endorsements, premium accounting, auditing, and renewals.
After working with many carriers, we found four common process challenges exist:
1. Resolving interdepartmental communication and process challenges
2. Obtaining reviews and approvals to complete projects
3. The need for efficiency without sacrificing accuracy and correctness
4. Completeness – ensuring that no critical steps are ever missed or forgotten
Organizations want to overcome these challenges to provide better service to clients and to be more efficient.
One way to solve this problem: Begin a business process improvement (BPI) project. Start with a single department / silo and document the process, then once each silo is complete, re-review the interaction of all business processes to find the pain points and bottlenecks.
These are common steps that are included once a BPI project is initiated:
- An organizational review session with leadership, management, and staff. If possible, a review of customer feedback will be completed.
- An analysis of all organizational and process data available.
- Process mapping sessions.
Below is a discussion of several strategies to address the first two process challenges.
1. Resolving interdepartmental communication and process challenges
Businesses are dynamic and organizations frequently add new work activities to adapt to the market. This can create process misunderstandings of the needs of different departments and staff members.
Introduction of new work activities and data sources can also create potential cybersecurity risks that need to be addressed.
Communication is key: Different needs must be clearly identified and defined to all stakeholders. It is recommended to start by defining the business needs of each department, including time requirements.
A common solution: Conduct a process mapping session to document the process steps, the inputs, outputs, and stakeholders. The map will also include any relevant measures and metrics and the desired outcome of the process.
Potential benefits from mapping a new interdepartmental business activity:
- Understand the challenges that each department faces
- Improve appreciation for their respective roles
- Reinforce the purpose of the process
- Improve communication between departments
- Ensure the process for completing the business activity is secure
- Reduce wasted time
2. Obtaining reviews and approvals to complete projects
Excessive review and approval steps in a process slow work completion down.
Review and approval steps are: Additional steps that require a review of a case, calculation, peer review, or a final approval – frequently performed by management – to move the process forward.
Additional oversight for a process is not always necessary, if the process is designed, automated, and documented properly, communicated to staff, and staff are trained appropriately.
A useful solution: Create a process escalation path or branch for certain criteria-driven scenarios to escalate an appropriate risk to management.
- This documents the criteria necessary to move the step to review and approve. Only if certain criteria or parameters are met would the step be sent to the manager.
- A common practice in this instance is to create a threshold. They are used frequently when approving certain dollar amounts.
From a cybersecurity standpoint, review all data sources and their usage – especially for billing and payment processes – where data can be intercepted by threat actors, so it is important to account for this when reengineering the process.
This reengineered process moves outputs through more efficiently and empowers employees to take initiative, build trust, and complete their work with minimal supervision.
In a dynamic and challenging business world, organizations must be proactive to stay competitive, build trust with staff, and create staff empowerment. By addressing these process inefficiencies an organization can improve customer service and corporate performance.
Linea Solutions has been providing strategic guidance that has improved our clients for over 25 years. We would be happy to meet with you virtually to discuss what type of assessment would be ideal for your organization. If you have questions about the best way to improve your organizational efficiency, contact us to see how we can help.
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