Success Stories:
Inefficient Claims Reporting and Processing System

Issue

KMRD worked with two large, fragmented organizations that were drastically behind in reporting and processing claims. The following are a few of the issues KMRD identified:

1. No clear expectations were set in the field on the reporting and processing of claims.
2. Reporting forms were poorly designed and automatically led to a significant amount of back and forth emails and phone calls.
3. The filing system was ineffective and inefficient. No one could pick up a file and understand where a particular claims is in the process.

The existing process was so inefficient it froze the risk management department in literally 1,000's of emails with no ability to respond.

Result

KMRD's team interviewed every stakeholder in the process and:

1. Redesigned the reporting forms so that they were user friendly and clear from a layman's perspective significantly cutting down the amount of correspondence need to resolve a claim.
2. Designed internal workflows that clearly defined the steps in receiving and processing a claim. These workflows increased the accountability those involved and also identified areas that could be delegated to an administrator. Ultimately it resulted in an administrator working on 95% of the claim. They were able to get the claim to "the 5 yard line" so that the risk management professional could make informed decisions in a fraction of the time it took in the past.
3. Designed an electronic filing system that eliminated the paper files and enabled anyone to pick up a file and understand the issues and the status of a claim.
4. Utilized Xchange to collaborate with venders and the field. KMRD's system enabled the risk management department to disseminate claims forms and procedures to the field efficiently and effectively. The field was given a user id and password to access Xchange for the latest and greatest forms. Because they accessed a portal, there was no need to announce and distribute each and every improvement to the forms and manual during the project!

Value

The risk management department was able to downsize due to the efficiencies gained. The field was now satisfied and now the deem the risk management department as a valuable resource rather than a hurdle.