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Similar to MIS #4 Slideshow
Similar to MIS #4 Slideshow (20)
MIS #4 Slideshow
- 1. WHAT WE DO…
- 3. CUSTOMER CLAIM PROCESS $$$
- 4. LIFE OF A CLAIM
- 6. SCANNING What IS that?!
- 8. Two Words: DATA ENTRY Slow & Tedious
- 9. Match Data & Receipts Reconcile Check Plan or ADJUDICATION
- 10. $ X CLAIM CLOSING CENTER
- 11. SO WHAT? BOT⋅TLE⋅NECK – noun: a place or stage in a process at which progress is impeded
- 14. WHAT DO WE DO?
Editor's Notes
- Been in business since 1940 MW offers Health, Dental, Travel, Life, and Disability insurance It’s a not for profit organization. 37.5 % market share
- 1.5 million customers in BC 8,000 different group plans from businesses, unions and associations Trends:
- Mail – scanning – date entry – adjudication – Accounts Payable
- In the mail room, a human opens each envelope received and sorts the claims. Open read sort
- As you can see it’s a really complicated and a long set of steps just for scanning.
- Matrix mess to go here (of the process)
- Click click click -
- Didn’t we already do this?!
- Where’s my money! This is the last step where a claim is accepted or rejected and the file is closed! Option1: accept and write check Option2: reject and reply with a letter of rejection/non-converage
- Think of a bottleneck on the freeway – all of a sudden you reach a point on the road were things get S L O W, and you wonder, what on earth is interferring with the flow of traffic?! With so much staff time involved the system is really inefficient and slow.
- Ok, so we’ve looked at the steps in the process and so now – where is the issue? -no matter what we still have to sort the claims to the appropriate dept -scanning: have you SEEN that machine?! (flash back to scanner) right now we are spending oodles of time to scan each claim ad set of receipts into the system which takes T I M E (and time is money, right?) this is obviously an area for improvement -data entry: after scanning we’ve now got to put it in the system – BY HAND. At current we have # of people putting each form into the computer…uhh? -adjudication: (there is that fancy word again) here is where we decide if they get the money, which means we have to review everything that has already been through the system – we Mail – scanning – date entry – adjudication – Accounts Payable
- What are we trying to fix exactly? -inefficiencies -errors -and C O S T : at current this process costs MW roughly 931,000 annually in labor and other direct costs (841 & 90k) – per claim .695$ and 14 hours from beginning to end
- So, what do we do and what do we need to consider? -we would like to bring greater efficiency to the process to limit labor costs and time – because time is money!