Claims: Effective Distribution and Monitoring of Workloads

Dave Lennon, Business Consulting Team Lead for North America, FINEOS

It all makes sense doesn’t it?  Effective distribution of work should be a no-brainer, but why do we struggle so much achieving this goal?  What can we do to ensure that everyone is working at an optimal level?

My previous project experience with FINEOS has found that either everyone does everything OR the opposite is true, where people work in such a silo that there is an overdependence on people to ensure turnarounds are being met.  Both strategies result in bottle necks where work isn’t being completed on time and customer satisfaction drops.

So what can we do to improve this situation?  It starts with defining what a user can and can’t do within the organization.  What’s their role?  These are key questions that will help achieve our goal here.  The definition of each role within the organization allows us not only to match users to roles, but also specific work items. For example, a role which deals solely with payments won’t be asked to do any medical investigation work.  The creation of these roles allows for a wider and more evenly spread of comparable work across the organization.  By doing this we can generate the following benefits:

  • Staff become more experienced in dealing with key aspects of Claims, and specialize in key business capabilities.
  • There are fewer dependencies on key people, as their work can now be accomplished by any user within that role.
  • It results in a more balanced workplace with people not doing the same repetitions each day, and dealing with a broad workload as defined by the role that they are assigned to.
  • It results in a more accurate reflection of the Service Level Agreements, as the role definition lends itself to a more specialized approach. This can result in increased turnaround times and increased customer satisfaction.
  • FINEOS functionality such as ‘Get Next Task’ allows for a more balanced work day as defined above, and eliminates the cherry picking of work that can sometimes occur within large organizations.

Coupled with the concept of roles, we need to ensure that the supervisors are aware of their responsibilities in ensuring that no user is being overloaded, and that each user is meeting their deadlines.  By consistently monitoring the work queue of their team, through reports or the accessing of a user’s work queue, supervisors can use this information to see if they need to reassign work, re-evaluate existing SLA’s on pieces of work, or even use it to target specific training needs.

By establishing and defining the boundaries of roles, we set the seeds for increased customer satisfaction, a more cohesive and streamlined claims management approach, and also a more targeted training methodology.  As discussed in a previous blog ‘How Do I Effectively And Efficiently Distribute New Disability Claims Among My Staff?’ by Dev Johnson, role assignment can take into account a person’s soft skills or analytical mind. By monitoring, we deliver on these results and ensure that the correct time is being allocated to pieces of work, and also that the correct people are assigned to the correct roles.

The huge benefits of effectively distributing work are out there, go get them!



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