Case Study: Insurance

insurance

Client

  • One of the largest publicly traded insurance companies in America
  • Highly recognized brand in insurance
  • Top quality service to over a million members

Background

The CEO recognized the need to better utilize resources while continuing to provide high quality service to members, agents and healthcare providers. An industry leader in terms of service and quality, administrative costs impacted their ability to profitably grow membership. The executive team highlighted productivity improvements as the key objective in managing costs while sustaining service and growth.

Our client had merged into a national entity several months prior to our engagement. The integration of systems was mostly complete. Our scope included work to coordinate and consolidate processes, reporting and performance management systems.

The client chose The AMS Group based on our experience in transaction processing and knowledge of work environments and our approach to organization performance improvement, which balances performance management techniques with a high involvement and continuous improvement focus.

Key Issues

  • Rework and non value-added activities represented 20 - 40% of the work content within the core processes
  • 30-50% of management and supervisory time was spent troubleshooting – at the expense of time for coaching, planning and follow-up
  • Production rates varied from the recorded activity standard by as much as 70% to 100%
  • Staffing levels, overtime and the use of temp resources had grown faster than membership and work demand
  • Performance bonus dollars were paid to nearly 80% of the team members and had become an entitlement
  • Detailed management performance information required up to a week for publication limiting the effectiveness of work flow and barrier removal activities.

Benefits/Strategic Results

The opportunity to improve operational performance focused on redesigning the work effort – eliminating non value-added activities, redesigning core processes and implementing a Continuous Improvement Program – and increasing operational effectiveness – improving goal alignment, supervisory skills and managerial systems.

  • 12% improvement in on-time claims processing
  • 19% improvement in productivity
  • 6% reduction in error rate (claims)
  • 8% reduction in overtime labor hours