Projects

KMRD Creates a More Efficient and Effective Claims Management Process

Two large fragmented organizations were drastically behind in reporting and processing claims.  KMRD designed workflows, forms and an electronic filing system to create a more efficient and effective claims management process.

The Issue

KMRD worked with two large fragmented organizations 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 emails and phone calls.
3. The filing system was ineffective and inefficient. No one could access a file and understand where a particular claim was 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.

Our Response: Effective Claims Management Process

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

• Resigned the reporting forms so they were user friendly and clear from a layman’s perspective significantly cutting down the amount of correspondence needed to resolve a claim.
• Designed internal workflows that clearly defined the steps in receiving and processing a claim.  These workflows increased the accountability of 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 the risk management professional could make informed decisions in a fraction of the time it took in the past.
• Designed an electronic filling system which eliminated the paper files and enabled anyone to understand the issues and the status of a claim.
• Utilized our risk management portal to improve collaboration with vendors and the field. KMRD’s system enabled the risk management department to disseminate claims forms and procedures to the field efficiently and effectively.  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!

The Results

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

KMRD automated the routine and refocused high impact personnel on high impact projects. That’s the KMRD difference.

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