9.5. Process Improvement
Step 7: Processes Defined. In this step, Larry works with a group of claims representatives and claims supervisors to construct a Process Map, which depicts the claim-handling process as it should flow. (In most instances, this type of group first needs to document the "Is" process as a backdrop for the creation of the "Should.") Their Process Map appears in Figure 9.3.
Step 8: Process Performance Improvement opportunities Identified. Having documented the claim-handling process, Larry identifies the desired performance for each process step. the actual performance, any gaps between desired and actual performance, and the impact of those gaps. He identifies significant gaps in the "claim qualified" and "claim assigned" process steps.
Step 9: Process Improvement Actions specified. In Step 9, Larry identifies the causes of gaps revealed in Step 8 and the Process Improvement actions that will remove the gaps. He limits his list of recommended actions to those that can be taken at the Process Level, without analysis at the Job/Performer Level. Larry finds causes that require clarifying performance expectations and providing feedback.
| CRITICAL BUSINESS ISSUE: Settlements PROCESS: Claims Handling | |||||||
|---|---|---|---|---|---|---|---|
| ORGANIZATION OUTPUTS (PRODUCTS) | DESIRED PERFORMANCE (STANDARDS) | ACTUAL PERFORMANCE | GAP (IF ANY) | IMPACT OF GAP | CAUSE OF GAP | ORGANIZATION IMPROVEMENT ACTION | PROCESS WHICH INFLUENCES GAP |
| Claim settlements | A. Payout/claim $1500 | $1700 | $200 | $1.8 million | Bad specs on new policies
Policies misrated Poor measurement of payout performance |
| Claim handling |
| B. Time/claim 60 days | 60 days | None | $1.4 Million | Claims misrouted through agents |
| ||
| C. Handling cost/claim $215 | $375 | $160 | |||||
Figure 9.3. PCI Claim-Handling Process.
Step 10: Job(s) with Performance Payoff Identified. As the last step in Process Improvement and as a bridge to Job Improvement, Larry identifies the jobs that contribute to the process steps in which there are gaps. His analysis indicates that the claims supervisor job—not the claims representative job-requires the most attention during the Job Improvement phase. Table 9.2 summarizes Larry's work in Steps 8, 9, and 10.