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Case Studies

Reengineering

Entity:

Private Self Insured

Industry:

Manufacturing

Challenge:

Athens identified a growing trend of future medical claims within our client’s population of open indemnity claims. The trend had begun to escalate and Athens decided that it was an important issue to bring to the clients attention and to jointly develop a strategy to address the growth of these claims. The objective: to identity the drivers behind the trend. Additionally, our goal was to curb and minimize the growth of future medical claims within their overall population of claims.

Solution:

We determined this challenge could best be addressed by focusing our efforts in two different ways:

Individual Claims – Gather as much information about each claim as possible

Organizational Reengineering – Look to modify and improve the processes and procedures that were being utilized to address these claims.

To best address the individual open claims we worked closely with the client to gather as much information on each claimant as possible. This additional intelligence allowed for the development of extremely focused strategies for each open future medical claim. Beyond the strategic implications, the information allowed us to better understand the types of claims and or claimants in general likely to end up in a future medical status. This information was critical to our goal of minimizing the growth of this population of claims in the future. Simultaneously, we analyzed in great detail how future medical claims were being administered for this program. We looked closely at staffing models, processes and procedures. Our goal was to engineer an innovative approach to managing these claims. We wanted to create a focused environment that would allow our staff to maximize closure opportunities and to drive down the total open inventory of future medical claims for our client.

Results:

The immediate benefit of gathering additional information on each of the claimants was that we were able to accelerate claim closures in several instances. Beyond the immediate closures, an additional benefit of the information gathering process was the acquisition of an in depth understanding of these claims and what the challenges with this population of claims might be in the future. The greatest benefit came from the organizational reengineering perspective. We were able to build a dedicated future medical claim handling unit with unique caseload requirements and administrative support structures in place. The individuals within the unit have been coached extensively on these claims and have also been provided very specific claim handling guidelines. The ultimate outcome is a highly focused, specialized staff that has delviered very favorable trends for the client.

For more information about this project, please see our white paper titled:
Future Medical – A Claim on the Rise (pdf file)