DailyKaizen

The value stream of the Model Line area is an administrative process that is focused on adjudicating the benefits of the members we serve. Every day we receive on average almost 30,000 claims. Most of these claims travel through our information system and auto-adjudicate, meaning that the computer system does all the necessary checks and there is no manual work required. There are many exceptions that lead to claims “pending” out of the system for a processor to manually review them. In fact, we have somewhere around three hundred full time employees focused on working these exceptions.
There are many reasons that a claim can pends, but all of them are due to defects in either the system or the data. Over the years as we moved from a completely manual process to one that is primarily automated we have lost touch with what the work really is. Associates are very specialized and only work a small range of exception types thus they don’t see how their work is contributing to the whole. As the processes have become more and more distant from the meaning of the work so have the performance management and reward systems. Instead of rewarding people to find ways to error proof and stop the errors from coming in to the system in the first place we reward people on how fast they can process the errors once they have occurred. Thus, work is viewed as just work and not as opportunity. Our great challenge is working with managers and associates to help them understand the cause and effect relationships that drive the exceptions to them in the first place. We are teaching them problem solving skills, and how to work with data. We are also beginning to disassemble the current performance management and incentive systems.

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