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Claims Workloads – What’s in a Number?

Claims Workloads – What’s in a Number?

We all know the old joke: “How many __ does it take to change a lightbulb?” Usually, there’s a punchline revealing some gross inefficiency at someone’s expense. While I’m about to pose a similar question, there’s no punchline intended. How many claims analysts does it take to manage a workload?

This is a common question for leaders of claim organizations that are trying to effectively run claims operations teams. Whether it’s Life, Disability, or Long Term Care, staffing is ultimately driven by a game of numbers. It starts with looking at the claim volume, but is there actually a magic number to arrive at?

The quick answer is no – we can’t throw out a “best practice” figure by product. If only it was that simple. To manage the claim workload and uphold sound risk management, it starts with assembling the right claims team.

Too little staff can lead to increased claim cycle times, decreased accuracy, and poor customer service. Too many on a team lends itself to operational inefficiency and poor expense management.

However, when most organizations start analyzing staffing levels, they soon face another challenge – the temptation to begin with the answer instead of first asking the right questions.

To begin, claims leaders can start by thinking about a few key factors outlined below. Taking the time to dig further and answer some basic questions will generate a better view on your claim organization’s needs and ultimately influence the outcome.

1.   Take Stock of Your Workload – Don’t “Guesstimate”

To understand how many claims analysts you need, you first need to evaluate the volume of work to be performed and how it gets done.

For example:

  • What tasks do you ask the claims analysts to perform?
  • Are they performing every aspect of the claim process (from intake to investigation to payment)?
  • Are there supporting roles that assist the process, i.e. a centralized customer service team or outsourcing partners that are utilized for a section of the process?
  • In more technologically advanced claim organizations, are there mobile or web self-service capabilities, or automation of administrative tasks?

It’s vital to recognize not just the workload levels but also the key parties who contribute to the claim process. What you learn can set you on the appropriate course to finding the right answers.

2.   Perfect Your Timing

Once you understand volumes and the inventory of activities, a successful claim organization has to understand how long it takes to complete the tasks. Here are a few helpful questions to ask yourself:

  • Is the claims adjudication technology easy to use?
  • Do claims analysts navigate multiple legacy systems, as well as imaging and letter generation applications?
  • Are the benefits calculated automatically, or does the claims analyst compare the benefits and policy information to arrive at the right claim payment?

The amount of time it takes for a claims analyst to complete a particular task is a key input into how many tasks can be completed in a day.

3.   What's Your Standard of Customer Service?

Another key area to evaluate is your claim organization's commitment to customer service. While this may not seem to impact staffing levels directly, consider these questions:

  • What are your organization's customer service goals and what metrics are you being evaluated on?
  • Does your company value cycle time, accuracy, and expenses? Most likely, a balance of all three is required, but where those metrics/goals are set influences how many people needed to complete the tasks within the amount of time desired.

While the claim life cycle is different for each type of claim, consider the level of service you want your claim organization to provide and then determine how you’ll best get there.

4.   Resources

Now that you know your volume, timing requirements, and customer services goals, the next step is to understand the availability of resources in your current environment. For example:

  • How many productive hours are in a day (minus meetings, vacation time, required training)?
  • What are the rates of attrition, disability, and other time logged away from work? How does that affect how many resources are available?

5.   Ok, Now What?

Once the previous factors are known, a claim organization can arrive at two different numbers to use to staff the organization.  Depending on where analysts like to put their assumptions, these could change a bit:

•    Full-Time Equivalents:  Basically, how many could get the job done and meet the goals if nothing gets in their way? Think in terms of no time off, no meetings, and always hitting the production and timing targets.

•    Staffing Requirement:  Layer on all of the assumptions around meetings, time off, attrition, training ramp up.

To Sum It Up

Stop looking for a magic number.  The key to understanding the right staffing levels for the claim roles is to understand the four key factors listed above. From there, you can develop a caseload model that makes sense for the organization.

However, I can’t emphasize enough to stay on top of it!  Over time, tasks will shorten or lengthen based on technology updates or process changes.  A healthy claim organization understands these factors and revisits assumptions frequently – before the punchline is on them.

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