Projects & Achievements
Desktop Processing Analytics
Served as a liaison representing the claims business unit working with business analysts to develop triggers within the guidewire claims system platform to alert claims associates of compliance related issues and improve claims quality and associate efficiencies.
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Also utilized desktop processing analytics combined with IEX workforce management to provide claims leaders with reporting to monitor claim associate work productivity throughout the day.
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This resulted in a +5% increased productivity of claims teams.
Intelligent Claim Processing AIS- FPM Automation Initiative- Pilot- NECZ
Served as a liaison with the technical office and AIS. Worked to provide attributes, venue/statutory requirements, state coverage limits as well as pilot the automation system for 6 months prior to implement companywide to provide feedback and recommendations as to the functioning of the automation- Issues identified included closing coverage issues and false exhaustion of coverage. Fixes were able to be implemented.
Claims Modeling
Assisted business unit in trouble shooting claims modeling first notice of loss reporting utilizing artificial intelligence with goal of straight through processing or low touch claims. This model entailed utilizing past data to recognize claims with no coverage issues and no injuries and assignment to material damage claims bypassing casualty teams for investigation. Improved the customer experience, measured by an increase in customer service index and improvement from 8.6 to 9.1. Also increased employee efficiency for getting the right claim to the right business unit with less touches or assignments.
Hospital Audit
Cost Saving Initiative-AIS- Expanded to include PA/NJ- Benefits include chronological detail of care rendered, identifies past medical history, identifies unrelated charges that may have been reimbursed otherwise, Physician provides sign off on unrelated/medically unnecessary determinations & determine if lower limits policy extensions are appropriate.
Knowledge Advance
Served on a team that assisted with developing a claims repository for casualty teams including non-injury, first party medical, bodily injury, and material damage to serve as a resource for associates regarding daily business unit needs. This served as a single point reference for the business units regarding daily claims processes, procedures and resources. This also served as a time efficient resource for the claim associates and added standardization among the business units.
Business Process Management- Redesign- Total Loss Expedited Settlement Initiative
C-4 PPO Edit- Regenerate Draft
An issue was identified by the medical adjusters regarding PPO priced medical bills. When PPO priced medical bills are edited in any way, the system automatically removes the PPO pricing and adopts reasonable fee schedule and /or UCR (usual, customary & reasonable) pricing. Failure to identify the PPO pricing being systematically removed requires multiple adjuster reconsiderations to be performed and can extend the process to pay a single bill to potentially 1-2 days. The benchmark process time for single bill is 1 minute for comparison. The team identified the ‘Regenerate Draft’ option within the AIS system will ensure the correct PPO pricing is applied to the document and reducing the 24 hours being utilized by the adjuster to 5 minutes utilizing the ‘Regenerate Draft’ feature. Reduced cycle time from 24 hours to 5 minutes. A job aid was communicated and shared with the entire First Party Medical organization.
Served on a team that entailed analyzing our current claims design and identifying a redesign to improve cycle times for settlement of total loss and improve the customer experience while reducing expenses. Brainstorming and collaboration allowed removal of downstream bottlenecks to improve efficiencies for the customer and associate. The redesign capitalized on digital resources (Docusign and an electronic power of attorney). This allowed the business unit to issue payment upon receipt of the same and resulted in improved cycle time of the claim and improve the customer experience. If the electronic power of attorney was not accepted in a specific state, the team would issue payment upon receipt of an electronic copy of a properly executed power of attorney. Benefits included the following:
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Cycle time reduction
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Date of evaluation to settlement (-5.31 days). Validated with CCC information
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Moving 18.54% of claims settled in 0-5 days in year 2020 to 64.51% in Qtr. 1 2021.
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Reduction in FedEx expenses- 2020 FedEx Spend was $20,918.15/monthly to $13,303.65/monthly
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Time Savings for the associates due to less follow ups. Goal - Reducing average follow ups from 3 to 2 at least 75% of the time and reduction of creating FedEx labels by 50%. Annual Savings predicted as $267,791.79 or $22,315.98 monthly savings.
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Customer Experience-
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CSI 2020 Year End Overall Satisfaction Score was 8.7 & improved (+0.3) to 9.0 Qtr. 2 2021
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OCA Complaints- Reduction -22.5% in complaint volume based on YOY Jan. thru June results (2020- 903 complaint in comparison to 2021 700 complaints)
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Genysis Claims Telephony
Represented the material damage claims organization in the role out of a cloud based telephony system with the goal of reducing voice mails and having a live person to assist customers throughout the day. Increased same-day contact by 10%, as well as decreasing customer complaints by 20% in comparison to the prior year. Also allowed monitoring of associate compliance for availability of phone calls.
Cycle Time Review
Bodily Injury Settlements- I served on a team of peers with the objective of reducing time a claim file remains open by utilizing the appropriate settlement releases in conjunction with the established Best Claims Practices in stage of the claim. Recommendations provided for usage of a Full and Final Settlement Release and Schedule Release. Additional ideas provided to consider extending Early, Fair & Reasonable offers. Create a Plan of Action prior to negotiations. Where appropriate continue to discuss settlement in the early stages of claim.
Ardsley VIN Search
Worked collaboratively with Claims Consultant, Technical Director, and Procurement Consultant to resolve casualty claims investigative needs (Registered & Uninsured Motor vehicle exclusion).
CAREER Cross-Functional Enhancement Program
- I served as the Program coordinator and partnered with centralized leadership and the Nationwide Academy to build the program intended to help associates learn more about other areas of Centralized Claims, expand associate’s understanding, and diversify their experience. This program tailored the Centralized Claims Team including Material Damage, Property and SIU disciplines. Some key aspects of participation and the program.
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Incorporates self-study and hands-on sessions in other centralized disciplines
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Involves up to 13 hours a quarter
New Jersey PIP Profitability Lead
Developed and implemented a New Jersey PIP Profitability Summit to monitor and create strategies with our Product, Underwriting, Claims, Legal and SIU teams to increase profitability with New Jersey for our company business. These meetings were conducted bi-monthly to monitor trends and seek ways to profitably operate within the New Jersey market. ANCS improved as a result of these meetings and collaborations.
A-3 Carrier Discovery Requests
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A pilot was conducted with the first party medical teams as to the need in completing a Pennsylvania Policy Discovery Request. This tool is utilized to identify if a party seeking benefits under the contract has higher priority of coverage elsewhere. Parameters were established along with a job aid to assist the medical associates in determining whether to complete a discovery request.
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Projected Cost Savings: 14,738 avoided searches x $15.00 = $221,070 cost savings
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14,738 avoided searches x 4.16 minutes = 61,310 minutes saved for adjusters.
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Claim Center Cognos Reports Initiative
In a Company Wide Initiative, I assisted the claims technical office with identifying Cognos reports beneficial to the casualty organization with the goal of sharing with all claims zone in order to drive performance and efficiencies. Technical office staff visited my location and observed reports and execution of the same.
Automation- PA Regulatory Status Letter
As a result of Corporate Compliance Reviews I worked with business consultants handling Claim Center and Legacy System (CICS), corporate compliance, technical office and legal counsel to develop a status letter and implement an automated status letter in CICS and Claim Center. Benefits is ensuring compliance in sending required letters and efficiency for the associates.
Zone Fraud Training for Managers
Selected as a leader to improve the zone SIU referral rate. This initiative entailed partnering with Material Damage, Bodily Injury and Casualty Associate Directors to identify, select and implement effective training for managers. The objective of this group initiative was to identify fraudulent indicators and promote SIU referrals to aid with improvement in referral rate and serve as a lost cost containment. This training led to an increase of SIU referrals.
Improved Business Unit File Quality and Calibration
First Party Medical Organization- Improvement in the business unit as follows:
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QA Front Line Manager YTD results from 94.59% (2017) to 95.83% (2019) for a +1.24 improvement.
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Calibration improvement during this same time from 93.57% to 98.02% for a +4.45 improvement.
Tactic- Our team devised a simple and realistic strategy to conduct (2) open file reviews per associate per month in which observations were captured in an excel document stored on our SharePoint site. I review this excel document weekly to ensure accountability on my level as well as at the manager level. The manager provides immediate “real time” feedback to the associate to reinforce the positive behaviors in addition to opportunities so the associate can immediately correct their behaviors and have a clear expectation in terms of file quality. This approach was impactful to our team as we were providing current observations and ‘real time’ feedback to the associate.
Engaged Teams
My teams have been highly engaged from direct (Manager) level as well as business unit perspective.
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2017 Direct Manager Team 4.95 engagement score (97th Percentile) Business Unit 4.60 (85th Percentile.
2018- No engagement survey
2019 Direct Manager Team 4.79 (93rd Percentile) Business Unit 4.49 (80th percentile)
2020 No Direct as transferred to Centralized MD. Business Unit 4.67 (82nd percentile)
2021 Direct Manager Team 4.66 (88th Percentile)
Engagement Organizational Project (Pulse Committee)
I was selected by the Associate Vice President and supported by all Material Damage Directors to serve as a project lead for assessing (3) key areas including 1.) Communication 2) Change Management/Agility and 3.) Materials and equipment to needed to do work right. I was responsible for establishing and naming a committee to serve as a focus group to work across departments and better understand the perceptions of the associates. The team collected data throughout the Centralized Material Damage Organization. The data was organized and presented to the leadership team. As a result of the associates’ feedback, subcommittees were formed within each business unit in order to seek feedback from the team and proactively work to resolve any issues at a discipline level but to elevate engagement issues to the Pulse Advisory Committee to share with the Associate Vice President for larger scale issues in an effort to resolve the same. Positive benefits of this committee included:
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Increased Pre-Settlement authority for associates (Total Loss)
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Increased Rental Authority for associates (Total Loss/ OYSARN)
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Developmental opportunities through and expansion of the ‘Cross Functional Career Enhancement Program’. (Centralized Material Damage Organization)
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Subcommittees developed at business unit levels to allow feedback flow from the associate level to the Associate Vice President level. (Total Loss/OYSARN/ PACE/SOC)
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Communication review at a discipline level. Business unit leaders have reevaluated the need and frequency of both meetings & huddles to make a deliberative effort to share time sensitive information and reduce emails and duplicative communications. (OYSARN/ Total Loss)
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Lunch & Learns- In partnership with ACT subcommittees & EDI teams specific business units covered Knowledge Advance & Claims Automation. (OYSARN)
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Implementation of several customer-focused process efficiencies pertaining to Processing and the Diminished Value teams. (OYSARN)
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Microsoft TEAM Sites- Developed with access to ALL associates as a communication channel to allow weekly updates and daily reports to reduce daily/weekly emails (SOC/ PACE)
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Technology optimization- Working with DPA to incorporate triggers for state specific regulatory & compliance items. This will create efficiencies for the associates when handling claims across multiple states. (SOC/Total Loss)
