Ideally, claims with identified issues have clear resolution steps and the processing time is kept to a minimum. However, sometimes a claim moves slowly. Those claims that are delayed in processing drive a lot of volume to the call center. The claimant wants to know why their claim is not moving, and the staff person on the phone might not have a satisfactory answer.
Even when there are documented resolution steps for all possible situations and the system can identify and assign tasks to the right queue, claims can still be delayed if there are many handoffs involved.
Example
Imagine a process where five work items must be completed, and teams are expected to resolve work items within 48 hours.
Scenario one: All five work items can be completed by a single staff person, and all five are done within 48 hours.
Scenario two: Each of the five work items needs to be completed by a different staff person, and all five are done within ten days (48 hours x 5 = 10 days).
Both scenarios resolve each work item within 48 hours, but the claimant must wait five times longer for a resolution in the second scenario.
While some handoffs could be unavoidable, minimizing handoffs in your process is critical to expediting claim resolution. No matter how modern your system is, if processes are not well defined, consistent, and efficient, it is impossible to set expectations with claimants for when their payments will be issued.
