Understanding the process
Lean Consulting was commissioned by Bupa to help them identify and deliver improvements within their UK claims department. A total of 150 FTE are involved in processing complex claims & adjustments.
We spent time observing the processes and speaking with front line and management colleagues. We quickly understood that they spend the bulk of their time dealing with claims that are not ‘straight-forward’, responding to challenges from healthcare providers and undertaking extensive compliance checks.
Identifying opportunities to improve
Our comprehensive review of the department identified a range of issues. There was a highly variable work-flow which meant that some teams would be extremely busy, whilst other teams were comparatively quiet. A lack of multi-skilling meant that many advisors were not fully utilised.
We also identified overworking of claims, such as checking previous work without identifying changes to reduce errors. Duplicating the checks in different teams was also an issue. There was also unnecessary investigation where some teams were checking for errors that no longer occured. Finally, we found significant time wasted due to unnecessary hand-offs, walk-ups and failure demand. For example, some of their inboxes were checked infrequently which meant that work was not actioned in a timely fashion which led to an unnecessary call.
Implementing changes in a sustainable way
Once process timings had been made, Team Leaders were positively engaged to manage productivity on a daily basis. Within 2 weeks, it was possible to identify a standard workload, how many FTE were required to run the process and an indication of the spread of performance within the teams.
Repeat checking and unnecessary investigation were addressed by identifying the impact on process time against the benefits accrued. We implemented a feedback loop to address root causes of errors & prevent recurrence of the failures. With improved training, upstream checks have been shown to be sufficient and we reduced the number of walk-up discussions.
Delivering tangible benefits
The benefit to the Claims Department was a reduction in effort of 20% of the overall FTE, equating to a saving of over £990k. Lean Consulting engaged with leadership to identify new work, transfers to other teams and no replacement of any staff attrition. As a result, the department was able to successfully restructure without redundancy.
In addition, procedures are now in place to capture errors and feedback into the automated claims checking rules.