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A6: The Insurance Claim Team (Updated 08/08/2007 05:37 PM )

MGT 415

Note:  The following problem is fictitious but employs names of, and news from, real organizations.  The idea is to increase the reality of the situation, and to improve your awareness of various industries and organizations.

You are a project manager for Ohio Casualty Group.  Recently, you've been named to a quality improvement team that has been formed to reduce the number of insurance claims with errors.  These claims are generated by Ohio Casualty claims representatives upon obtaining information from personal and business clients directly or through agents.   

Early in the process, the team decided to examine data related to what is going on currently related to error rates, types of errors, etc (see tables below).

The team has asked you to analyze this data and to bring a report of your findings to the next team meeting.

The team also asked you to bring some ideas about the causes of erroneous insurance claims to the next meeting.

Some things to consider during your analysis:

  • Make sure to select the proper 'quality tool' for the job.  You may need a different tool for each data set.

  • What can we conclude from this analysis?  Be careful not to conclude too much.

  • What data might the team still need to get an accurate picture of the current situation?

 

Table 1: Claims Processing Rate vs. Claims with Errors 

Processing Rate (claims/hr) Claims with Errors
20 16
30 25
40 28
10 8
20 12
60 35
35 22
40 32


Table 2: Types of Claim Errors and their Frequency

Error Type Number
Wrong agent 54
Wrong claim category 246
Incorrect customer 65
Claim total incorrect 537
Wrong source department 75

 

Table 3: Daily Count of Claims with Errors

Sample Error Count
1 33
2 12
3 18
4 29
5 28
6 8
7 76
8 38
9 14
10 41
11 23
12 9
13 11
14 17
15 34
16 27
17 56
18 9
19 15
20 62
21 39
22 12
23 19
24 18

 

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