APPLYING BUSINESS PROCESS MANAGEMENT TECHNOLOGY TO THE PRACTICE OF SUBROGATION: A REVIEW OF REAL-WORLD RECOVERIES AUTOMATION By Dr. John Kendall, Clear Technology, Inc., Westminster, Colorado In the business world, just about every back and front office operation relies on people to perform mainly repetitive, clerical and procedural activities that does not require sophisticated reasoning skills. In other words, the service industries, and especially the insurance sector, significantly underutilizes the power and potential of their human capital because of the absence of automation systems that have the functional requirements needed to make these complex processes obsolete. The only tool that insurers have had to do this work is people. And so the insurance industry still employs legions of workers who are often bored, overburdened and stressed, who apply rules in an inconsistent and subjective manner, don t get the process right all the time and, in short, create a processing engine that is as flexible as a ninety-year-old gymnast with a knee splint. On this journey to develop an automation system that can replicate the techniques and strategies that people use to get complex work done, it will surprise no member of NASP that developers of automation systems have turned their attention to the strange and wonderful world of subrogation. Like the Chinese proverb be careful what you wish for, because it may come true, we found all the complexity we ever dreamed of in our analysis and modeling of the subrogation process. For one enterprise insurance client, the first automation target was the company s subrogation business. A service domain characterized by deep complexity, high outcome value and by nature a people-intensive process, we believed automation would prove extremely worthwhile. Ironically, the customer selected subrogation as the first area in which to test process automation because it felt the process was its most straightforward. It was soon discovered that these manual processes are more complex than anyone had realized, typified by the following characteristics that had made it extremely resistant to automation in the past: Long lifecycle duration: Subrogation cases are some of the most time intensive transactions in the services sector. An average lifespan can be from weeks to months, with a typical lifespan from initial claim of 180 days. Multiple steps: Subrogation involves more than 150 activities, tasks, calculations, systems interactions and collaborative inputs over time. Random events: The sequence in which these steps are executed is determined by when certain events occur in random order, which makes it impossible to define linear process flows. High caseload: Each recoveries specialist must carry a caseload of 250-300 recoveries cases, but can only work on one case activity at a time. Need for collaboration: Each recovery case may require varying degrees of involvement and collaboration with other people (e.g., legal departments, third parties named in the claim, police departments, etc.) Interaction with multiple systems: Recoveries specialists must work with various internal and external computer systems and react to changes and updates in claims status. Given these complex characteristics that define the subrogation process, it is easy to understand why it had not benefited from typical IT approaches like workflow or custom application development. Any approach
that takes a linear, hard-wired process-flow strategy is doomed to fail since the subrogation process (and many others like it) is non-linear, unpredictable and volatile. The toolkit of the subrogation manager today consists mainly of clear and documented procedures, continuous closed case file review, agent performance metrics, training, his or her own prior experience and some basic technology (workflow, diary/scheduling, predictive dialing, etc.). Clearly, these tools can optimize a people-intensive process. But what if there was a new tool available that could actually automate recoveries? What would be the implications for subrogation professionals if they adopted such automation? Given the unique process characteristics of subrogation, combined with the normal dynamics and economics of people-intensive operations (turnover, mistakes, labor and overhead costs, etc.) a business case can easily be made for automation. For example, research at several leading insurance enterprises has demonstrated that not every case eligible for recovery is identified during the first notice of loss or subsequent adjudication action plan and processing - a major source of leakage. Also, determining the correct amount to be apportioned and recovered is subject to variation when left to the judgment of individuals. In addition, the delays in cycling through cases and responding to events in a timely fashion cause recovery time frames to stretch significantly with the time cost of money, which in turn compounds the leakage costs incurred by insurers. Another point: due to burdensome complexity, some insurers don t start subrogation until after a claim is settled, putting them at a disadvantage when establishing liability, estimating the amount to be recovered and managing to an optimal recovery rate. While even small improvements in these leakage areas can deliver large financial benefits, business flexibility can be derived from improving management-level insight into processes that are handled primarily by people. In most subrogation centers, it is almost impossible for managers to know the exact status of any single recovery case; what decisions have been made thus far, what tasks and activities completed and what calculations and negotiations concluded, let alone have visibility into the status of the full case load across the whole subrogation operation. In this environment managers are flying blind, with only the rear-view mirror as their guide to continuous improvement in their operations. So on a less abstract level, these problems in subrogation manifest themselves as follows: The time spent by managers seeking the status of subrogation claims consumes the better part of their work week, with the primary goal being proper workload allocation. Wouldn t it be better to have reports on claims status generated automatically? What about those 400 policy changes that were handed down last week? Wouldn t it be more worthwhile to the organization to have those changes implemented by automation rather than the current manual process? And what about your knowledge workers? If they re making mistakes on the identification and update of total amount to recover, how much is your organization leaking daily, monthly, annually? If recoveries specialists are spending all their time doing the mechanics of looking up witness statements in one place or phone numbers for all of the people involved in the case from three different systems, or keeping track of when all the payments have been made so the total subrogation value can be computed, or tracking agreement of liability with third parties, when do they have time to do the truly high-value work of dispute negotiations? Building on that, if you knew you had ten complex cases currently pending against a single third-party, you might want to pool all of those claims and negotiate them together for the best result. However, the only way you are going to know you have ten pending claims against a single third-party is through the view of an automated process.
How do you even begin to build an automated subrogation system? Consider the following: 1. There is a special class of process that is non-linear, unpredictable and volatile. 2. This class of process has resisted traditional automation tools and approaches. 3. People are the only tool that has been able to get the work done within this class of process. 4. Therefore, to create significant enterprise value, we need to develop an automation system that can replicate the same techniques and capabilities that people employ to do this type of work. One vendor has developed such an automation approach that is now being deployed at a major global insurer. The business process automation platform (also known as Business Process Management or BPM) has been designed to automate even the most complex people-intensive processes in any back or front office operation. It is an automation engine that can juggle the data, procedures, logic and events in the same way people do to get these non-linear and volatile processes resolved. The goal will be to automate as much of the low-value-add work within the subrogation domain as possible so that specialists can concentrate on highvalue work, not administrative work. Such a model will significantly improve the overall financial performance of the subrogation operation. Embedded within the automation solution are all the core capabilities that people commonly use to get this type of work done. The automated subrogation system at the insurer can handle the following process requirements with ease: Automatic process activation: Through continuous polling and navigation of different core systems, the automated subrogation solution triggers key steps in the recovery process (e.g., checking for payments made to providers). Case management: The solution coordinates the overall recovery case, allowing the gathering of required information and processing of necessary steps as a single unit of work. State based processing: Serial execution of the next appropriate step is based on the state of the data at any point in time. The system knows what information is available and what information it is waiting for and has the ability to react to changes in the state of a recovery case and move to the next appropriate step. Simultaneous, real-time collaboration by people with different skills across the lifecycle of the case. Zero code application building: The system requires no programming to configure the specific automation solution needed by a company. Instead, the software was designed to allow business process owners to model their own process and then configure their own solution in weeks. Continuous Outcome Optimization: The system was designed with reporting capabilities to unlock new opportunities for continuous improvement. It tracks every step that was executed, every decision made, every piece of data used and every event that occurred. This means that the subrogation manager can, for the first time, begin to gain real insight into case status, outcomes being delivered by each specialist and a high-level view into possible process bottlenecks. It is important to point out that the software actually does all this work. It is not trying to make each step more efficient. It is not trying to support decisions and improve human judgment. Rather, the goal of such an IT project is to fully automate all the things that can be automated and only leave those activities to which people will add value.
Through the in-depth pilot deployment at this insurer, a number of other powerful and unexpected benefits have been discovered. The ability to model how the best person does the work today and replicate that method exactly in software as a first step means that we can lift the average performance of a team to the best practice level overnight. This approach assumes that the process is not broken, only that it is not executed the same way every time. You do not need to do extensive re-engineering to get a big result. And because the software can be configured using the same names for data, rules, procedures and events that the recoveries specialists use today, they recognize the process as their own. Therefore, training and change management is minimized and overall project rollout is eased. One specialist, who has used the automated system, remarked, Before this system I had to remember - for all my 250 open cases - where each case was at relative to our internal 5-page process flowchart. Now this new system does that for me. It remembers what has happened, the current state and what to do next! The system has taken away all the grind, so now I can do the job I am paid to do - recover money. This article appeared in the Spring/Summer 2003 Issue of the NASP Subrogator. NASP
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