The Most Effective Claims Process Map

Process mapping your claims

A claims department can have significantly varying flows depending on the losses handled within a specific group. Property claims departments may handle things differently than liability claim departments do. An auto claim handling office will have a different procedure than the workers’ compensation claims department. A manager’s role is to manage these processes and ensure efficiency. One technique for making sure that these processes run smoothly is to create a claims process map for workflows in your department. Process mapping your claims procedures can identify inefficiencies to ensure your office runs smoothly.

A process map can also be called a flow chart, functional flow chart, or workflow diagram. It is a visual representation of the steps in a process.

Why Create a Claims Process Map?

The advantages of working through a process map are that an organization can improve its efficiency by identifying bottlenecks, repetition, or delays that could be solved when people work together.

Creating a claims process map is similar to making a recipe. There is an initial statement of what you want to cook, the gathering of all the ingredients, and step-by-step procedures for assembling all the components and preparing to combine them into a final meal. Process mapping is no different.

Process mapping is a visual rendition of the process. These graphic renditions help define the process for users and provide a structure from which a claims manual can be built. Process maps can be refined and changed whenever something within your department changes, such as a new procedure, new personnel, or new regulatory requirements.

How You Can Start Process-Mapping Your Claims

Many techniques can be used to prepare a process map. Software systems are available, such as those designed to show what the process does graphically. However, the sticky note method works best if you are in a group setting, which is the best way to develop a process. The sticky note process involves using multi-colored three-inch sticky notes and a large wall that everyone can see. This is an exercise in team-building as well. Depending on the number of individuals in the room, the session can be performed in various ways. However, as an example, we will consider a claims department with five people with five different functions.
To start, each individual can be given a package of sticky notes and asked to write down ten specific things they do throughout the day. If ten things are too many, limit it to five. Once these are gathered from the participants, the sticky notes can be placed on the wall so that everyone can see them. Then the work begins. You will need to determine in which order those specific tasks go. It can get confusing, primarily when jobs are handled at one stage by one person and another set by another.

Divide and Conquer

This is where the technique of swim lanes can come into play. It is best to use a whiteboard for this process if possible. If not, simple light blue painter’s tape can be used to designate lanes on the wall. Each lane will represent an individual or a department. The sticky notes can be placed within those lanes and move from one lane to another.

As the process is mapped out, it’s best if arrows can be drawn between the sticky notes to show the flow of the work.

Traditionally, different symbol shapes are used for other activities. For example, the start and finish of a process are usually designated by a circle or an oval. When using sticky notes, try to use a different color for a start and finish. After that, each step in the process is usually designated by a square or a rectangle. Whenever a decision must be made, turning the sticky note into a diamond is best. With these simple shapes in mind, it is straightforward to structure a process and graphically show how that process is carried out from start to finish.

Manage For Success

Process mapping your claims can become very complex as decisions are made throughout. However, laying out the process graphically is straightforward to see when decision diamonds create inefficiency loops. An inefficiency loop is when a decision results in an answer that returns the approach to a starting point. Showing these inefficiency loops graphically can help everyone understand where the bottleneck occurs and how to correct it.

Some organizations will participate in process-mapping projects that take several months to perfect. Once the process map is in place, it can be maintained with minor tweaks over time.

From a practical standpoint, having all the sticky notes on the wall with drawings and notes can be burdensome if everything is kept in one room. A simple snap with a cell phone camera and a transfer to an email can distribute that information as a document to all the participants and management so that everyone understands the process results. If you find bottlenecks or inefficiencies in your claims department, consider setting your staff up for a process-mapping session. They work pretty well, are easy to accomplish, and can be great team-building exercises.

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