When I got home from my mission I took on a temp job as an insurance claims processor for a medical company until school started up. If someone had both VA insurance and private insurance, medical costs were supposed to be covered by the private insurance first. Often people would use their government insurance instead. In that situation, my group was responsible for processing government reimbursement claims. Previously the company had only had employees work on these when they had spare time, so months of backlog had built up.
After training, my group did a great job of efficiently processing the VA claims, and we got done with the backlog well before the company expected. After the backlog was finished, there were only enough current VA claims coming in for a couple people, but since we had done so well, they wanted to keep us longer. Previously the company had also contracted to process Medicare reimbursement claims, but their previous attempts had resulted in many errors. They decided to train us for processing the Medicare claims with the goal of having 99% accuracy.
In this change for the department, I felt the company did well at the first four steps for leading change. They had a sense of urgency (the government was threatening fines since the backlog had grown so long), had formed a powerful coalition, created a vision, and communicated that vision. However, on the fifth step, empowering others to act on the vision, I feel the company struggled. The following are examples of how employees were not empowered.
1. Although they had worked on the processing system, it was still difficult to use. There was no processing manual because the last group in charge of processing Medicare claims had created the process and either not written it down or written it down on sticky notes. Because the company had relatively high turnover in the processing department, and these claims were processed in another state, information was difficult to come by. The company tried to remedy this by creating a training manual during training. Also, the couple weeks of training were run on a test platform to see what errors came up. Even with this work, unknown errors still surfaced, slowing processing.
2. The company wanted to make sure to keep the highest performing processors. Periodically they would pull a high performer out of our group and place them in full time employment somewhere else. This decreased both the staff and skills available for the project. Because they knew I was leaving for school, they never offered me full time employment, so I got to experience the entire process.
3. Despite the fact that there were numerous problems and the system was more difficult to use, they did not significantly reduce quotas. This made everyone stressed because they expected high quality. Most people except the highest performers were having a hard time consistently meeting the quota. At the same time, there was a certain type of claim that would be incorrectly rejected in the system. If a claim was identified as one of these in the system, we were told to set them aside, which was much quicker than completely processing a claim. These claims were often clumped together to make an entire batch. Some people began looking specifically for batches of these claims to pad their numbers, resulting in many claims that were set aside and fewer that were processed.
I left for school before the process was complete, but I know many of the employees ended up leaving before the project was over.
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