Corporate management sought productivity goals for nine regional fraud departments that accelerated investigator contact with the individuals involved and set specific time frames for incident resolution. Local management resisted, preferring open-ended completion metrics regardless of case complexity and lessening of goal stringency.

Gathered the regional managers to explain the vision and potential magnitude of any changes, discuss the nature of contemplated goals, and receive feedback. Framed a project plan for an extensive procedure review. Collected representative samples of investigative files and asked IT to average the activities conducted against the time required. Merged the data with complementary metrics to pinpoint deficiencies by office and investigator. Conducted root-cause analysis to identify repeating weaknesses. Coalesced the insights gained into performance goals for time to make initial subject contact, frequency of supervisors’ progress reviews, and duration of case analysis. Incorporated a six-month assimilation schedule and compliance grace period into the activation schedule. Justified the revisions to the office managers by reviewing study results and explaining how the new requirements would increase the number of cases managed and shorten average case life. Finalized the project in two months instead of the anticipated three, presented the plan to leadership, and received approval to proceed.

Enforcing the new goals shortened average case life 24%, increased the investigative load 3%, and bumped administrative productivity 5%.

Senior executives directed the corporate fraud department to establish universal guidelines for conducting investigations and rating files and to manage the company-wide audit. Regional management felt each office needed different rules, advocated retention of existing documentation practices, opposed grading files on a pass-fail basis, and insisted on assimilating local handling methods into any changes.

Partnered with the claims performance review team to better understand the processes employed by the regions and the supportive programming. Verified through analysis of the disparate regional protocols the ability of a common standard to meet investigative standards. Used the insights gained to advise IT on the nature of replacement software that would support the envisioned common procedures. Introduced the concept of “guest auditors” to conduct a stated number of file evaluations in each office and demonstrated the cost savings provided. Convened a team of experienced staffers in each location to perform audits until the “guest” arrived and gradually eliminated third-party audit assistance. Chaired calibration sessions and incorporated the input into file-quality goals with progressive installation steps stretched over the ensuing year. Created supervisor and manager training suitable for online delivery ensuring each group received all guideline updates at the same time in the same way. Secured cross-region support by reviewing each office’s first executive summary with local senior management, personally addressing concerns and unanticipated problems, and facilitating any necessary refinements.

After three audit cycles, the variation between regional self-review audits and corporate-wide evaluations improved from 11% to 3%. Auditor error sunk to .4%.

Each regional fraud-department office-maintained investigator staffing levels based on parochial practices and often overlooked state mandates. Devising a single hiring procedure acceptable to all local managers faced the challenge of accurately predicting which locations would experience what volume of investigations and when.

Gathered data on case activity (corrected for seasonal impact), compared the metric to investigator headcount, and calculated the maximum number of events each agent could discharge monthly. Analyzed six months of individual office records and forecasted the field force needed each month for a year. While preparing the presentation, received an alternate solution from the department director that relied on different variables. Asked by management to test both versions. The study confirmed the effectiveness of the initial methodology.

After four months in operation, the new staffing formula corrected associate shortfall by 7%.

The company’s eleven-year-old case-management system relied on old technology, contained eight identified security vulnerabilities, and did not meet the department’s operational needs in 25 areas. Corporate officers resisted funding remedies due to minimal appreciation of the system’s criticality and the lack of a sufficient cost-benefit analysis.

Engaged the head of IT in evaluating the feasibility of upgrading existing programming. Determined the need of more than one thousand hours to bring the system to acceptable functional standards while resolving only one of the security failings. Consequently, dismissed the revision idea and initiated a project with an enlarged scope. Thinking broadly, identified the potential of saving $1.8 million by combining available applications, SaaS products, and the automated scoring software in an enhanced resource. Requested a list of essential features for such a program from a team of corporate SMEs and sought ballpark pricing from three qualified vendors. During business-plan review, presented senior management with a detailed analysis of the cost reductions and emphasized the chance to achieve security compliance. Convinced the decision-makers that the investment gained more than merely greater user-friendliness. Earned budget approval and initiated the POC/RFP process.

After receiving a clear description of the upside benefits and downside risks, the company invested $600,000 in modernizing the case-management system.

COVID-19 quarantine restrictions forestalled continuation of the company’s traditional in-person training. However, the local offices did not have the equipment needed to conduct online alternative sessions.

Located a WebEx application that allowed adequate trainer-student interaction. Prepared directions on proper use, ran tests, and settled on the program as a workable solution. Charted a plan for the curriculum change, collaborated with training-department heads to troubleshoot expected obstacles, and conferred with IT on technology issues. Guided transition of classroom activities to the remote format and condensed or consolidated sections of the student manual. Prepared workarounds for tutelage not immediately amenable to digital presentation. Updated instructor manuals adding directions on quiz preparation and time management. Conducted train-the-trainer classes and held regular team meetings to keep the shift on schedule. Chaired a group session one week before the go-live deadline during which every teacher had to demonstrate proficiency with the WebEx tools. After each of the first three remote classes, offered daily assistance answering questions and providing direction.

Switching to remote learning saved the company hundreds of thousands in travel expenses alone. Those gains, and proof of training-quality maintenance, caused management to continue remote and self-guided instruction after the quarantines expired.

Below-goal results on customer-service surveys caused senior management to request an action plan capable of boosting ratings to 95%. No data existed to indicate which aspects of claims handling contributed most to the low scores.

Six months of analyzing survey data pinpointed low scores for “explaining the (settlement) process” as the primary contributor to the poor grade. Combed through adjuster performance reports in search of substandard call- and/or file-quality reviews or evidence of job-improvement mentoring. Evaluated the thoroughness of existing customer-service and file-handling directives to access possible contribution to the inadequacies. Discovered that certain types of losses consistently scored substandard service evaluations. Joined with performance coaches in restructuring predetermined responses to customer questions and ensuring adjusters understood the necessity of addressing all anticipated needs before ending phone conversations. Narrowed instruction away from the full call to a tighter focus on describing how settlements are handled. Designed and deployed an innovative training resource that replaced traditional in-person sessions, one-on-one monitoring, and group overviews with a suite of easily accessed online infomercials devoted to singular subjects. Introduced special call audits conducted by the training team.

Instead of taking the anticipated nine-to-12 months to reach the goal, the program succeeded in five.