Workforce Management: VSP Automates to Meet Claims Demands

As the nation's largest vision benefits provider, VSP receives more than 16.5 million claims a year. To handle that volume, the Sacramento, Calif.-based insurer developed its own claims system in the early 2000s, but it retained a variety of manual processes and relied on experience and intuition to ensure the smooth and timely handling of claims, acknowledges Mark Lingren, VSP's claims operations manager.

As a result, maintaining demanding service levels -- for example, the company commits to paying 95 percent of its claims within five days -- often was achieved at the cost of adding overtime at periods of peak activity, according to Lingren.

Seeking to modernize this aspect of its claims organization, in July 2010 VSP began working with Melville, N.Y.-based Verint to streamline processes, align and automate the assignment of claims to processors based on skill set and availability, and measure service levels intraday so the carrier could more effectively make adjustments to workloads to meet service deadlines without incurring unnecessary overtime, Lingren reports. VSP officially kicked off the transformation project in September 2010, working with Verint to observe processes, determine best practices, and establish future forecasting models using the vendor's Impact 360 Desktop Process Analytics (DPA) and Workforce Optimization (WFO) tools to improve the flow and efficiency of claims processing, according to Lingren. "We're making a transformational change into a more automated environment for managing our business when it comes to managing staff, claims volume and inventory, as well as implementing a way of projecting what the future will look like," Lingren says.

"Our way of assigning staff and forecasting our incoming claim volume has traditionally been a very manual process executed at the unit level and relying on individual experience," he continues. "With the Verint tools, instead of every supervisor having to decide every day what staff will handle what tasks, we can automate assignment and take the guesswork out of daily operations."

Anthony O'Donnell has covered technology in the insurance industry since 2000, when he joined the editorial staff of Insurance & Technology. As an editor and reporter for I&T and the InformationWeek Financial Services of TechWeb he has written on all areas of information ... View Full Bio