Key Results Summary

Developing Scenario / Role Based Training for a Claims System

Situation:

The casualty claims units of a major international insurance firm implemented a new claims handling system that included a Diary function. Managers, Adjusters, and Claims Assistants within each casualty unit used this tool to:

• Record notes in each claim file about the work that was done and the steps taken to settle each claim.
• Record reminder notes for activities and/or follow-up required in the future.
• Communicate instructions to other unit staff such as a Manager recommending an action to an Adjuster.
• Schedule regular file reviews.

At the time the module was first introduced all staff were trained in how to use the Diary tool. That training was conducted by job title; i.e., all casualty Adjusters were trained as a group.

Several months after the Diary tool was implemented the Claims File Review team noticed that claim files were not being documented as well as they could be and that the volume and quality of Diary notes was much lower than it was under the old manual system. Claims management requested refresher training for all staff using Diary.

Action Plan:

Interviews with casualty claims staff were conducted. The major gap in their understanding of the tool was how it allowed them to work together and coordinate file activities. Discussions with the File Review team provided numerous examples of claim files that were deficient.

Six claim file handling scenarios were created that were based on actual examples. These scenarios stepped through the handling of each claim over the course of several weeks or months. The File Review team provided “best practice” tasks and activities for each scenario. These supplied Diary tasks for the roles of Manager, Adjuster, and Claims Assistant within the casualty units. The scenarios and tasks were cross-checked against the Diary functionality to make sure that every aspect of the module was covered.

Training claims were created and processed to set them up for the scenarios. Training curriculum was written to provide the functional training and quick tips to use the Diary more quickly and efficiently. Since best practice techniques were used to create the activities these were also part of the curriculum.

Each casualty unit in all claims offices were scheduled for refresher training. Units were scheduled at the same time so that the various training scenarios could be processed as a group in the hands-on exercises.

Results:

All casualty units in every office were given the refresher training. Each unit staff member played their own job role in the hands-on exercises processing the six claim file scenarios. Trainees were provided a hands-on review of the modules functions, tips and tricks, and best practice file Diary techniques.

Within two months the File Review team reported a marked increase in the quality, consistency, and volume of file Diary notes. Casualty unit staff members surveyed after the training reported that the tool was much more useful and easy to use after the training because they all knew how their work interfaced with other unit members and how to use best practice techniques to quickly Diary their files.

Long-term Results:

This course was subsequently made available as an e-learning course. The scenarios, tasks, and other course content easily converted to online presentation. The course was designed to identify which role the trainee was learning such as Claims Assistant. Based on that information the other two roles were simulated within the course so that the trainee experienced the interaction and flow of information in addition to learning specific functions, best practices, tools, and tips/tricks.