Absence Management Consulting Case Study

The Situation: A healthcare products and services company with nearly 50,000 employees and $10 billion in annual sales was providing absence management through multiple vendors, each of which operated independently with minimal central coordination.  With approximately 2,000 open FML/STD claims at any given point in time, there was significant dissatisfaction in the field with absence management services. The process was also plagued by high costs, inefficient processes, fragmented services with unclear accountabilities resulting in high instances of incorrectly handled claims, long cycle times and a high risk of non-compliance. In addition, the company was collecting little data on absence management which made it virtually impossible to reduce absenteeism or enhance services.

Our Approach: Our first step was to gain a clear understanding of the situation, the client goals, absence management philosophy and past issues. Our approach then consisted of three major phases:

(1) Absence Management Strategy and Solution Design

  • Led by Six Sigma Black Belt, per the client’s preference
  • Aligned with business strategy, field input and buy-in
  • Re-designed/developed consistent processes through rigorous and through process mapping
  • Selected new technology capable of serving as a central absence management data repository

(2) Rollout and Change Management

  • First launched proof of concept in the form of a pilot to further refine model and gain field buy-in
  • Created detailed SOP documents for each process
  • Worked with technology and business staff to implement new system
  • Trained field HR staff in new processes and systems
  • Assisted with communications to HR staff and employees

(3) Short-term Outsourcing

  • Assumed short-term responsibility for processes and centralized services
  • Cross-trained internal staff
  • Recruited long-term manager, nurse case manager and transitioned services to staff

Primary Solution Components: The client’s ultimate goal was to in-source FML and STD claims management. Given the organizational environment, we advised the client to establish a high-touch, decentralized model with field HR representatives who tasked with processing and managing claims for their employees which provided the field control and high level of customer satisfaction that the company had not experienced under its former program.  Ownership of technology, processes, claims approvals and light nurse case management was centralized to ensure consistency and integrated through a main call center that served as a central point of contact for all inquiries.

LTD disability and Worker’s Compensation claims continued to be handled by external vendors but service levels were tightened and processes were better documented. Overall, all processes were re-engineered to eliminate non-value added tasks and shorten timeframes for turnaround. The legal team was also integrated into the process to ensure that risks were reduced to the level acceptable to the company.

The Results: Our work at the company:

  • Significantly enhanced customer satisfaction.
  • Reduced total absence management costs and vendor costs.
  • Better integrated the overall absence management program.
  • Created a central repository of data and gave our client the ability to produce comprehensive absence management reports.
  • Increased consistency in claims processing and reduced the overall risk of non-compliance.