Transcript IFA CLAIMS PROJECT PLAN revised with builds from A&L comm as

IFA CLAIMS PROJECT
PLAN
ISSUE
Claims Ambassador (“CA”)
There is an urgent need for a
dedicated person on the claims side
who will serve as a ‘claims
ambassador ‘. This person should be
well versed with the claims process
and at the same time should be a
person with good interpersonal
skills and be conversant in several
African languages.
ACTION STEP
WHO WHEN
• Identification and appointment of a Claims Ambassador – done (Kate
has been appointed on a 2-3 month trial period.
Job description and Key measurements of the CA will be reviewed
•Communication of the appointment of the new CA. (Russel to provide
Kate’s details to Kagisho for him to communicate this to the L&As)
•Kate should also be introduced at Leaders meetings in particular high
Areas such as KZN, WC, EC as a starting point
Russell/Riaz 30 Sept
Kagisho
Kagisho/
•Kagisho to be the liaison for all A&L claims queries. This is for managing Kagisho
the query process both ways.
3-5 sep
30
Sept
With
Immediate
effect
ISSUE
Claims Communication
Payouts
There needs to be a clear plan to
ensure that effective
communication of our payout
history is made to the network as
we often do not communicate this
effectively.
Ongoing communication
Communication around claims is
seen as sporadic and often in
response to issues at hand. A long
term plan needs to be developed to
ensure that Claims communication
is done on a regular basis.
Confidentiality
Due to confidentiality and legal
issues we are often not able to
dispel negative sentiment about
claims in the network even though
the claim has been addressed
satisfactorily.
ACTION STEP
• A detailed communication plan needs to be developed which will
address communication to both staff and the network. This plan will
cover the full spectrum of issues associated with communication of
Claims issues. Participants for this session are; Kagiso, Mthunzi, Aysha
Peter, Kate and Kemble. To be communicated to Francois and Riaz
WHO WHEN
Russell
30
Sept
The Communication plan should also cover:
• Payouts communication should cover monthly Rand amount paid
out, the number of policies paid out for the month as well as the
amount (in Rand terms) that has been paid out since inception.
•Communication around repudiations and reasons why should also be
addressed.
•Commission Guarantee info, which is a major selling point. We need
to get lots of marketing mileage on this benefit alone!
•Please add appropriate stories (without individual names). Its is the
stories not the figures alone that will demonstrate the benefits of claims.
•The plan should cover the ST and MT, and various channels from the
leaders meetings to Izindaba and posters.
• Francois to be provided with monthly info to add to “Sizwe’s column”
for the web.
Izindaba to have a corner set aside for claims on a monthly basis for at
least the next six months. Thereafter a review should be done and a
Column should be available every second month.
Russel l
• A workshop involving Claims, Compliance, Kagiso , Mthunzi and
Kemble needs to be conducted to explore alternatives to address the
Kagisho
negative sentiment arising from the legal and confidentiality constraints.
From
next issue
17
Sept
ISSUE
Network Education
Training
Training that covers the claims
processes and policies needs to be
provided to both staff and
presenters who in turn would need
to provide this training to the
network. This will ensure that there
is a common understanding of the
policies/rules and procedures
around claims.
ACTION STEP
WHO WHEN
TRAINING MANUAL
• The development of a training concept
Helen
/Russell
5 Sept
•The collation of a training manual.
Helen/
Russell
Mid
Sept
•Approval and sign-off of manual (by Riaz and Francois)
Helen
•Training commencing with staff training and thereafter presenters
(Kate to attend a select number of training sessions to better
understand issues faced by the network and where the gaps in
understanding are.
• Web friendly version (summarised) to be posted on the web.
Helen/ HR
Keeran
• Update the claims process flyers, print and circulate. This could also
be summarised onto banners and posters
Helen Aysha
End Sept
from Nov
to 2010
End Sept
Russell/Aysha End Sept
DVD (Sense from the L&A Comm meetings is that this is a nice to have)
• Exploration of the viability of a Claims DVD (Feasibility to be conducted Russell
by a team comprising Russell, Keeran and Leon)
End Oct
PRESENTATIONS
Presentations need to include a slide stating that applicants need to
read the application form and make sure that the product they choose
applies to their needs and health
Keeran
End Oct
ISSUE
Network Education
Education that covers beneficiaries
ACTION STEP
WHO WHEN
BENEFICIARY EDUCATION
• A flyer should be developed specifically for beneficiaries- “Notice to
your beneficiary” which is added to the policy pack and outlines what
a beneficiary needs to do to lodge a claim.
•Educating the network that the claim is only paid to the beneficiary and
What the implication is if the beneficiary is a minor.
To form one of the issues to be addressed in the Claims Communication
Plan.
Russell/
Aysha
Russell/
Aysha
Mid
Oct
30 Sept
ISSUE
ACTION STEP
Process Maps
PROCESS MAPPING AND REVIEW
The entire claims process needs to
be mapped and these processes are
to be reviewed and communicated
to staff and the network. This will
ensure that the network has a clear
understanding of the processes and
will reduce the level of uncertainty
or confusion that exists within the
network.
• Mapping of processes – Done
• Review of process maps ( to be done by Peter, Riaz and Aysha)
• Exercise to be done to assess what % of the funeral Comforter Benefit
Benefit paid on time. The aim is to determine whether we need a
different process without the need for an assessor for amounts
under say R 10k. This will mean that a dedicated resource handles this
- This has already been put in place
COMMUNICATION
•Formulation of communication concept
WHO WHEN
Peter
7-14
Sept
Peter
30 Sept
Done
Peter/ Aysha 18 Sep
•Approval of concept (Francois, Keeran, Mthunzi, Kagiso, Russell and Riaz) Peter
• Communication roll out
21 Sep
Peter/Aysha 23 Sep
ISSUE
Formulate a relationship
approach for funerals
Of Commission Earners
Attendance of IFA management at
the funerals of L&A and presenters
as well as of IFA at the funerals of
downlines and of commission
earners offers the business an
opportunity to reaffirm our culture
of being a family to the network.
ACTION STEP
• On a claim to be lodged, Claims to check if the person is a Commission
earner on view IFA. If commission earner advise IFA Executive team
WHO WHEN
Russell
18 Sep
Kagiso
18 Sep
•Rules of process and who to do what and sign off:
Commission Earners receive a call from the Regional Exec and Kagiso Club earners, must
receive a call from, regional exec, 1 snr. Exec, and CEO.Legends and Achievers must
receive a call from CEO and Chairman.
Call assigned to a member of Executive team to call family
Establish IFA position and activity in the network with BDS and or RBM
Based on position and activity levels of the IFA, an Executive attendance will be decided upon
Where possible a hands on assistance by the RBM .The assistance involves making sure all the
necessary paperwork for the FCB, where applicable, is dealt with and any other form of an
administrativeInitiatve and regular feedback bothways.
•IFA Division to invest in a funeral kit i.e
•IFA Tables
•IFA marquee
•IFA chairs
Mthunzi
30 sep
The funeral kit still needs to be investigated and costed and also the Logistics of who will have access
to the kit and test if the kit can not be a benefit offered in the future.
Claims on Line
The development of a web based
function which allows for claims to
be lodged on-line and to monitor
the status of the claim. As part of
this exercise a mobile solution also
needs to be considered.
• To conduct initial research and to formulate the concept which will also Russell /Tim mid Oct
Include a mobile solution
There could be 2 approaches, 1st set up the training and communication
documentation on the web, then investigate a claims on line processes.
Tim has been briefed on this and we would want to launch this before the
end of the year. Please include Tim in these discussions.
ISSUE
A&L issues
Current query process
ACTION STEP
A&L Committee
• the A&L Committee and IFA managers are to be provided with a summary of the
Peter
18 sep
Queries on a monthly basis. This summary will cover issues raised and how they were addressed at a higher
addressed at a higher level as given the regulatory and confidentiality issues it is not
always possible to provide the detail. The communication will be via email.
•Email list of members of the committee to be provided to Peter
Expiry date of forms
There is a misunderstanding within A&L
forum that claim forms have an expiry.
WHO WHEN
Kagiso
3 Sept
There is NO expiry date on the claims form. The only time there is an expiry date is
when it comes to ENCASHMENTS where there is an expiry date of 7 days. This is due to
the fact that we have to compute surrender values for encashments and these
values do not remain static but do change as the unit values which we use to compute
the encashment values change.
Thie above to be communicated to the network so that they have a clear understanding. Helen/Russell From Oct
This will be incorporated into the claims training process and feedback to be given to
A&L Committee
Riaz
3 Sept
A&L to assist in resolving and
expediting claims
Given the nature of our market , many of
whom are not familiar with technology or
are unable to read English the A&L believe
that they are able to assist the network in
expediting their claims.
There is a legal constraint regarding A&L acting as intermediaries. To explore what are
the alternatives approaches that can be followed without circumventing the law a
workshop is to be held comprising the A&L Committee, Claims, Kagisho, Kemble and the
compliance unit.
To consider fax receiving capabilities at platinum venues
Russell/
Kagiso
Keeran
18 Sep
30 Sept
ISSUE
A&L issues (cont.)
Reduced documentation
for Unnatural death claims
ACTION STEP
WHO WHEN
RESPONSE FROM CLAIMS UNIT ON UNNATURAL DEATH CLAIMS:
The claims department is aware of the challenges that many face in obtaining police
ADDRESSED
documentation for some claims received. This resulted in a review of the processes.
However any amendments to processes have to consider or build in adherence to laid
down laws, and regulations and at the same time must ensure that the process is always
fair and does not penalize a client unnecessarily. This review also considered whether
other forms of validations existed in the absence of police documentation. Last but not
least we also had to ensure that we are mindful of fraud which continues to affect the
industry as this has a direct bearing on our re-insurers who also have certain
expectations or process requirements.
By amending our process in SOME INSTANCES, we have been able to have a faster
turn around times when the police are unhelpful. But it must be borne in mind that
claims from certain areas, or having a certain cause/type of death are still assessed in
the normal regard as it has not been possible to amend our processes in such cases
given the requirements listed above.
Having said this though it must be stated clearly that if a document is waived, it does
not mean that all the police documentation is waived. We will continue to exercise
caution and follow processes as laid down by law, regulators and our reinsurance
companies.
The above needs to be communicated to the network by adding to the Claims training
document and the web document.
Above to be communicated to A&L Committee
Russell/Helen
Riaz
From Oct
3 Sept