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Existing Situation: lvls Jones is the CEO of the Sunshine Insurance Company that offers all kinds of insurance policies. Business is very good and is
Existing Situation: lvls Jones is the CEO of the Sunshine Insurance Company that offers all kinds of insurance policies. Business is very good and is expanding every month by about 10% increase in sold policies. However, disability claims are also in the rise about 15% over the previous year. During the year end review, lvls Forester has discovered some serious issues and has contracted you as the Business Analyst team to identify the problems along with suggested solutions. The rst area under review is the disability claim ofce nicknamed \"The Settlement Bucks Team\" (SBT). The adjusters are nding themselves victims of clients who constantly call, follow them home and some to the point of harassment. This happens for various reasons; some are unhappy with their settlements, others are attracted to the adjuster. The company wants to keep a personal touch with the client, but is experiencing staff turnover and move requests. Currently, the adjuster is required to contact the client as soon as a claim is received. All claims are rst submitted by a phone call and are followed up with a standard claim form mailed out to the client with a personalized letter from the adjuster. Each adjuster signs the letter and encloses their direct line telephone number for the client to call, bypassing the main switchboard. Each claim is handled individually and can take up to 6 months to reach an agreeable settlement. Once the adjuster has reviewed the submitted claim a recommendation is sent to the supervisor. The recommendations can be assign an investigator, suggested medical treatments, deny the claim or a suggested settlement. All decisions are communicated to the client, rst by telephone and conrmed with a letter. The SBT group takes great pride in their work and their client satisfaction level is at a constant 97%
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