Answered step by step
Verified Expert Solution
Link Copied!

Question

1 Approved Answer

The following text describes tasks involved in processing of a medical insurance claim: Task A (Receive complete data from hospital regarding patient and procedure). This

The following text describes tasks involved in processing of a medical insurance claim: Task A (Receive complete data from hospital regarding patient and procedure). This takes 15 minutes per claim. There are four agents who each perform the data collection process. Task B (Adjudication of claim). A legal expert uses policy documents and Federal regulations to assess and ascertain the rightful claim amount, which requires 25 minutes per claim. There are five experts who each perform adjudication of claims. Task C (Payment). This requires an agent to set up transfer of payment to the hospital, which takes 10 minutes per claim. There are three agents assigned to take care of this step of the process. To cap the number of instances a processed claim is challenged by the hospital or the patient, the insurance firm has hired an expert to randomly evaluate 15% of the processed claims once the transfer payment has been set up (i.e., upon completion of Tasks A, B, and C). This expert takes 40 minutes to evaluate the claim and make any adjustments, if needed. Recently, the firm has been receiving a high number of complaints regarding settlements of claims. To further improve the quality of service, the manager decides to hire a graduate student intern, such that this intern will randomly evaluate P% of the processed claims once the transfer payment has been set up (i.e., upon completion of Tasks A, B, and C). The intern, due to lesser experience, will take 60 minutes to evaluate the claim and make any adjustments, if needed. What should be this P percentage, such that the rate of processed claims does not suffer/decline upon adding the graduate intern to the process? (Choose the highest possible value from options stated below.)

For the insurance firm question above, please provide a brief description of steps followed to obtain the answer.

Step by Step Solution

There are 3 Steps involved in it

Step: 1

blur-text-image

Get Instant Access to Expert-Tailored Solutions

See step-by-step solutions with expert insights and AI powered tools for academic success

Step: 2

blur-text-image

Step: 3

blur-text-image

Ace Your Homework with AI

Get the answers you need in no time with our AI-driven, step-by-step assistance

Get Started

Recommended Textbook for

Public Finance In Canada

Authors: Harvey S. Rosen, Ted Gayer, Jean-Francois Wen, Tracy Snoddon

5th Canadian Edition

1259030776, 978-1259030772

More Books

Students also viewed these Finance questions

Question

How is the education level required for a position established?

Answered: 1 week ago

Question

Why is a job analysis important?

Answered: 1 week ago