When a new claim is submitted to the city, the assigned adjuster must successfully set up the claim file in the City’s claim handling system, or RMIS (Risk Management Information System), now handled by Origami Risk, in order to document a claim file with necessary information related to the claim file and investigation until the file is resolved and closed.

This measure allows us to see how efficiently and effectively our division is responding to new claim submissions to show we are providing customer service.

The more timely we set up a new claim in Origami, the better the customer service we are providing internally and externally. The higher the percentage, the more timely we are setting up the claim file for handling so it shows we are providing customer service. The lower the percentage, the less timely and efficiently we have set up new claim submissions so it shows our customer service will need to be improved by setting up claim files more timely.

Our target is 95% of the audited files were timely set up in Origami after assignment of the new claim file is given to the adjuster. It is an ongoing measurement of our customer service and efficiency in claim file handling. The closer we are to 100% shows that our adjusters are properly handling the newly assigned claim files as expected. We also compare it to our prior year to see any improvement in our customer service. The measure is based on the number of newly set up files set up within 1 business day, or 24 hours, in the randomly audited files, pulled monthly, divided by the number of actual assigned files audited. For instance, 4 completed timely file set ups/5 assigned audited files = 80% completion ratio. I audit up to 5 random files assigned to each adjuster for the prior month or, if the adjuster received less than 5 new claim files, the amount actually received.

Data Source Details & Calculation Information:

Data for this KPI comes from Origami Risk Database, which is accessed by named users only. Currently only members of Risk Management have access to this database.

To download data:

1. Login to Origami Risk Database with proper username and password.

2. Select the Reports tab at the top of the page and scroll down to select Report Name: New Claim Report – Monthly J.

3. Run report as a pdf or excel spreadsheet. I prefer an excel report so I can cut and paste the required information.

4. Download the report. It is saved on Jason Barksdale’s desktop under a folder named Performance Review FYxx (the xx is based on the current fiscal year, i.e. FY17).

5. Inside Performance Review FY17 folder are individual folders named by adjuster.

6. Inside each adjuster folder is a Performance Audit excel spreadsheet titled: Adjuster – FY2017 pt1 Performance Office Audit Info.xlsx. The Audit sheet is set up for monthly audits for the 1^st half of the current fiscal year. The 2^nd half of the current fiscal year is designated by pt2 in the title. An example of the title is: Adam – FY2017 pt1 Performance Office Audit Info.xlsx.

7. Up to 5 claims are randomly selected from the New Claim Report – Monthly J report, per each adjuster, (if adjuster does not have 5 claims then just an actual amount opened for the adjuster is used) and transferred over, cut and paste the claim number and claimant name, to the Adjuster – FY2017 pt1 Performance Office Audit Info.xlsx audit spreadsheet and saved under each adjuster’s file in this folder. The claim number and claimant name are pasted into Column B and C in the excel spreadsheet.

8. Each adjuster’s randomly selected claims are audited according to the criteria established on the Adjuster – FY2017 pt1 Performance Audit Info report to determine if the received claim was set up in Origami within the acceptable timeframe – which is 24 hours/1 business day of receipt by the adjuster. This information for the audit is gathered by going into the specific claim file in Origami Risk to review the dates and notes that document the date it was set up in Origami by the assigned adjuster. It is a Yes (Y) or No (N) answer on the audit in column F to determine if it was completed. The amount of Yesses are added up at the bottom of each month and used for the measure against the amount of claims selected for the audit for that month.

9. Once all of the adjuster audits are complete, the number of claims selected for audit and the number of Yesses generated from each adjuster audit spreadsheet are transferred over to another spreadsheet found in the Performance Review FY17 folder titled: Performance Office Information 2017.xlsx (it is also set up and saved as new for each fiscal year thus updating the title with the fiscal year). This is where the measurements are saved according to each individual adjuster. The total amount combined for all adjusters for audited claims and completed with a yes are found under columns AA and AB for the associated month. The combined numbers for the month are then transferred to the ClearPoint data sheet 407984. It is a ratio based on the number of Completed Yesses divided by the number of actual files audited (example: 23 completed Yesses / 25 files audited = 92% were successfully completed).

Series, Formula, & Target Information:

On the ClearPoint data sheet, laid out by month within the fiscal year, Column B captures the amount of received claims entered timely, yesses made, from the audit for that month; Column C captures the total files audited for that month. This measure shows our percentage of our documented customer service by verifying if the adjuster has timely set up the newly assigned claim in order to begin handling it.

Column B was changed to “Total # of received claims entered timely from audit each month.” Column C was changed to “Total # audited each month (for claims entered).”

The calculation is (Column C/Column B = %) or Column C – Total # of received claims in month / column B - # files audited in month. If 23 claims were entered timely from the audit / 25 files audited in month = 92% were successfully completed.

Targets:

There is a target of 95% of the audited files to be successfully entered into Origami Risk timely.

High variance is 95% or greater.

Low variance is 88%, which is based on the 2^nd half of FY16 actual completion percentage of this measurement and when the standard was implemented

Evaluation:

The high variance percentage is attainable and still leaves room for an occasional mistake in either forgetting to set up a new claim or not doing it until after the 1 business day/24 hour requirement for a claim. It reflects the level of efficiency and customer service provided by the adjusters in claim handling.