From a Laval mail-opening floor to a mutual's operations

Mandate

Shorten the wait between a member's first contact and a decision, and keep claims and service running through site, supplier and workforce failures.

Outcomes

• Cut the median short-term disability first decision from eleven to six business days, counted from first notice
• Moved medical-document indexing to audited staff in Canada and built a register of 64 subcontractors
• Kept and cross-trained a second bilingual service site after a 26-hour telephony fault
• Introduced phased retirement with named successors for senior claims staff

Decisions in context

As chief operating officer I am accountable for what happens between a member's first contact and the moment a claim is paid, a plan is changed or a question is answered. Six vice-presidents and directors report to me, covering disability and health claims, contact centres, plan and policy administration, document operations, and supplier risk and continuity. I set the operating plan with our president and chief executive and present it to the board each year. Every quarter I report operational and outsourcing risk to the risk committee, including measures that look worse than we would like. I do not decide individual claims, set premiums or reserves, or approve investments. The three cases on this site come from this role. Each began with a measure or an assumption that was more comfortable than members' experience, and each needed money or time to correct.

Reason for the move

Current appointment; considering a first independent seat with my board's consent.

Mandate

Give members and plan sponsors the same quality of service in French and English, whichever site answers.

Outcomes

• Opened the Greater Sudbury centre in 2017 with 90 bilingual staff
• Traced repeat calls back to claims causes with the claims directors
• Moved both centres to home working within nine days in March 2020

Decisions in context

Running the contact centres meant hearing what our processes produced. A member who called three times about the same disability payment was usually reporting a claims problem, not a telephone one, so I worked with the claims directors to trace repeat calls to their causes. Choosing Greater Sudbury for a second centre in 2017 was a decision about bilingual labour supply as much as continuity; we compared four cities on French-speaking candidates and on staff turnover at comparable employers. The move to home working in March 2020 took nine days and depended on a small network team working through two weekends. Afterwards I asked for a list of everything that had nearly failed. Several items, including our reliance on one telephony carrier, were still open when the 2022 outage came, and I regard that as my responsibility.

Reason for the move

Appointed chief operating officer when the senior vice-president of operations retired.

Mandate

Make disability decisions faster and more consistent without increasing reversals on appeal.

Outcomes

• Set case-load limits for long-term disability case managers
• Began short written case notes capturing senior examiners' reasoning
• Built return-to-work arrangements with employers able to modify duties

Decisions in context

Disability claims taught me that speed and quality are not opposites, but they can be traded badly. A quick decline that is overturned on appeal costs the member months. I led examiners, case managers and nurses handling short-term and long-term files, working with our medical consultants, who held clinical judgement, and with legal colleagues on appeals. We set case-load limits after finding that some case managers carried more than 160 open long-term files and could not contact members regularly. When three senior examiners retired within a year, we discovered how much of their reasoning existed nowhere but in their heads. We began writing short case notes on difficult decisions. That modest practice became, a decade later, the basis of our phased-retirement programme for an ageing claims workforce, and it remains the part of this role I value most.

Reason for the move

Moved to lead member service and the contact centres, where repeat disability calls had become a visible problem.

Mandate

Run claims intake, adjudication and payment for client plans to agreed service levels.

Outcomes

• Reduced paper-claim turnaround from nine business days to five
• Introduced daily exception queues with named owners
• Prepared service and privacy evidence for client audits

Decisions in context

Halvenbrook administered health and dental benefits for self-insured employers and union benefit trusts across Ontario. It was my first role running a claims operation end to end, and my first using English as a working language. I managed adjudicators, a data-entry team and a small payments-reconciliation group, and became senior manager in 2008. The role showed me outsourcing from the supplier's position. Clients audited our service-level reports and asked about privacy procedures, yet almost none asked who else touched their documents, how our staffing would cope with a peak or what would happen if we lost a building. A supplier will usually answer accurately the questions it is asked. The questions a client never asks are where its exposure sits. I still apply that lesson when reviewing Vireloux's own suppliers and their subcontractors.

Reason for the move

Returned to Quebec when Vireloux asked me to lead disability claims operations.

Mandate

Replace paper file rooms in group claims with document imaging without interrupting claims payments.

Outcomes

• Converted health, dental and disability files to imaging over four years
• Wrote the document classification and indexing standards examiners used
• Cut file-retrieval time from about two days to minutes

Decisions in context

Vireloux hired me to help move group claims from paper file rooms to document imaging. I started as a process analyst, mapping how a disability or dental file travelled between mailroom, examiners and archives, and became manager of the programme in 2002. The technology supplier provided scanners and software; our work was to decide how documents were classified and indexed, and how an examiner would find a physician's statement among dozens of receipts. We converted the files over four years without stopping claims payments. I also learnt the limits of my discipline. A faster workflow that examiners did not trust would be bypassed within weeks, so we tested every change with them first. I completed a part-time MBA during this period, which helped me present the programme's costs and savings to finance colleagues without overstating either.

Reason for the move

Moved to Toronto to run a complete claims operation and to work in English.

Mandate

Measure and redesign the flow from mail opening to payment posting.

Outcomes

• Created an exceptions team that cleared unmatched slips in two days instead of eight
• Rebalanced shift staffing against daily mail volumes
• Introduced error-rate measurement at each processing step

Decisions in context

Quarvelle opened and posted bill payments for utilities and municipalities from a large processing centre in Laval. As an industrial engineer I timed and redesigned the flow from mail opening to posting, balanced staff across shifts and measured errors at each step. The most useful finding of those years was that the slowest stage was usually not the one that drew complaints. Posting was quick once an operator could identify an account; the delay lay in exception trays of unmatched slips that belonged to nobody. We created a small exceptions team with authority to contact clients, and unmatched items cleared in two days instead of eight. I reported to the operations manager and had no direct reports. The role gave me the habit of measuring a process from the customer's side of the counter, and I took that habit into insurance.

Reason for the move

Joined Vireloux to apply process engineering to an insurer's claims documents.