Rebecca Jones

Challenge

Complex claims are rarely complicated by one issue; they are complicated by how the issues interact. On one trip, a delayed flight caused a missed cruise embarkation, the baggage was delayed, and the traveler became ill on board. Each event touched a different benefit, with different limits, conditions, and documentation.

Approach

• Reconstructed the full timeline from itineraries, receipts, airline records, and medical documentation
• Interpreted the certificate to determine which benefit applied to each expense, including medical, delay, and baggage coverage
• Applied limits, deductibles, and currency conversion, and identified recovery opportunities with the airline
• Documented the rationale clearly as the official claim record, so the decision could withstand any review

Result

• An accurate, fully supported decision the traveler could understand, even on the parts that were not covered
• A file that held up to quality review, part of sustaining 90%+ audit quality
• The foundation for later work: knowing exactly what a defensible file looks like, and what it costs when a claim is handled poorly

Challenge

Claims overpayments, known as leakage, represented significant financial risk, yet they had never been measured consistently. Leaders needed one clear view of where leakage occurred and why, so they could act with confidence.

Approach

• Applied headquarters' methodology and defined the root-cause categories that explained why leakage occurred
• Co-designed a layered KPI framework with Quality and Claims leaders, moving from Financial Accuracy to Payment Accuracy to leakage and root cause
• Authored about 30 Standards of Practice and quick reference guides to make the standard repeatable
• Led the enterprise rollout in partnership with each business unit, directing the Power BI reporting with a dedicated reporting partner

Result

• Multimillion-dollar annual leakage quantified for the first time
• Double-digit improvement in Financial and Payment Accuracy, surpassing target
• Leakage on examiner-handled claims reduced by more than half
• Rolled out as the baseline for every business unit

Challenge

A pass/fail audit told leaders whether an error occurred, but not what it cost. Review time was spread across routine data-entry checks instead of the outcomes that mattered most: financial accuracy, compliance, and the customer experience.

Approach

• Partnered with Quality and Claims leadership to redesign the audit, replacing pass/fail scoring with weighted measures of compliance, financial impact, and customer satisfaction
• Refocused reviews on claim outcomes rather than routine data-entry checks, and streamlined feedback requirements for reviewers
• Established a tiered calibration cadence with team leaders, managers, and directors, so every level scored and coached to the same standard
• Turned audit findings into targeted corrective actions, including retraining, mentor pairing, and authority adjustments, and created a feedback guide later used in new-hire training

Result

• Laid the foundation for the Financial Accuracy, Payment Accuracy, and leakage measures later adopted globally
• Faster, more focused audits, with reviewer time redirected from documentation to the outcomes that matter
• One consistent quality standard, from frontline associates to directors
• Coaching tied directly to evidence and built into how new hires were trained

Challenge

Training alone was not closing a persistent accuracy gap in examiner-handled claims, and leaders wanted faster payment for customers. Automation was the answer, but leaders were concerned it would increase leakage rather than prevent it.

Approach

• Mapped the end-to-end workflow and partnered with Business Intelligence to analyze representative claim samples, building the evidence for change
• Partnered with Claims and Quality leaders to simplify the workflow, cleared through compliance review
• Addressed leadership's leakage concerns by defining eligibility safeguards, based on coverage, timing, and data requirements, that routed higher-risk claims to examiners
• Helped enable structured data capture that allowed automation to process eligible claims without manual handling
• Audited automated performance from start to finish and partnered with the RPA developer to refine the decision rules until the gap closed

Result

• Leakage on automated claims reduced by about 90%
• Payment on eligible claims accelerated from weeks to days, and then to as little as one day
• Fewer document requests and stronger first-touch resolution for customers
• Examiners freed to focus on complex claims, and the operation better able to absorb volume surges during hurricanes and winter storms
• Expanded into full-scale automation across U.S. Claims, then globally, and recognized with an Allianz Stars award

Challenge

Quality reporting was assembled manually after month end, so leaders saw trends only after they had become problems. They needed timely, trusted insight to act early.

Approach

• Defined the data requirements with Business Intelligence and designed a data model built around how leaders make decisions
• Built KPI measures for Financial Accuracy, Payment Accuracy, and leakage rate, by volume and dollar value
• Designed a highly customized drill-down experience, from the executive view down to granular root cause, with performance flagged against targets
• Validated every measure against source data, led user acceptance testing with managers, and published a step-by-step user guide

Result

• Real-time visibility replaced multi-day month-end reporting
• Leaders began partnering with their teams immediately on the impact of their work, and coaching started sooner
• 26 team leaders and 5 managers trained to self-serve, with reporting reaching audiences up to the COO
• Time once spent on manual reporting redirected to deep-dive analysis and process improvement for leadership
• The executive-to-root-cause design became the model for later reporting, including global leakage reporting, and was recognized with an Allianz Stars award