What do an attorney, a fraud investigator, a claims analyst, a medical credentialing specialist and a university advisor have in common?
While these professions are vastly different on the surface, they all share core underlying requirements in how they have to handle their work, writes Monique Williams, Hyland Southern Africa regional manager.
Each occupation involves:
* A need to gather, organise and coordinate information, data and documents.
* A need for ongoing evaluation, assessment and review.
* The requirement of a knowledge worker to make decisions.
* A need to be prepared for internal or external audits.
* The need to manage compliance
These requirements make all the vocations outlined above well-suited to leverage a case management solution approach to better manage the content and processes that surround their everyday work. However, a common misconception exists that case management only has a role in certain industries. For decades, healthcare has used case management in planning and coordinating patient support, resources and wellness services. The same goes for areas like social services and court case management, where the concept also has long-time roots.
Yet, the approach and supporting software capabilities of case management can deliver value across many different industries and types of work.
* Contract management – All organisations have a need to store and manage contracts, amendments, key third-party information and other supporting content that defines relationships and obligations. Once approved and executed, contracts are routed for review and renewal at specific time periods, requiring attorneys, or contract administrators, to update information and decide whether to renew, renegotiate or terminate agreements.
* Fraud investigation – When a suspicious transaction, or some other event, triggers the start of an investigation, fraud investigators need to gather and organise all information and supporting content related to the client. Next, they analyse and evaluate the evidence to make an effective decision: whether this is indeed a fraudulent transaction or just a false alarm.
* Claims processing – When a customer makes a claim on a policy, the claims adjuster must review and assess the claim, gathering all related information — from underwriting decisions to claim history. The adjuster assesses all information — including first notice of loss documents, medical bills and correspondence — in order to make a decision on approving the claim.
* Medical credentialing – For each clinician that a hospital or healthcare organisation employs, it needs to collect, organise and store background information, and all appropriate accreditations, certifications and licenses, as well as other details such as degree and continuing education information. That’s a lot of information. And these credentials must be assessed, updated and evaluated on a regular basis by credentialing specialists to identify any deficiencies.
* Student records – University advisors require a full view of all the information surrounding a student, including all related content, upcoming appointments, a history of dropped courses and a way to collaborate and take notes, to ensure they are able to provide appropriate guidance students need.
In all these vocations, audits can happen at any time, so organisations must be prepared to provide timely access to information, documentation and a history of interactions to avoid fines and penalties. In addition to sharing common requirements, these processes also share a legacy of ineffective handling via tools like Excel spreadsheets, email inboxes, disorganised network shares, paper files and antiquated Access and Lotus Notes databases.
Within these five different areas, types of knowledge workers and unique problems comes five opportunities for one effective case management approach. The right case management platform has the configurability and flexibility to solve all these issues and more, regardless of the industry served or type of cases.
Companies adopting case management capabilities are reaping the benefits, including a complete, central view of all information. Work is faster and more effective, tasks are streamlined, conversations are tracked and managed, and key data and documents are instantly accessible. Case management capabilities improve collaboration and offer support for audits and compliance.
However, the greatest benefit of case management can be seen with the actual recipient of the service — the customer or client, patient or student. Better case handling and access to information in context means more personalised service, faster incident resolution and more accurate investigations.