In the Beginning: The BSM Scenario
dmcclure 0600011K8N Visits (1805)
Without providing a lot of background, I'd like to see some comments from the community along these lines:
“Kristal is away from her normal workspace and is noti
Since early this morning, Kristal has been getting bombarded with emails and text alerts from the Sally on the HealthCo account team saying that members from HealthCo, a key partner, cannot submit online health claims.
Kristal received a text message from Bill the manager of the HealthCo Claims Support Contact Center saying that the call center is experiencing high call volumes today and they don’t have enough staff to answer all the calls.
In between meetings, Kristal checks her mobile dashboard and reviews her critical success factors (CSF) and current performance and status.
The main screen shows a list of CSF categories relative to her LoB’s business goals, objectives and expected outcomes. She sees the Member Care Claims category is depicting a red status and shows that there are two of three CSFs in this category that have currently active violations. She swipes across that category name and moves to the next screen showing all of the CSFs in that area.
Kristal notices that a CSF associated with member care claims submitted via the online portal is in a critical state, a CSF associated with telephone claims submission is in a marginal state and a CSF associated with claims submitted via branch agents is in a normal state for the current day. She swipes across the critical CSF to reveal the three key performance indicators relative to claims submitted via the online portal, their current values and status relative to their daily targets and their trend over the daily target period. (the daily target may be a portion of a bigger target period (e.g. monthly target))
Success % / Failure %
Avg Resp Time
She reviews the screen and sees that the total number of care claims submitted for the day is 495 which is well off from the expected target for today. The number of claim submission failures and the average claim submission response time has been trending in an abnormal direction over the past four hours. She swipes back and then across the CSF for telephone claims submission and reviews the KPIs for that CSF which indicate the call volume has been trending upwards over the past four hours and is in a marginal state.
Kristal reviews the mobile dashboard situational awareness page and does not see any currently registered outages or incidents from her organization that may be the cause of these problems. Kristal has a feeling that there may be a problem related to the care claims portal application and immediately contacts her application expert Melissa indicating via text message that there may be a problem with the care claims application as seen in the current KPI trends for care claims submitted via the online portal application.
Kristal clicks the ‘send message’ button on the dashboard and navigates through her contact list to find Melissa’s contact information. She taps the icon to include a link to both the mobile and browser based dashboard so Melissa can review what she sees and sends the message.
Concerned about how the current status and performance may be impacting her key partners, Kristal navigates to review critical success factors and KPIs relative to her top five partners. She quickly notices that service quality being delivered to HealthCo has degraded from expected objectives. She contacts Sally on the HealthCo account team to let her know she has her team actively investigating the problems that HealthCo members are experiencing. Kristal promises Sally that she will update her as soon as possible and that if needed she can call the HealthCo executive team directly.
Kristal monitors the situational updates from Melissa by watching for updates to her mobile dashboard’s situational awareness page. She sees that Melissa has engaged with the technology team and the next update is expected within 15 minutes.