REQUIREMENTS WORK PLAN
Claim Management System Implementation Project
Alberta Benefit Plan Ltd.
Prepared By
Daniel Price
November, 15, 2010
DMIT228
Section C CONTENTS
CONTENTS 2
INTRODUCTION 4
Document Purpose 4
Document Overview 4
Project Overview 5
ORGANIZATION 6
Organization Structure 6
Requirements Roles and Responsibilities 6
Requirements Schedule 7
Requirements Resourcing 8
Budget 8
Tools, Techniques, and Methodologies 9
REQUIREMENTS REPOSITORY 9
Requirements Artefacts 9
Requirements Types 9
Requirements Attributes 10
Requirements Traceability 10
RISK MANAGEMENT PLAN 10
Purpose 10
Risk Management Strategy 11
Responsibility and Accountability 11
Risk List 11
REQUIREMENTS ACCEPTANCE PLAN
…show more content…
Internal Communications Lists internal communications and describes how they are done.
External Communications Lists external communications and describes how they are done.
Escalation Contacts Lists the name and contact information of the people who serve as escalation points and describe what areas they are responsible for.
Project Overview
The name of the plan is the Claims Management System (CMS) Implementation Project. This is a corporate-wide strategic proposal, involving stakeholders and representatives from all functional areas within the company. The plan of this project is to increase the effectiveness and efficiency of the information systems used by the Alberta Benefit Plan personal. This is absolutely critical to the prosperity and longevity of the company.
This Claims Management System (CMS) must be integrated seamlessly into the existing Member Enrolment Management System (MEMS), which was successfully deployed two years ago. The two systems should run together without any hiccups. The initial scope includes the following claim types, which need to be confirmed and revised during project initiation:
• Dental care claims
• Extended health/vision care claims
• Short-term disability claims
• Long-term disability claims
• Life insurance claims
• Health spending account reimbursements
The ultimate goal of this project and this system is to help increase market share for the
EMGT 170 class will hold a 5 kilometers run called the Pacific Undies Run as a part of our class
We discussed in the previous theme the development of a market and how to determine if a product fits or if it needs alteration. Now, we look at the product in the marketplace and how long it can survive.
This business plan leads the way. It renews our vision and strategic focus on the quality and value we put in our products and the market segment originally targeted. Our vision has been broadened by the success we have found in the marketplace, to the extent of adding new products and current plans on additional items and services. It has given us a step-by-step plan to meet and exceed our goals for increased sales, gross margin, and
Presented results and devised a business case for the Board members, detailing the impact, the financial gains both in purchasing the system and the saving it would inevitable produce, the time frame to implement and start analysing its effectiveness and any constraints it may show, which was very negligible.
Next we proceed to another significant role within the MCO. This sector is labeled enrollment and billing. As these individuals ensure that the clients are enrolled in to the MCO’s administrative IT system (Kongstvedt, 2009). This system enables outside medical providers to confirm that the client is eligible for medical coverage. Furthermore, this system enables the MCO to properly bill employers the correct capitation payment in order to keep members enrolled (Kongstvedt,
Working in partnership with injured workers, employers and other stakeholders to deliver a high standard of customer service at affordable prices that are valued, with teams managing specific industries to provide end to end claims management process, from claim determination through to return to work (WorkCover Queensland 2015c). The Customer Services division aims to enhance claim management outcomes to deliver better services to customers. This division is the main issue focus of this report defining CRM issues.
The modern claims capability which works on a monumental scale has been built on decades of rising and competing demands. Nationwide, the current claims are capable enough to support and finance the largest economy of the United States. Therefore, this protects the millions of Americans from catastrophic loss due to medical expenses, supports disease management, safeguards against medical fraud and abuse, plays a crucial role in tracking national healthcare trends, and warning against bioterrorism and health pandemics. In order to finance and handle this program, employers tried to seek the help from the multiline insurance companies to estimate the financial risks involved and analyze the process claims. To reflect the enhancing complexity in the field of healthcare, financing and billing practices by the provider have brought many changes (Kongstvedt, 2012).
Huffman Trucking has recently decided to change the health insurance benefits for its Union-represented employees, offering a choice of a standard and a premium health plan with different premium, co-pay, and deductible options and offering a choice between a standard and a premium dental plan, as well. In order to efficiently and securely track the benefit election options of each of its employees and maintain a system of tracking benefit selection, use, and more, Huffman Trucking has issued a service request for the creation of a software program that will enable user and administrator access to necessary information. The following paragraphs examine issues relevant to the development of this system and its implementation that should be considered by those responsible for carrying out these tasks.
Once completed, the corporate assets should be more than adequate to support MRP usage along with other corporate endeavors in the ERP realm.
By combining these two strategies, we will generate moderately low R&D costs, granting us the option to either pursue high contribution margins or competitive prices, depending on the demands of the evolving markets. In the early stages of our products’ life, a large portion of capital funding will be allocated towards awareness and accessibility for our product in hopes to obtain a large market share through the various promotions and sales our marketing department will implement. As our company continues, one third of previous marketing funding will be reimbursed to maintain customer awareness and accessibility. Our Company will focus on generating a high production capacity for all of our products as early as possible. Estimated capacity growth will be greater than annual industry growth. Automation will also be a key production focus and is essential to limiting costs and increasing margins. In order to finance such activities, a large amount long term debt will be issued in early rounds to support company growth. Stock may also be issued when additional funds are needed. We welcome the leverage such financing methods will bring as it will be needed to finance and achieve our ambitious goals. In later rounds we will look to increase stock prices and equity through stock retirement and dividend distribution.
Excellence in fulfilling the promise. Clients do not buy features, they buy benefits. To realize a benefit, a claim must be made and proof presented. This company has had success on claim after claim.
This Feasibility Study Template is free for you to copy and use on your project and within your organization. We hope that you find this template useful and welcome your comments. Public distribution of this document is only permitted from the Project Management Docs official website at:
However claims management is actually simple to understand. Claims management is the practice of handling claims made by insurance company clients. Many people make insurance claims every day. In fact approximately 6 billion insurance claims are filed each year (Federal Bureau of Investigation). The responsibilities of claims managers can fluctuate greatly depending on what type of insurance policies their company’s offer, The United States Department of Labor database Occupational Safety and Hazzard clarifies the general responsibilities of a claims manager,” responsible for the overall management and direction of all administrative matters pertaining to compensation for injury and claims related activities (other than injury) for an incident” (United States Department of Labor). Claims manager are overseers of risk management in the prevention of incidents and loss of company funds. To do this claims managers are in constant contact with an employer’s Incident Safety Officer, Liaison Officer, or a Company Human Resource Manager (United States Department of Labor). The role of a claims manager also includes common management responsibilities such as supervising other members of staff, overseeing insurance sales, and dealing with any complaints relating to the sales staff (Claims). To be a successful claims manager one must have a bachelor’s degree to enter into
This provides the information for Project Sponsor to understand the current business as well as the expected change(s) in this SRS.