Presentation on theme: "National Council of Self Insured Employers Max Koonce Sr. Director Risk Management Walmart Stores, Inc."— Presentation transcript:
National Council of Self Insured Employers Max Koonce Sr. Director Risk Management Walmart Stores, Inc.
2 Walmart Stores, Inc. is comprised of: Walmart U.S. (approx. 1,400,000 associates) 4,005 Walmart Retail Stores 602 Sam’s Clubs 142 Distribution Centers Walmart International (approx. 800,000 associates) 6,148 Retail Units 27 Countries
3 The Walmart Property & Casualty Focus: Receive prompt and appropriate medical care that is focused on their recovery and return to gainful employment; Receive prompt and appropriate disability benefits; Compliance. Workers’ Compensation ensure associates that suffer work injuries: Addressed promptly and appropriately while recognizing the importance of our customers in the retail environment; Compliance. General Liability Program ensure all customers claims are:
4 Flexibility To ensure continual evolution of the program it must allow for: Scalability Sustainability All tools must act as “enablers” to allow your property and casualty program to pursue overall company objectives.
5 Casualty Reserve Review - Q1 FY15 Program structure allows Walmart to concentrate on our associates and customers through: Self Administration RMIS Risk Control Process Improvement
6 Casualty Reserve Review - Q1 FY15 Administering claims through our wholly owned subsidiary TPA helps ensure: Appropriate claims management by: Data integrity: AccuracyAccuracy AnalysisAnalysis FunctionalFunctional Owning the processOwning the process Experience in best practices between in- house TPA and outside TPA vendorsExperience in best practices between in- house TPA and outside TPA vendors Compliance focusCompliance focus Direct relationship between operations and risk managementDirect relationship between operations and risk management
7 Casualty Reserve Review - Q1 FY15 Risk Control, although not part of our Risk Management Team, is an integral partner that focuses on: Accident prevention Safe place to work / safe place to shop Accident investigation Post accident support Risk Control
8 Casualty Reserve Review - Q1 FY15 Process improvement involves: Workflow process improvement Trend analysis Coverage Decisions Utilization of real-time data from all aspects to drive:
9 Casualty Reserve Review - Q1 FY15 Are there additional resources needed for the claims management process? How do you best utilize the available resources? At what point should resources be inserted into the process? Resource Allocation - What characteristics determine: Claim exposure; Claim difficulty; Claim duration. Based on score, who should be managing the claim? Claims Scoring - Workflow Process Improvements:
10 Casualty Reserve Review - Q1 FY15 What triggers indicate caution? What path should be taken based on the triggers to involve: Greater in-depth investigations: Additional external resources; Etc… Claim Triggers - Scoring Phases: As the claim progresses score at different intervals such as 90 day, 180 day, and 9 months. Progression determines path of handling. Complexity - Workflow Process Improvements:
11 Casualty Reserve Review - Q1 FY15 What characteristics determine outcome of the claim? Return to work Maximum medical improvement Claim duration How should those characteristics be weighted as to impact on claim resolution? Determine physicians who obtain best outcomes for your injured employees. Where allowed by state law, select physicians who obtain the best outcomes for your injured employees. Physician Modeling - Workflow Process Improvements:
12 Casualty Reserve Review - Q1 FY15 Property Business Continuity Planning Emergency Response Operations General Liability and Workers’ Compensation Safety Objectives Driving the APPROPRIATE behaviors Exposure - Trend Analysis:
13 Casualty Reserve Review - Q1 FY15 Supplier Rating What product do they provide? What is the risk associated? How is that risk going to be borne? Determine the Gap that is present in the coverage What should insurance package look like? Product - Coverage Analysis:
14 Casualty Reserve Review - Q1 FY15 In conclusion, our program structure: Works with our business model Ensures that we capture and evaluate the data to drive improvement Allows for optimum focus on our customers and our associates