IT Hire Wire

Jim Tomczyk
Project Manager specializing in IT healthcare
Hudson IT Contractor

Q: What has been your career path?

A: My path to project management began years ago, when I was a developer. I learned early that even the most elegant code (coding is an art form, after all) was useless if it didn’t serve the customer’s needs. By always keeping the customer in mind, it helped me to learn and grow the skills needed to move up the ranks in IT: requirements analysis, design, development, testing, implementation and support. My PM experience has included projects across several industries, including my current assignment in the Enterprise Program Management Office at a major health insurance company.

Q: How has the current economic environment impacted customer service? 
 
A: After too many years of neglect due to trimming the bottom line, companies are finally realizing that they are losing more revenue from bad customer service than they are saving by their cost-cutting measures. Customer service has become common fodder for comedy skits such as on “Saturday Night Live!,” to the point where it has almost become an oxymoron. In addition, the pressures of today’s economy are causing companies to support their increasingly demanding customer base with fewer and fewer resources. And while today’s technology provides an ever-greater level of transparency, that doesn’t necessarily translate into customer loyalty. Version 2.0 of “the customer is always right” has become “the customer wants it all and wants it now.”

Q: How has customer need evolved in today’s health insurance industry?

A: While the U.S. government and insurance company associations (that govern brand licensing) mandate strict policies on how insurance claims are processed, an insurance company that takes weeks or months (or years… don’t get me started!) to settle a claim is fighting a losing battle at a time where customers are continuously becoming more and more technology savvy. Health insurance companies need to upgrade their applications to meet the goal of satisfying increasing customer demands in order to retain and even grow their customer base. The smart choice is to join the recent trend among more established and advanced companies and improve customer service through the use of real-time technology.

Q: What is real-time technology?

A: Real-time technology is a set of systems and applications that respond in a timely fashion to requests for information and are composed of two essential components: timeliness (processing a request within a required period of time) and capacity (processing a certain number of requests within a required period of time). Coupled with predictability (processing various types of requests in a predetermined way), dependability (maintaining a required level of availability and information quality) and relevance (how well the information provided meets the customer need), real-time technology can be a powerful tool in improving the quality of customer service. 

Q: What are the benefits of real-time technology in the health insurance industry?

A: The area that will benefit the most is claims processing, which is the single most important area of customer service for health insurance companies. Real-time access to insurance claim status information has been around for some time to a greater or lesser degree. However, the latest trend in improved customer service is to provide information as to how the claim will be processed (or “adjudicated”) and how much financial liability the customer (policyholder) will have to bear, in real-time, before the claim is formally submitted. The benefits are significant: advanced planning, selection between related services, selection of service providers and reduction of callbacks to the insurer (to see how their request for information is doing), to name a few. Insurance companies will benefit through increased staff productivity (reduction in multiple calls to and from the member while the information request is being processed), increased revenue through customer retention and new customers (after all, happy customers stick around and spread a company’s reputation).

Q: What are the challenges PMs may face with real-time technology?

A: The challenges revolve around the modification of existing business processes and applications. This will test the expertise on all sides (business, technical and PM) and will play havoc with your project schedule and budget. Current systems typically have been kluged and cobbled for decades to run in batch mode (especially applications written in some Creaky Old Basically Obsolete Language [any similarity to COBOL is unintended and purely coincidental... honestly!]). The knowledge base may have been depleted over the years through advancement, attrition or even retirement (in my current project, there are several retirees that have been brought back as consultants). And that means resource allocation could become difficult when multiple projects are competing for the few available subject matter experts. Even determining project scope can be a problem when the details of information sources, data paths and application interfaces have been lost in the mists of time (we don’t need no stinking documentation!).

Q:What do you recommend for IT professionals?

A: Keep in mind that the trend towards improved customer service is not just specific to the health insurance industry. Almost all industries are moving in this direction. Real-time technology can serve as both a short-term and long-term solution that will have a positive impact on the bottom line. So it’s important for IT professionals to ramp up on real-time technology and be proactive in discussing the benefits with their managers or prospective employers.

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