Unrepresented segment role-plays guide

Trainer Prework:

• Familiarize yourself with the cases. Strongly consider developing your own cases to reflect scenarios typical to the MCO. Doing this has consistently proven to enhance the claim representatives understanding and execution of the processes.
• Review the role play analysis section in the Appendix at the end of the Trainers Guide. This will help you guide the debrief discussions after each role play.
• Create a list of participants for each breakout group. Assess the personalities of all participants and design groups with mixes of high and low performers. There should be no more that 4 claim reps per group.
• For each group, arrange meeting rooms and make sufficient copies of feedback sheets and additional case studies developed locally.
• Ensure there are enough different role plays available so each claim rep is able to play both an insured and a claimant at least twice.

Practice Role Plays:

Purpose: To learn how to contact claimants according to CCPR guidelines. It is important to do so so that claim representatives begin to familiarize themselves with the process and can make them routine.

When: After the unrepresented segment training and before any claim rep begins handling unrepresented BI [bodily injury] claimants.

Materials: Role play presentation pack, additional copies of feedback sheets, copies of any local development role play scenarios.

Actions (before role plays):

• Ask if there are any questions about unrepresented claim handling.
• Briefly review the presentation pack and training format.

- Explain role plays designed around sample cases followed by feedback sessions.

- Emphasize the 9 step process and the requirements to complete all steps.

• Communicate that although the role plays seem uncomfortable and unnatural, they are the most effective way of learning the skills and new procedures.
• Hand out extra copies of the feedback sheets and explain their use. Note that everyone is required to provide feedback. Instruct the group to note specific words, phrases and tone of each conversation. Positive and negative feedback as well as suggestions for improvement should be elicited from the group.

Actions (during the role plays):

• Choose the claimant and claim rep.

- Advise that claim rep can use the claimant contact checklist or feedback sheet to guide the conversation caution participants to watch for use of claims "jargon"

- Do not interrupt the role play session unless someone is badly off course

- Allow role play to last 10-15 minutes

- Each claim rep should write one comment on each of the 9 steps. Specific phrases used by the claim rep should be captured.

• After the role play session is over, the trainer should facilitate a discussion of elements of the contact that went well and those that may require improvement. Consider having players repeat all or portions of the case.
• Continue conducting the role plays, with each claim rep taking turns playing and claimant and the claim rep. Direct claim reps to develop one of the role plays into a face-to-face meeting with the claimant.

Action (after the role plays):

• Review overall phrases and reinforce positive actions.
• Ask the group if there are any questions about the process.
• Schedule role play follow-up training with all participants approx. 10-14 days after implementation begins.

The Role Play Exercise is Complete When:

• Every claim rep has demonstrated effective use of the 9 step process.
• Every claim rep has practiced a face-to-face meeting in role play.
• Every claim rep has acted in the claim rep role at least twice.
• There are no remaining questions about the general processes.
• Follow-up training has been scheduled.