National Council of Self Insured
Employers
Max Koonce
Sr. Director Risk Management
Walmart Stores, Inc.
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
2
The Walmart Property & Casualty Focus:
Workers’
Compensation
ensure associates that suffer work injuries:
• Receive prompt and appropriate medical care that is focused on their
recovery and return to gainful employment;
• Receive prompt and appropriate disability benefits;
• Compliance.
General Liability
Program
ensure all customers claims are:
• Addressed promptly and appropriately while recognizing the importance
of our customers in the retail environment;
• Compliance.
3
To ensure continual evolution of the program it must
allow for:
Flexibility
Scalability
Sustainability
All tools must act as
“enablers” to allow your
property and casualty
program to pursue overall
company objectives.
4
Program structure allows Walmart to concentrate
on our associates and customers through:
5
Self
Administration
RMIS
Risk Control
Process
Improvement
Casualty Reserve Review - Q1 FY15
Administering claims through our wholly
owned subsidiary TPA helps ensure:
Appropriate claims
management by:
• Owning the process
• Accuracy
• Experience in best
practices between inhouse TPA and outside
TPA vendors
• Analysis
• Compliance focus
• Direct relationship
between operations and
risk management
6
Data integrity:
Casualty Reserve Review - Q1 FY15
• Functional
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
Risk Control
Accident
investigation
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Casualty Reserve Review - Q1 FY15
Post accident
support
Process improvement involves:
Utilization of real-time data from all aspects
to drive:
Workflow
process
improvement
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Casualty Reserve Review - Q1 FY15
Trend
analysis
Coverage
Decisions
Workflow Process Improvements:
Resource Allocation • 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?
Claims Scoring • What characteristics determine:
• Claim exposure;
• Claim difficulty;
• Claim duration.
• Based on score, who should be managing the claim?
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Casualty Reserve Review - Q1 FY15
Workflow Process Improvements:
Claim Triggers • What triggers indicate caution?
• What path should be taken based on the triggers to
involve:
• Greater in-depth investigations:
• Additional external resources;
• Etc…
Complexity • Scoring Phases:
• As the claim progresses score at different intervals
such as 90 day, 180 day, and 9 months.
• Progression determines path of handling.
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Casualty Reserve Review - Q1 FY15
Workflow Process Improvements:
Physician Modeling • 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.
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Casualty Reserve Review - Q1 FY15
Trend Analysis:
Exposure • Property
• Business Continuity Planning
• Emergency Response Operations
• General Liability and Workers’ Compensation
• Safety Objectives
• Driving the APPROPRIATE behaviors
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Casualty Reserve Review - Q1 FY15
Coverage Analysis:
Product • 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?
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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
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Casualty Reserve Review - Q1 FY15
Allows for
optimum focus
on our
customers and
our associates