You are currently employed by a company called Hyperclaim Incorporated. The comp

Question

You are currently employed by a company called Hyperclaim Incorporated. The company processes workers compensation claims, moto vehicle claims, and healthcare claims for hospital networks or groups of hospitals. You are assigned to a team of 12 persons responsible for processing workers’ compensation claims for the Mighty Medical Network. In calendar year 2017, your team generate 2.8 million dollars in revenue for the network and your network is the largest client in the company. However, there are several persistent problems working the network that include:

The network staff send incorrect or incomplete information to your team causing rework and work delays.

The network staff refuses to change any of the procedures on how the process information.

In addition, your team is understaffed and there is a backlog of workers compensation claims waiting to be processed.   In a recent department meeting, you learned about how the company gets new clients. There is a team of people, one who is employed by the hospital network and one that is not. Sara is the employee and Beth is not. Sara researches hospital networks that are in financial distress and then visits the hospital network for 120 days, assists them in changing procedures, and recommends your company to process past claims. Usually Sara will secure a two-year contract for your company to serve the network. After 120 days, Sara comes to the same network that Beth just left and goes through information and picks through little details that are not relevant that your team may have not processed. Then, Beth attempts to convince the network to switch from the company you work for to a company owned by her son. Keep in mind Sara and Beth work together. Finally, Hyperclaim cannot afford to hire any new workers at this time or assign any extra persons to your department.

With this in mind:

What internal and external problems does Hyperclaim have?

What actions would you take to correct the internal or external problems that Hyper claim currently has?

Are there any legal issues here that Hyper claim must address?

Explanation / Answer

External problem- Sara and Beth work together. However, Beth is not an employee of Hyperclaim. Hence, the company does not have control on the work ethics of Beth.

2. Solution to the internal problems-

Solution to external problems-

          The company should not appoint any outside worker without any contractual agreement to work for the company. This would enable the company to have a control on the ethical behavior of the company. The company can also take legal action if Beth is legally employed for Hyperclaim.

3. Yes, there is a legal issue that Hyperclaim must address. Sara comes to the same network that Beth had just left. This shows that there is a mutual understanding between Beth and Sara. Then, Sara picks the through little details that are not relevant that your team may have not processed. Then, Beth attempts to convince the network to switch from the company you work for to a company owned by her son. This is a legal issue because Beth and Sara are doing an unethical act by working against Hyperclaim. This is a legal issue because they betray the company. This betrayal has resulted in monetary damages for the company.

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