DDBA 8582 Week 4 Skills-Based Role Design Example

A Shared Core for Enrollment, Claims and Provider Services: A Role Design Paper Rewriting Three Insurer Roles That Peak in Different Seasons Around Common Skills With Small Distinguishing Modules, and Arguing Where Skills-Based Design Beats Job-Based Design and Where It Does Not

Student Name

Walden University

DDBA 8582: An HR Plan for Organizational Agility

Instructor Name

Month Day, Year

A Shared Core for Enrollment, Claims and Provider Services: A Role Design Paper Rewriting Three Insurer Roles That Peak in Different Seasons Around Common Skills With Small Distinguishing Modules, and Arguing Where Skills-Based Design Beats Job-Based Design and Where It Does Not

Why This Cluster

Three roles at the composite Iowa insurer peak at different times. Enrollment specialists are busiest from October to December, during open enrollment for employer groups. Claims handlers are busiest from January to April, when deductibles reset and members use care early in the year. Provider services representatives, who answer questions from doctors' offices about payments and contracts, peak in June and July, when provider contracts renew. A person able to move among the three could follow the work around the calendar. Member services telephones were considered and excluded, because they peak in January alongside claims.

Overlap Matrix

[after]

Five of eleven skills are shared fully, and three more are shared partly. Skill lists come from the insurer's training curricula and job analyses completed in 2024.

Table 1

Skills Required by Each Role

The Redesigned Map

The redesigned structure defines a common core all three roles carry: benefit structures, eligibility, system navigation, privacy and communication standards, taught in a 15-day core program. Three modules set the roles apart. The enrollment module, 8 days, covers employer file processing and coordination of benefits at enrollment. The claims module, 20 days, covers coding, adjudication rules and appeals. The provider module, 12 days, covers contract terms, fee schedules and provider appeals. A person holding the core and one module performs one role; adding a second module, 8 to 20 days, allows a move between roles without starting over. Today a move from enrollment to claims requires the full 10-week claims program.

Where Skills-Based Design Wins

Lawler (1994) argued that organizations facing changing work benefit from defining people by the skills and competencies they hold rather than by fixed jobs, since skills can be redeployed as needs change. That argument fits this cluster: the work moves with the seasons, and the skills overlap enough that the incremental training to move is small. Kalleberg (2001) described functional flexibility as the capacity of a core workforce to move between tasks, which is what the shared core produces.

Where It Does Not

Skills-based design does not suit every role. Utilization review requires a nursing license, so its core cannot be shared with clerical roles. Provider payment approval is deliberately restricted for control reasons, separating the person who approves from the person who processes; broadening that role would weaken a safeguard. And roles whose peaks coincide, such as claims and member services telephones, gain little from shared design because both need everyone at the same time.

Costs

Hopp et al. (2004) found that limited cross-training arranged so that each worker covers an adjacent station captures much of the benefit of full flexibility, which supports training a second module rather than all three. Training a second module for 20 people a year costs about 300 training days. Pay may need a modest premium for those holding two modules, which the Week 8 cost model will estimate.

Effect on the Scenarios

The redesign changes the Week 3 audit's findings. In Scenario A, enrollment specialists holding the claims module could add about 15 handlers to claims after open enrollment ends in December, closing the shortfall the audit found. In Scenario C, staff from the shrinking Medicare supplement unit who already hold the core would need only a module, not the full ten-week program, to move into group administration.

Career Paths

The design also creates a career path: a person holding the core and two modules is more valuable and can be paid accordingly, which gives staff a reason to learn a second module rather than an obligation imposed on them. Without that path, cross-qualification looks like extra work for the same pay, and uptake will be low.

Limits

The overlap measure counts skills, not their difficulty; a partly shared skill may take longer to complete than its label suggests.

References

Hopp, W. J., Tekin, E., & Van Oyen, M. P. (2004). Benefits of skill chaining in serial production lines with cross-trained workers. Management Science, 50(1), 83-98. https://doi.org/10.1287/mnsc.1030.0166

Kalleberg, A. L. (2001). Organizing flexibility: The flexible firm in a new century. British Journal of Industrial Relations, 39(4), 479-504. https://doi.org/10.1111/1467-8543.00211

Lawler, E. E., III. (1994). From job-based to competency-based organizations. Journal of Organizational Behavior, 15(1), 3-15. https://doi.org/10.1002/job.4030150103