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