Charter Scope and Provider Voice in a Dispute Unit
Regional health insurer's provider dispute unit handles about 2,100 disputes a month with 14 specialists. The published commitment is resolution within 10 business days, but the latest month-end report shows 27% unresolved after 30 days and a backlog of 3,900 cases. Overtime is 9% and rising. The operations director sponsors a Yellow Belt-supported project with this charter: 'Reduce disputes by 40% in 60 days by improving the claims platform.' Scope is listed as dispute intake, claims adjudication, provider enrollment and contracting. The only available data are monthly totals; there are no reason codes, and the team has not observed intake calls. Interviews with 18 providers show the top complaints are repeated document requests and not knowing case status; speed matters, but predictability matters more. Two specialists argue the real problem is IT, while the supervisor wants the team to focus on 'working harder and clearing the backlog.'
1. Rewrite the problem statement so it is measurable and bounded, and identify at least two scope decisions you would challenge. Add one customer-focused CTQ.
Read the worked answer
The current statement is a goal plus a presumed solution ('improving the claims platform') and a deadline, not a problem. A usable problem statement names the gap, location, time frame and impact. Example: 'From January to March, 27% of provider disputes (about 567 of 2,100 per month) remained unresolved beyond the 10-business-day commitment, versus a target of 10%, with a backlog of 3,900 cases and 9% overtime.' This is measurable, has a baseline and gap, and does not name a cause.
Scope challenges: (1) Claims adjudication, enrollment and contracting are upstream systems with different owners; including them makes the project unmanageable in 60 days and dilutes the dispute-process focus. Keep them as interfaces or separate projects. (2) 'Reduce disputes by 40%' confuses volume reduction with timeliness; the VOC points to status certainty and repeat document requests, so the primary metric should be % resolved within 10 days and first-pass complete requests. A 60-day target may be a stretch; set a milestone and review.
CTQ: 'Percentage of provider disputes resolved within 10 business days, measured from intake timestamp to closure timestamp, target at least 90%.' This is customer-focused because providers experience predictability and closure, not internal platform activity.
2. Map the key stakeholders and explain how the Yellow Belt should engage them, including the supervisor who wants the team to 'work harder.'
Read the worked answer
Stakeholders: sponsor/operations director (high power, high interest) - approve scope, remove barriers, protect data access; providers (high interest, lower power) - VOC source, validate CTQ; dispute specialists (high interest, high influence on the process) - process knowledge and adoption; supervisor (high power over daily work, mixed interest) - needs to see the project as reducing firefighting, not criticizing staff; IT/claims platform (high power, lower interest) - interface constraints; compliance (high interest) - document-retention rules.
A power/interest grid helps choose engagement: manage closely for sponsor and supervisor; keep informed for IT and compliance; consult providers and specialists. The Yellow Belt's role is support, not unilateral scope change: collect and validate data, document the process, arrange VOC, prepare visuals, and escalate conflicts to the Black Belt or sponsor.
With the supervisor, avoid arguing about 'working harder'; show the baseline and ask the team to identify where time is lost. Invite the supervisor to a process walk and give them a role in validating the problem statement. Use the 3,900 backlog and 9% overtime as shared pain, and agree on a small pilot. The goal is to convert a blame message into a process message while keeping the sponsor informed of any scope change.
3. Turn the VOC findings into CTQs and explain why 'reduce cost per dispute' is not a CTQ.
Read the worked answer
VOC statement to need to CTQ:
- 'I do not know what is happening with my case' -> predictable status -> % of cases with a proactive status update at defined milestones; time from document receipt to status update.
- 'You keep asking for the same document' -> first-time completeness -> first-pass complete request rate; number of document requests per dispute.
- 'It takes too long' -> timely resolution -> % resolved within 10 business days; cycle time from intake to closure.
- 'I get transferred' -> ownership -> % of cases with a named owner and no handoff after first contact.
Each CTQ needs an operational definition, data source and target. For example, 'first-pass complete request rate = disputes where all required documents are requested in one contact and accepted without a second request / all disputes.'
'Reduce cost per dispute' is a business outcome, not a customer CTQ: it is internally focused, can be improved by denying valid disputes, and does not tell the team what the customer experiences. It may be a secondary business metric, but the project should be driven by the provider CTQs. Also, the VOC shows predictability matters more than raw speed, so the team should not over-weight cycle time alone.