Managing Claim Department Operations ICA 4

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Acceptance: favorable reaction to change in which an employee cooperates w/ mgnt's req. in support of the change, but doesn't work enthusiastically to effect it
Acceptance theory of authority: the source of authority is the person who is influenced, not the person who influences
accountability: the obligation of an employee to be judged according to the competence with which the employee fulfills responsibility
achievement-oriented leadership: leadership style that emphasizes excellence, establishes challenging goals and performance standards, and expresses confidence in subordinates'ability to reach goals
across-the-board-raise: usually a percentage-of-salary increase given to all employees redardless of their performance
action plans: plans that result from operational planning
action points: times or events which signal a manager that an original plan is not appropriate and that a contingency plan should be implemented
activities: in a plan, the tasks and approaches that will be implemented in order to reach goals
adhocracy: an organizational form that typically develops in complex, dynamic environments with advanced technology and unspecialized tasks
affirmative action: a systematic plan to seek, hire, promote and retain minority group members if such persons are underrepresented in a firm
alternation ranking method: perf. evaluation method that requires a manager first to list the most competent employee and then to list the least competent one, according to a specified behavior or group of behaviors. Next, 2nd most competent and 2nd least competent,...
application form: means for a job applicant to supply an org. with relevant info concerning education, work experience, personal background and references
Artificial Intelligence (AI): system that emulates the thinking, learning and judging abilities of humans
assessment center: process by which a group of managers provide a group of job candidates with a 2 to 3 day stimulation of work exercises
attendance incentive plan: provision of additional pay or vacation time for the number of days less than a specified number of days that an employee is not absent from work.
authority: the right to perform an action or not to perform an action, as well as the right to direct someone else to perform an action or not to perform it
authority gap: situation in which no one is responsible for accomplishing specific organizational activities
authority overlap: situation in which 2 or more individuals or subunits have been assigned authority and responsibility for accomplishing the same organizational activities
autocratic leadership style: a leadership style that includes a tendency to make most decisions without consulting subordinates
automation: process of using machines to perform all or nearly all aspects of a work function
average reserve system: a computerized system used to establish claim reserves
avoidance: a conflict management techinque in which a person does nothing about a conflict, refuses to answer questions or denies that a problem exists in hopes that the conflict will somehow disappear
avoidance learning: performance of a desired behavior in order to avoid an anticipate negative consequence
balance sheet: a financial doc that shows an org's assets, liabilities and owners' equity at a specific point in time
balance sheet budget: budget that presents a forecast of the level of an org's assets and liabilities provided that the org's other budgets are met
behavioral design: an approach to organizational design which notes that the bureaucratic structure should be ammended to reduce the degree of formality and to include employees in the decison making
behavioral management theory: a theory of management that focuses on concern for employees' social and phychological well-being
behavioral model of decision making: a model that describes the ways in which most managers make decisions
behavioral modeling: process by which trainees watch ineffective or effective work-related behaviors in performances by live personnel, by videotape or by other means
behaviorally anchored rating scales (BARS): a type of graphic rating scale that provides a numerical value for each increment of observable behavior as specified by job analysis
bill of material: detailed list of all materials req to make a product or to deliver a service
bona fide occupational qualification (BFOQ): genuine, job-related trait needed for an employee to perform a certain type of work
bonus: a one-time payment for a job performance, generally considered a short-term incentive for performance
bottom-up approach: an approach to organizational change in which lower-level employees act as intrapreneures for their own depts or divisions, and use their expertise to recommend technological improvements
bottom-up budgeting: a budget-setting approach that requires managers to prepare their own departmental budgets for approval by upper-level managers
bounded rationality: concept that a person has limited ability to be rational or logical
brainstorming: a qualitative technique for generating alternatives or solutions without analyzing or criticizing any of them
breakeven analysis: procedure used to identify the point at which funds spent (cost of production) and funds received(revenues) will be equal for a specified product, service or approach
breakeven point: the moment at which the profit and the loss of an element are exactly the same
budget: a single use plan stipulating the financial resources designated for certain activities that are to be accomplished within a set period of time
budget committee: a committee made up of senior managers from several functional areas to provide budgetary data and guidance to lower-level managers
budget variance: the difference between planned and actual amounts of expenses and income
budget worksheet: a budget setting aid that outlines budget categories used within an org and that provides space for a manager to figure allocations for each category
budgeting: the process of establishing budgets
bureaucracy: an org structure according to a rational plan, with well-defined positions, a clear division of labor, and a clear chain of authority
business games: simulations of realistic organizational situations or problems in which trainees fulfill certain roles or are assigned to make decisions according to information presented to them
business-unit strategic plan: a strategic plan that outlines the operations of one line of business
cafeteria plan: a range of benefits from which each employee can select the benefits that best suit his or her lifestyle or preference
capacity planning: forecasting the demand for various forms and types of products and services, determining how fully an org can meet the level of demand, and, if necessary, evaluating the arranging for supplementary means of fulfilling demand in excess of what the org currently is able to meet
capital assets: major assets such as buildings, large equipment, heavy machinery and land
capital expenditures budget: a budget that includes anticipated expenses for acquiring such major assets as buildings, large equipment, heavy machinery and land
career: a series of job tasks and positions held during a person's working lifetime
career anchors: a group of values, motives, and abilities that guide a person's career
career development: the career-related activities that an employee undertakes in order to develop skills, to id strategies, and to realized his or her potential as fully as possible
career ladder: a specific and formal progression of jobs that are linked one to another and that lead toward upper-level responsibilities within an org
career path: a route of job progression along which an employee is able to advance systematically through an org
career plateau: a career level from which an employee is unlikely to be promoted or to move upward in the organizational hierarchy
case reserve: an estimate of the amount of money that is needed to pay a claim
case studies: an off-the-job training technique in which conditions and problems are described to a trainee, who must then evaluate the situations and offer solutions
cash-flow budget: a budget which provides projections of incoming cash flows in order for an org to be certain that it has sufficient cash to meet its ongoing financial obligations
cash-flow statement: statement that notes the sources of cash or other funds and disbursements of those funds
causal modeling: a procedure that closely examines past events in assessing cause-and-effect relationships and in making predictions which include the probable effects of changes in any variable
central tendency error: an evaluation error in which an evaluator tends to avoid the high and low ends of a rating scale and gives most employee performance ratings in the middle of a scale
centralization: concentration of authority and power at top organizational levels
certainty: a condition which indicates that a decision maker has been able to gather all the info req to make a specific decision
chain: a communication network that involves communication flowing from one person directly to another person, and thence to a third person, and so on
chain of command: the unbroken line of authority that connects all organization employees
change agent: a person or group that is given responsibility for leading an org through a planned change
changing: in the Lewin model of change, the implementation of a desired transformation and the decision as to whether the change produces effective behavior or results
channel: a means of trasmitting encoded meaning
circle: a communication network that enables each member of the network to transfer info directly to 2 other members of the network
claim appraisal codes: numerical listings of correct and incorrect actions relating to claim handling
claim department: an organizational structure that functions to consider and handle claims
claim generalist: a claim examiner whose assigned responsibilities cover a broad spectrum and whose training is generalized
claim manager: the person responsible for directing the activities of the claim department
claim philosophy: a company's attitude toward processing and paying claims
claim specialist: a claim examiner whose assigned responsibilities fall within a narrow range and whose training is specialized
classical design: an approach to organizational design which defines universal principles and determines specific approaches that could be used to guide the design of organizations
classical management theory: a theory focused on discovering logical, rational techniques to increase the efficiency of an org's production of goods and services
classical model of decision making: a model based on the assumptions that the best decision in any situation is one that is economically sound for the org, strives to fulfill stated, well defined organizational objectives, is based on logic and reason, and is made under conditions of certainty
classical departmentalization: the grouping of work activities according to the need to respond to certain clients or categories of clients
closed recruitment: a recruitment process that allows a manager to choose, from current employees, the type of persons, and sometimes the specific individual, whom the manager wants to fill a vacant position
closed system: a system that does not interact with its environment
cluster: a grapevine communication pattern that is produced as persons pass on info to the co-workers in their cluster of friends and acquaintances, usually in a fairly predictable order
coaching: a specialized career development activity that provides an employee with an opportunity to spend time working with a manager whom the employee is being prepared to replace
coercion: forcing employees to accept a change by threatening to fire them, to transfer them to undesirable locations, or to give them poor performance evaluations
coercive power: power that is based on a leader's ability to punish another person
cognitive test: a type of employment test that evaluates candidates' ability to learn and reason
cohesiveness: the tendency of group members to feel loyal to one another, to want to remain in the group, to want to preserve the group, and to resist the influences of non-members
collectivity stage: the stage of the org life cycle in which a rapidly growing org creates some departments or divisions and establishes some regulations, but generally remains informal
command group: a functional group made up of managers and their subordinates
commission plan: a compensation plan in which an employee's pay is based on the quantity of products and services sold or produces
commitment: agreement with a leader's viewpoint and a willingness to fulfill a leader's expectations
communication: the transmission of information from one person to another person, or from one group or department to another
comparable worth: a concept which focuses on the question of equitable pay given for jobs that may differ in content, but that require comparable skills, abilities, and knowledge
compliance: acceptance of a leader's direction, although not with enthusiasm
compressed workweek: a type of job scheduling in which employees are generally scheduled for fewer work days and longer periods of work time each day
compromise: a method of reducing or resolving conflict that involves achieving consent by having each party make concessions to the other
computer-based training (CBT): training that uses a computer terminal and monitor to present facts, problems, or questions to a participant
computerized spreadsheet: a tool that allows creation of matrix structure and performance of mathematical operations on stored data
concurrent control: a type of control that measures and evaluates an activity in progress to assess how consistent the activity is with performance standards
conference method: an off-the-job training technique that requires trainees to participate in small groups, with a trainer present to provide feedback and guidance, but not to take charge of the conference
conflict: any type of opposition or antagonistic interaction between 2 or more parties
consensus: a method of reducing or resolving conflict that involves discovering a resolution which is best in the situation, rather than trying to allow one side to win
consideration: the concern that a leader shows for developing a warm, trusting, and supportive work atmosphere for subordinates
consolidation: the combination of 2 companies in order to form a 3rd company
consultant: an industry expert who is not a member of a particular org and who has no vested interest in any aspect or division of that org
content plateau: a plateau in which an employee has learned every aspect of a current job, with the result that work activities may become routine and unchallenging
content theories of motivation: theories that focus on understanding people's underlying needs and the ways those needs energize and motivate people to act in certain ways
content validity: a type of test validity determined by the degree to which a test's contents reflect the actual content or requirements of a job
contingency approach to management: a management approach that assesses various options and matches a chosen solution with the demands of a specific situation
contingency design: a flexible organizational design approach that considers the variables present in a specific situation and the effects of various solutions to management problems
contingency plan: a course of action that can be taken if certain, usually undesirable, events occur
continuous schedule of reinforcement: reinforcement of a behavior everytime it is shown
contract manager: a leased senior-level employee who oversees a specific facet of a co's operations for a certain period of time
control system: a series of procedures or steps that an org uses in order to monitor organizational activities and to correct deviations or flaws
control tools: procedures or techniques that permit managers to measure an org's progress toward its objectives and to make appropriate corrections
controlling: a process of monitoring and correcting the progress of an org toward its stated objectives
co-optation: the disarming of resistant employees by absorbing them into a group and by giving a key resister a position of leadership so as to defuse animosity
coordinating: defined by Henri Fayol as the process of establishing harmonious relationships between the resources and the activities of an org to ensure that the org reaches its desired goals
coordination: a process of integrating various functions of interdependent subunits within an org so that those subunits may work together smoothly
core benefits: the nonoptional benefits that are provided by an employer and that every employee must accept
core job dimensions: the components - skill variety, task identity, task significance, task autonomy, and job feedback-that are necessary for positive results in a job
corporate-level strategic plan: a strategic plan which outlines and coordinates the operations of an org that contains 2 or more lines of business
counseling: the act of providing nonevaluative, constructive feedback to individuals
criterion validity: a type of test validity determined by the degree to which people who perform well on the test also perform will on a job and the degree to which people who do poorly on the test also do poorly on the job
critical incidents: a method of job analysis in which only the work behaviors that result in successful or unsuccessful job performances are noted
critical path: in a PERT or CPM network, the sequence of in-series activities that require the longest completion time and that provide for no slack time
critical path method(CPM): a work scheduling technique in which a manager plots out the essential steps to complete a project
critical psychological states: frame of mind resulting from the presence in a job of each of the core job dimensions; these state include meaningfulness of work, responsibility for work outcomes, and knowledge of work results
culture: the underlying norms, values, attitudes, beliefs, and knowledge shared by the persons associated with an org
cutback: the intentional withdrawal of organizational resources in order to adapt to a business environment that is no longer favorable
cybernetic control system: a self-regulating system which has built-in devices that provide immediate feedback to a system and that automatically correct deviations from a systems's desired objectives and activities
data: raw facts, figures, and events that have not yet been analyzed, summarized, or otherwise organized
data management: the org, arrangement, review, and access of data and info by using a computer
debt ratio: a type of leverage ratio that is calculated by dividing the org's total liability by its total assets
decentralization: a method of org in which authority and power are passed down from top organizational levels to successively lower positions in the org
decision confirmation: the tendency of a decision maker to settle on a decision early in the decision-making process and then to spend the remaining time in justifying the decision rather than in analyzing additional info, revising conclusions, and diligently seeking alternatives
decision making: the process by which a person analyzes available alternatives and chooses a course of action in responding to a specific situation
decision package: detailed data about an activity's expenses, revenues, benefits, limitations and other info that will enable managers to compare each activity to other proposed activities and to decide the merits of each activity
decision support system (DSS): an interactive, computer-based system that permits users to access and manipulate info and to generate reports using info not routinely available thru an MIS
decision tree: a qualitative decision-making technique that can assist a manager in evaluating alternatives when decision must be made in sequence
decline stage: stage of the org life cycle in which an org is no longer able to produce what it was designed to produce, to service what is was designed to service, and to adapt successfully to changes in its environment
decoding: the translation of a transmitted message back into meaning, which may or may not be the same meaning as that originally encoded and transmitted by the sender
delagating: in situational leadership, a leadership style in which a manager neither instructs employees on how to do a job nor provides a great deal of emotional support and approval for them
delegation: the assignment to another person or group of formal authority for carrying out specific activities
Delphi Process: a means of managing group decision making and forecasting by developing a consensus
democratic leadership style: a leadership style that includes a tendency to allow subordinates to take part in making decisions
demotion: the act of moving an employee to a lower level of the organizational hierarchy
departmentalization: the grouping of similar or related work functions - jobs, activities, or processes - into units, and those units into larger units
dependability test: a type of employment test that evaluates candidates' job-related attitudes and values
descriptive model: a management science model that describes events as they exist at a given time, but does not present an optimal action
development: activity directed toward learning and improving the skills needed for future job performance
devil's advocate: a person who challenges a group's decision-making process and strongly presents unpopular or minority opinions
diagonal communication: a type of formal communication that takes place between persons who occupy different horizontal and vertical levels of an organization
differentiation: a tendency towards fragmentation that creates barriers among the employees and the divisions of an org
direct supervision: one means of achieving vertical coordination
discharge: the dismissal of an employee who does not otherwise wish to leave an organization
discipline: a process of managing employee performance so that employees are encouraged to adhere to organizational rules and procedures
disparate impact: discrimination that results when any employment procedure, althought applied uniformly, causes a large proportion of job candidates of a protected class to be elimated from consideration
disparate treatment: discrimination that can result from the creation and application of rules based on sex, race, age, national origin, or other protected factors
dissonance reduction: the tendency of a decision maker to reduce feelings of emotional disturbance after a decision has been reached by ignoring or forgetting potential risks and uncertainties concerning the decision, and not to monitor the results carefully and thoroughly
divestiture: the sale of a division or department to another company
divisionalized form: an organizational form that usually requires large numbers of middle managers who are given broad decision-making authority within their own division
driving forces: the influences that encourage a change to occur
dysfunctional conflict: conflict that produces resistance to change, as well as highly charged emotions, political infighting and maneuvering, decreased production, and lack of cohesiveness and cooperation among an org's employees and work units
econometric model: a series of regression equations solved simultaneously in order to predict large-scale economic changes and the impact of those changes on an organization
economic order quantity (EOQ): a mathematical model that enables a decision maker to calculate the optimal amount of inventory to order.
effectiveness: the quality of taking the correct steps and performing the proper actions to reach organizational objectives
employee-centered leader behavior: leadership behavior that pays attention to the human aspects and job satisfaction of employees and that involves them in setting and reaching performance goals
employee privacy: the right of employees to be protected from unwanted disclosure of personal information
encoding: the transformation of meaning into a form that can be communicated
entrepreneurial stage: the stage of the org life cycle that features creativity and gathering resources
environment: any elements in a system's surroundings that might affect the system's functioning or activities
equal employment opportunity (EEO): Legal requirements for non-discriminatory treatment that apply to almost all public and private organizations
equal pay for equal work: the payment of equal wages for the performance of jobs that require equal skills, responsibility and effort, and that are performed under similar working conditions in the same establishment
equity theory: a theory which states that people feel motivated to perform when they belive that their rewards are fair in relation to the rewards given other people
error of irrelevant judgment: an evalulation error in which an evaluator makes unwarranted, often unconscious, assumptions and judgments about an employee's perf because of the employee's sex, age, race, religion, length of employment, previous perf, political viewpoint, appearance, personality, or some other characteristic or quality that is unrelated to the empolyee's work activities
event: In PERT or CPM network, a specific goal that represents the point at which one or more activities has been accomplished
exception report: a report that calls to a manager's attention deviations either above or below the established levels of deviation from a performance standard
existence needs: according to Alderfer's hierarchy, a person's needs for material and physical entities
existence-relatedness-growth (ERG)theory: Alderfer's content theory of motivation, focused on 3 kinds of needs grouped into a hierarchy
exit interview: a meeting in which a manger or HR unit member questions a departing employee about working conditions and about ways of improving problem areas
expectancy: the event or outcome that a person expects to happen as the result of a certain behavior
expectancy theory: a theory which states that a person is motivated in proportion to that person's expectations of success in a task or opportunity and desire to accomplish the task or develop the opportunity
expense budget: the forecasted costs of production in an organization
expert power: power derived from a person's information, knowledge, and expertise
expert system(ES): an information-manipulating system based on established facts and on historical reactions and responses to situations
external audit: a process of employing an auditor from outside an org to evaluate the org's financial records
external recruitment: the process of seeking job candicates from outside an organization
extinction: ignoring an unwanted behavior or withdrawing a desired reward or consequence of that behavior
extrinsic reward: a payoff that a person receives from the other persons or from an organization
feedback: communication sent in response to the sender of a message
feedback control: a type of control that assesses the results of a completed activity, determines the causes of deviations from organizational standards or goals, and applies the findings to plan for future activities
financial audit: an independent assessment of an org's financial accounts and statements
financial budget: a budget that presents an org's projected resources of income and the org's plans for spending the income
financial ratio: a ratio that compares the numbers in 2 sets of financial results
financial resources: a type of organizational resource consisting of the funds used to pay for both the immediate and the long-term operations of an organization
financial statements: financial control tools that enable an org to evaluate its financial performance and to assess the org's flow of goods and services
fixed costs: expenses that are not expected to change during the budget period regardless of the amount of business transacted or, in the claims area, the number of claims handled
fixed interval schedule of reinforcement: a response of behavior at regular, predictable times- at the same times each day, for instance, or on the 15th of each month
fixed ratio schedule of reinforcement: a response to every "nth" behavior -every 7th, or 50th behavior, for instance
flat organization: an org in which there are few managerial levels between top-level and bottom-level employees
flexible budget: a budget that includes fixed and variable costs and the circumstances under which variable costs would be expected to change
flextime: a type of job scheduling that permits employees to select their work hours in accordance with their personal preferences
focused audit: an analysis of claims that are selected by claim type, claim disposition, benefit application, group policy, or other specifically identified criteria, without regard to the individual employees who handled the claims
force field analysis: a model of change which states that change results from the competition between 2 types of forces: driving forces and restraining forces
forecast reports: predictions based on the use of predictive models that focus on specific organizational problems and opportunities
forecasting: the process of making organizational and environmental predictions based on available information
formal authority theory: a management theory that authority exists because some person or group has conferred it on the person holding the authority
formal group: a group, including appointed or official leaders, that is created in order to produce work
formal organization: the established org structures, including functional, product, client, territorial, process, time, project, hybrid, matrix, network
formalization and control stage: the stage of the org life cycle in which an org has grown large and the orginizational form is more bureaucratic than it was in earlier stages, with more prescribed rules and regulations and a definite hierarchy of relationships
friendship group: a type of informal group that evolves because its members enjoy each other's company
frustration regression: the act of falling back to focus on lower-level needs instead of continuing to try to satisfy upper-level needs
full support: a favorable reaction to change in which an employee provides leadership for other employees in implementing a change
functional authority: the right of an employee to determine other employees' or departments' tasks and activities that are related to the employee's responsibilities
functional conflict: conflict that tends to encourage creativity, effective decision making, and increased effort and production, and to aid the personal development and
job-related maturity of persons within an organization
functional departmentalization: the grouping of work that has common functions or similar activities
function foremanship: a distince division of labor between management and workers, with managers taking responsibility for planning the work and determining workers' job assignments; proposed by Frederick W. Taylor
functional-level strategic plan: a basis for managing the operations of a specific division or department within an organization
game theory: a theory which helps a decision maker to make predictions about the effects of an org's actions on that org's competitors and especially to predict the actions that competitors will take in response
Gantt chart: a graphic scheduling technique that enables a manager to plan and control production; developed by Henry L. Gantt
glossary of budget terms: a document that lists and defines budget-related terms used within an organization
goal acceptance: the degree to which a person agrees that a certain goal is his or her own responsibility
goal assignment: the act of specifying a goal as the responsibility of a certain unit or individual
goal commitment: the degree to which a person is determined to accomplish a certain goal
goal displacement: the establishment of easily quantified, but less important goals instead of less quantifiable, but more important goals
goal theory: a theory which states that an org can motivate employees by setting certain types of goals for them
goals: the conditions or targets that a manager expects to reach
gossip: a grapevine communication pattern that is produced when one individual selects other people and passes info to each of them, one at a time
grapevine: a communication network that is the primary means of informal communication
graphic rating scale: a series of performance standards accompanied by a scale on which an employee is to be rated
grievance procedure: a means by which employees can report on-the-job problems and can receive prompt, adequate assistance with them
group: 2 or more persons who have a shared identity or purpose
groupthink: a tendency to hurry toward compromise or consensus instead of taking the time to devise the best possible solution
growth needs: according to Alderfer's hierarchy, a person's needs for competence, personal growth, creativity, and development of potential
guaranteed piecework plan: a plan that provides a specified and guaranteed minimum amount of compensation for an employee who produces a specified number of units or items within a certain period of time
halo error: an evaluation error in which an evaluator allows an employee's high or low performance in one area to influence the ratings given for the other areas in a performance appraisal
hardware: a computer's physical components, including electronic circuits, memory, input/output devices, and devices for storing information
Hawthorne effect: workers feel a strong incentive to increase their productivity when they perceive that managers are paying special attention to the workers and are concerned about the workers' well-being
hierarchy of needs: Maslow's hypothesis of motivation that includes 5 levels of human needs, arranged in a hierarchy
hierarchy of relationships: the ways in which every employee in the org is linked to other employees and to the org's chief executive officer
high power distance: a high degree of inequality among levels, departments, and employees in an organization
high specialization: characteristic of a job in which an individual focuses on one or a small number of organizational tasks
high uncertainty avoidance: the preference among employees for specific instructions and definite goals and procedures rather than an unstructured, unpredictable work environment
holding costs: the expenses associated with handling, storing, and financing materials
horizontal communication: a type of formal communication that flows between groups or individuals who are on the same level of the organizational hierarchy
horizontal coordination: integration between units or on one hierarchial level of an organization

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