Question

San Juan Insurance Company (SJIC) processes 14,000 insurance claims per year. When a claim arrived, it waits for two days, then a general-clerk check if its has been correctly filled. At any time, the general-clerk has an average of twenty-eight claims. Those that are correctly filled (80% of the total claims) are sent to a junior-claim-adjuster, which usually takes four hours to revise each claim. Those incorrectly filed are send back to the customer. Then, the junior claim adjuster send the claims to a senior-claim-adjuster, which rejects 25% of the claims. The senior-claim-adjuster takes 2 days to reject a claim and four days to accept a claim. The office works 50 weeks per year, five days a week, eight hours a day. a) On average, how many insurances’ claims are being processed by the claim adjuster? b) On average, how many claims are in SJIC? c) On average, how long does an insurance claim patient stay in the ER?

Answer 1

a) Insurance claims processed by the claim adjuster

= Insurance claims processed by junior claim adjuster + Insurance claims processed by senior claim adjuster

= 0.8*28 + 0.75*0.8*28

= 22.4 + 16.8

= 39 claims

b) Average claims in SJIC = 14000/(50*5)

= 56 claims

c) Insurance claim patient stay in the ER = 2 + 0.5 + 2

= 6.5 days