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View Diary: Dear Supremes: An Expose of The Health Care Monster By An Industry Insider (100 comments)

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    glorificus, marina, antirove

    your concern and head's up. You are correct that if "outed" I would be fired and probably sued and maybe even prosecuted. I am fortunate that I enjoy a wide lattitude within the purview of my "position."

    I will say that every syllable I utter over the phone is recorded. Every movment I make is video recorded as well. I had to sign a waiver that every key stroke I make on my work computer is subject to scrutiny. Part of this is industry security protocol due to the senitivity of the information I deal with and part of it is simply a menas of geeting more "production" form me (and my coworkers) as we are evlauted LESS on the actual correct information we give than we are on how long we took to complete the call.

    I do not however operate unilaterally but I am becoming proficient in the art of "schmoozing" with other employees who have the means and the method and the authority to override certain thngs, so I can get results for my caller. This does not imply anythng unethical, just greasoing the wheels so to speak . You are also correct about a target per centage of negative claim results, But as long as the entirte department stays within the poarameters, it isn't hard to fly under the radar and maybe get a "neutral" claim processed in favor of the consumer, particularly if it is an admin type or error- entry type denial. These are just the realitites........ I admire and appreciate you expertise in the area of IT

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