5 things your claims system should do for you


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Iasa 2013 technology session: 5 things your claims system should do for you
Claims has never been called the “fun” part of insurance. Let’s face it, it’s when those hard-earned premium dollars take a hike back out the door. And, while there’s no way to change the fundamental premise behind paying claims, there are ways technology can overhaul the claims management process, making it more efficient, and less painful, for everyone. Today’s modern claims technologies can differentiate you from competitors and give you control of your claims management process by helping you to leverage critical loss data, eliminate leakage, accelerate resolution, reduce loss adjustment expenses (LAE), speed claims processing times and improve customer service. However, it is important to understand some of the basics that your company should be able to do with your claims system now. This session will discuss the requirements that constitute a suitable, comprehensive claims management system, and one that fits your company-specific needs and style of business.

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5 things your claims system should do for you

  1. 1. 5 Things Your Claims System ShouldDo For YouSession Number 471
  2. 2. John RoblinJohn Roblin, Chairman & CEO– Cover-All TechnologiesJohn Roblin has served as Chief Executive Officer of Cover-AllTechnologies since December 1999, and as a director since March2000. He was named Chairman of the Board of Directors inFebruary 2001. He served as President of the Company fromDecember 1999 to November 2008. Prior to joining the company,Mr. Roblin was CIO and Senior Vice President for CIGNA Propertyand Casualty since 1998. From 1994 until 1998, he was CIO andSenior Vice President for Advanta Corporation. Prior to 1994, hewas the CIO Chubb & Son, USF&G and Traveler’s Personal LinesDivision.
  3. 3. Shared Perspectives Some people see things that are and ask, Why? Some people dream ofthings that never were and ask, Why not? Some people have to go towork and dont have time for all that.George Carlin The problem is never how to get new, innovative thoughts into yourmind, but how to get old ones out.Dee Hock, Founder of Visa There is nothing so useless as doing efficiently that which should not bedone at all.Peter Drucker That wasn’t flying. That was falling with style.Woody, A Toy Story
  4. 4. 5 Things Your Claims System ShouldDo For You What is a Good Claims System?• What are the objectives? How measured?• Designed to serve the customer? The company? Both?• Designed for today? Tomorrow?• How can better data, information and knowledge create value? Sharing Their Perspectives with us today:• Bill Garvey, CEO – Eastern Shore Consulting, Inc.• Bob Khosropur, SVP of Operations – Mariposa Insurance Services• Gary Plotkin, Principal – KPMG Financial Services Advisory
  5. 5. Bill GarveyBill Garvey, CEO – Eastern Shore Consulting, Inc.Bill Garvey, originally from Massachusetts, lives and works in Halifax,Nova Scotia. Bill has held senior level management positions in Claimsand Information Technology. Bill brings a realistic approach todeveloping strategies that link business goals to automationsolutions. He leads initiatives to search for and install industrialstrength software, and has helped insurers change the paradigm forhow they conduct software searches.Bill provides more than software analysis. He has installed majorinsurance systems, often as an early adopter. He understands"buyers remorse" and the complexities involved in acquiringoperational software. Bill has deep product knowledge of thesoftware vendors in the Property/Casualty and Life/Health space.
  6. 6. Before Your New Claim System DoesAnything For You… But first, the new system and vendor should…• Help you analyze your operation for transformation•Workflow analysis from FNOL to closure•Organizational changes•Claim management’s vision Know what and where you want to “be” before you replacea Claims system
  7. 7. First – Accelerate the Claims Process Remove bottle necks• Automatically assign the right people• Escalate claims that aren’t getting proper attention Reduce cycle time• Lower cost per claim• Higher customer satisfaction• Reduce loss leakage & LAE
  8. 8. Second – Improve Productivity Reduce the adjuster learning curve Create an intuitive work experience Place services and links at the adjuster’s fingertips Leverage Web services Leverage ancillary applications
  9. 9. Third – Manage the Claim Process Flexible workflow rules• Respond to organizational changes• Reassign/ escalate losses Real time productivity data• Allocate field resources• Define claim specialization Management reports
  10. 10. Fourth – Leverage Claims Data Transform useless notes into precious data Predictive analytics• Claim severity• Subrogation opportunities• Fraud Management reports• Injury type• Settlement trends• Venue issues
  11. 11. Fifth – Improve the Customer’sExperience Online reporting and status Electronic submission of documents Multiple payment options Mobile access
  12. 12. Bob KhosropurBob Khosropur, SVP of Operations – Mariposa Insurance ServicesBob is a senior Insurance executive for personal property and casualtyinsurance, recognized for the passion and skills to build out claimssystem and processes from the ground up. Honored in 2011 by ClaimsMagazine as ‘Claims Person of the Year’ for work in modernizingclaims systems. Bob has extensive experience in catastrophemanagement, strategic sourcing, and specialty underwriting. Over a24 year career he has developed and enhanced operations andstrategies through effectively communicating and derivingcollaboration among otherwise divergent groups. Bob holds abachelor’s degree in chemistry from Goddard College in Vermont.
  13. 13. Core Claims SystemsCustomer-centric Claims Service ThroughInnovative Technology
  14. 14. Customer-centric Claims Service ThroughInnovative Technology Basic Facts of Life & Loss:• Policyholders call to hear some good news only.• More bad news after their boo-boo is not greeted well.• Claim years are like dog years - the first five minutes of the claim are likethe first two years of life; and it sets the stage for all to come.• Policyholders don’t know about or care about interfacing, software as aservice, outsourced solutions or anything else except the boo-boo.
  15. 15. Customer-centric Claims Service ThroughInnovative Technology Basic Facts of Life & Loss:• Loss should only have four simple parts for the policyholder:1. You know who they are2. You’re happy to help3. Something good will happen soon4. It’ll all be over before you know it
  16. 16. Customer-centric Claims Service ThroughInnovative Technology The Slightly Less Simple Basic Facts of Life & LossOther Stuff
  17. 17. Customer-centric Claims Service ThroughInnovative TechnologyGreat Expectations The policyholder is welcomed (by phone, web-site, hand-held app, etc.) The policy’s existence is verified Emergency action can be taken immediately General information and expectations can be given Follow-up is guarantee-able Field work is seamless – done once and for all No frustrated inquiries should ever come from the policyholder or agent Payment is predictable Recovery of deductible is never forgotten
  18. 18. Modernizing Claims ManagementProcesses & SystemsThe Core Claims System Solution should be web-basedProvide company-wide access to claim records, financials, tasks, diaries, vendors,contacts, theories of defense, images and documents Access from remote desktops/laptops/pads Easy to populate FNOL elements by staff or by third party call center Highly customizable by in-house administrative staff Add or remove granularity to reporting elements Alter roles and authority limits as required
  19. 19. Modernizing Claims ManagementProcesses & SystemsClaims System Feel and Touch Able to improve claims turnaround time Ease of use Screen flow logic Multi-tasking between screens and various claims Semi-transparent panels Reliable to the touch and feel – 24/7 Rapid screen-to-screen transition Quickly train new users to reach a level of proficiency in its functionality Speedily develop lines of insurance and their respective coverages and perils
  20. 20. Modernizing Claims ManagementProcesses & SystemsClaims System InterfacingAbility to interface with suppliers of service, e.g. Subrogation Estimating software Aerial imaging Independent adjusters Damage mitigation and repair vendors Legal services
  21. 21. Modernizing Claims ManagementProcesses & SystemsEnhanced Features – examples: Segmentation of Claims – Split assignments and Access Collision assigned and handled by physical damage specialist Bodily Injury handled by casualty specialist PIP handled by centralized units Subro investigated by in-house or outsourced specialist SIU handled in secrecy Claims Activities / Tasks Utilize a rules-driven task reminder system for scheduled activities Follow-up queues for management Compliance edits to assist with multiple state variations Forms and wording assistance Process consistency - treating all customers with the same quality ofresponse
  22. 22. Modernizing Claims ManagementProcesses & SystemsDon’t forget the Basics Logically record /retrieve the first notice of loss, and all subsequentinvestigation and damages of parties involved Statistical reserving, and manual revision for loss and expense Create payments with simple transactional logs readily available for audit andreview The ability to create, use and store correspondence, reports, photographs,sound files, emails, etc. Identify and monitor subrogation / salvage recovery potential Identify and monitor litigated files
  23. 23. Modernizing Claims ManagementProcesses & SystemsCan’t Manage Without Enforce authority limits based on company role to monitor reserving andpayment practices Enforce policy coverage limitations Basic financial reporting tool for daily inquiries Catastrophe coding and management SIU scorecard and flagging Vendor/Contact management capabilities (across claims)
  24. 24. Thank You
  25. 25. Gary PlotkinGary Plotkin, Principal – KPMG Financial Services AdvisoryGary Plotkin is a Principal at KPMG and a member of the ITAdvisory Services practice for Financial Services focusing onInsurance clients. Gary has 22 years of Financial Servicesexperience specializing in Business and IT transformation work.Gary has split his career between Advisory Services managementand the roles of CIO and CTO for large and small InsuranceCarriers. He has a strong background across the full life cycle ofstrategy and project delivery with several $100M+ programmanagement experience including software development,implementations and transformation initiatives. Gary’s pastclients include leading entities in the financial services industry.
  26. 26. Claims - the Customer’s Moment of TruthHaving a claim is the “Moment of Truth” for the Carrierto build brand loyalty and customer retention Insurance is not a tangible or well understood product for Customers but aclaim is a REAL AND POTENTIALLY TRAUMATIC EVENT Claim professionals have the DIFFICULT TASK of balancing company policiesto reduce expenses and loss payments while maintaining a high-level ofcustomer satisfaction Satisfaction does not equal overpaying claims. It means SETTING ANDMEETING EXPECTATIONS
  27. 27. Customer Visibility and SupportRecent JD Powers Study* on Auto Claim Satisfactionfound the following: Focusing on keeping CLAIMANTS UPDATED and quickly communicatingwhat will be covered in the claim has a major IMPACT ON THEIRPERCEPTIONS of how fairly they are treated Insurers continue to focus and improve on offering more OPTIONS to keepcustomers informed on the progress of their claim with 64% of claimantsindicating they were offered options. Failing to adequately explain and update claimant may lead to theirQUESTIONING THE SETTLEMENT offer and potentially increasing the rate ofnegotiations, which negatively impact overall satisfaction.2012 JD Powers Auto Claims Satisfaction Study
  28. 28. Customer Visibility and SupportBest of Breed Companies: Truly ENGAGE CUSTOMERS to assist in the claims process by providing themwith easy to use interactive applications and mobile accessAbility to diagram accident scene, upload pictures, document homecontentsSupport telematics data for claims assessment Providing customers with VISIBILITY into the claims process, while enablinginteractions and FEEDBACK to allow REAL-TIME customer satisfactionInsurance carriers providing online updates via email or text on the statusof a customer claimAbility for Online viewing of Auto Body repairs to a customer vehicleDedicated Portals for customers to share their claims stories andencourage positive interaction
  29. 29. Is the Insured Satisfied?How is Customer Satisfaction identified: Most companies evaluate customer satisfaction with claims POSTSETTLEMENT. This is TOO LATE in the process and does not provide thecompany with an opportunity to ensure a positive customer interaction For those companies that have decided to conduct open claim customersurveys‘, is there a FEEDBACK LOOP in place to provide the data back tothose interacting with the customer Is the customer satisfaction DATA AVAILABLE to claims operations REAL-TIME to help address process improvement or is it only a function ofmarketing
  30. 30. Building Customer IntimacyA recent Gartner report* states that “just one-third of P&CCarriers know their customer” Claims Systems Need to support Customer PREFERENCES Customer preferred means of communication (Email, Phone, Text, etc) Language preferences Customer Lifestyle - what do they want to know and how often DATA IS CRITICAL to support Customer Intimacy New product development Cross-sell opportunities and marketing to the right customers at the right time Retention programs and revised pricing (what is this customer worth?) Enterprise customer knowledge - Is the customer information shared (whereallowed) with other areas of the company and the AgentInsurance and Technology Magazine, Feb 2013
  31. 31. SummaryClaims is the single most important interaction between thecustomer and the Insurance carrierClaims systems are no longer about addressing back-officeoperational efficiencies but rather Customer Facing front-officeBrand-building capabilitiesInvestments in Claims needs to look beyond the traditionalreturn on investment and also address loss opportunity costsUnderstanding the context of the claims systems within theaspects of the larger application architecture is necessary giventhe integration of the platform and the need to share data withthe overall Enterprise
  32. 32. Questions John Roblin• jroblin@cover-all.com Bill Garvey• billgarvey@easternshoreconsulting.ca Bob Khosropur• bob.khosropur@mariposaltd.com Gary Plotkin• gplotkin@kpmg.com
  33. 33. Please Complete the Session Evaluation Form onthe Conference App and Include Your ConferenceRegistration ID# to be Included in a Drawing for aFree Conference Registration for the 2014 AnnualConference!NOTE: Your Conference Registration ID# is Located at theBottom Left Hand Corner of Your Badge.