Wed145pm thefutureoftechnologies
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Wed145pm thefutureoftechnologies Wed145pm thefutureoftechnologies Presentation Transcript

  • The Future of Technology and Claims Investigations Wednesday, June 25, 2014
  • Host: Michael Rivers Manager, Claims Analytics and Consulting Services ISO Claims Services, ISO 3
  • Panelists: Marcia Halvorsen Claims Operations Manager GuideOne Insurance Ella Tayrien Manager, Claims Department Traders Insurance 4
  • Why Talk about technology? “Analytics is defined as the scientific process of transforming data into insight for making better decisions.” - INFORMS The Institute for Operations Research and the Management Sciences (INFORMS) 5
  • Does further investment matter? 6
  • What am I hearing?  Manual effort “It is up to the insurer to do its diligence to obtain any information that would serve…the third party's claim. Is this time consuming and expensive? Most definitely.”  “I don’t know how we are doing.” – March 2014  “…if it is not automated, the manual process may get missed.” – June 2013  “A claim is a claim is a claim." “Those who subscribe to this school of thought are aggravated that someone hasn't yet come up with a computer algorithm that would replace the need for adjusters altogether!” 7
  • What has been done already?  Subrogation/Liability • Structured and consistent investigations • Not new as adjusters expected to do this already 8
  • We are not done!  The insurance company is changing • Office consolidation and work from home models • Adjusters assigned claims from multiple states  The occurrence of fraud is increasing • “Aite Projects Insurance Fraud Will Cost $80 Billion Annually By 2015” By Christina Bramlet, PropertyCasualty360.com 8/2013  Compliance • For statutes, there are many public sources. Manual effort to apply to the applicable claim • Case law, manual efforts to manage as well 9
  • MedSentry & Provider Fraud 10 http://www.aota.org/DocumentVault/Surveys/LCD‐Outpatient.aspx?FT=.pdf
  • What makes initiatives fail?  Don’t state goals such as: • “must have 15% of claims with more liability” • “must have 4 referrals to the subro team” • “must have 100% closure rate”  Improve the investigations leads to better outcomes. 11
  • Benefits of Analytic Decision Making:  Benefits of Analytic Decision Making: • Information in – intelligence out • Objective and consistent • Proactive decisions • Considers multiple inter-related factors • Efficient and scalable • Optimizes use of human subject matter experts 12
  • Discussion / Feedback 13