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 I...
Why Talk about technology?
“Analytics is defined as the scientific
process of transforming data into
insight for making be...
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...
What has been done already?
 Subrogation/Liability
• Structured and consistent investigations
• Not new as adjusters expe...
We are not done!
 The insurance company is changing
• Office consolidation and work from home models
• Adjusters assigned...
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 r...
Benefits of Analytic Decision Making:
 Benefits of Analytic Decision Making:
• Information in – intelligence out
• Object...
Discussion / Feedback
13
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Wed145pm thefutureoftechnologies

  1. 1. The Future of Technology and Claims Investigations Wednesday, June 25, 2014
  2. 2. Host: Michael Rivers Manager, Claims Analytics and Consulting Services ISO Claims Services, ISO 3
  3. 3. Panelists: Marcia Halvorsen Claims Operations Manager GuideOne Insurance Ella Tayrien Manager, Claims Department Traders Insurance 4
  4. 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
  5. 5. Does further investment matter? 6
  6. 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
  7. 7. What has been done already?  Subrogation/Liability • Structured and consistent investigations • Not new as adjusters expected to do this already 8
  8. 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
  9. 9. MedSentry & Provider Fraud 10 http://www.aota.org/DocumentVault/Surveys/LCD‐Outpatient.aspx?FT=.pdf
  10. 10. 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
  11. 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
  12. 12. Discussion / Feedback 13
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