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Wed145pm thefutureoftechnologies



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