The insurance industry is highly competitive and regulated, leading companies to consolidate, reduce costs through efficiency, and comply with numerous state statutes. Technology is increasingly used to expedite claim processing, including e-forms, e-medical records from healthcare providers, and data analytics to identify trends and potential fraud. Resources are also changing as companies allow telecommuting to attract talent, reduce costs, and improve retention, though guidelines define expectations for remote employees.
- Insurance companies are increasingly using data and analytics to improve fraud detection. By analyzing large amounts of data from claims, underwriting, and other sources, insurers can identify patterns and flags of potentially fraudulent activity.
- However, adopting new analytic technologies can be costly, and regulations make sharing some data between insurers and departments difficult. Insurers must weigh these challenges against the losses caused by fraud.
- As analytic capabilities advance, fraud detection is moving from a siloed function to one integrated across the insurance lifecycle, from underwriting to claims. This holistic approach allows insurers to gain a more complete view of fraud risks.
Top 5 Consumer Expectations in the Insurance Industry - InvensisInvensis
Read what Consumers want from their Insurers (http://goo.gl/wJxHKE) and how outsourcing can help insurers to satisfy customers in the insurance industry. Top Five Consumer Expectations in the Insurance Industry which will help to keep insurance companies agile and efficient, and make them ready to meet the changing demands of their patrons.
Invensis Technologies (http://www.invensis.net) a leading IT BPO company with more than 14 years of experience, specializes in providing customer care, document process automation and IT services to insurance industries which helps insurance companies enable to leverage the new opportunities.
Please contact us at sales {at} invensis {dot} net OR Call us Now from US +1 (302)- 261-9036, UK +44 203 411 0183, AUS +61 3 8820 5183, IND +91 80 41155233 or browse (http://goo.gl/xmCoeO) for more details on our services.
Harnessing the data exhaust stream: Changing the way the insurance game is pl...Accenture Insurance
Vast new data streams create opportunities for insurers to identify and act upon hidden insights, but they also open the door for new business models and competitors.
Data-driven insights make it possible to create new products and new revenue streams, typically in partnership with players from outside the industry.
Harnessing external data is a complex undertaking, but insurers can start by developing a comprehensive plan and then undertaking specific, high-return initiatives that build momentum and help transform the enterprise into a winning competitor in the new digital arena.
Harnessing the data exhaust stream: Changing the way the insurance game is pl...Accenture Insurance
Learn how external insurance data and analytics is changing everything, from pricing risk to interacting with customers. Read more: https://www.accenture.com/us-en/insight-harnessing-external-data-stream
This document discusses the challenges insurance companies face in keeping up with technological advances. It notes that only 15% of insurance businesses consider themselves technologically progressive, and that outdated systems and a generational gap are hindering modernization efforts. However, improving efficiency, customer experience, fraud detection, and mobile technologies could help companies better serve customers and gain competitive advantages if they are willing to invest in new technologies like smart machines and the Internet of Things.
The document discusses the key shifts underway in the insurance industry as it transitions to a digital model. Empowered consumers demanding personalized experiences, innovative competitors, and new technologies are driving insurers to move from a policy-centric model to one focused on the customer. Insurers must utilize data and analytics to develop new products that anticipate customer needs and can be purchased through any channel. They also need to build ecosystems of partners and modernize legacy systems to keep pace with these changes and remain competitive in the digital insurance landscape.
Building a Code Halo Economy for InsuranceCognizant
By finding meaning in the digital data that accumulates around people, processes, organizations and things, insurers can simultaneously reinvent how they operate and reshape their customers' experience.
- Insurance companies are increasingly using data and analytics to improve fraud detection. By analyzing large amounts of data from claims, underwriting, and other sources, insurers can identify patterns and flags of potentially fraudulent activity.
- However, adopting new analytic technologies can be costly, and regulations make sharing some data between insurers and departments difficult. Insurers must weigh these challenges against the losses caused by fraud.
- As analytic capabilities advance, fraud detection is moving from a siloed function to one integrated across the insurance lifecycle, from underwriting to claims. This holistic approach allows insurers to gain a more complete view of fraud risks.
Top 5 Consumer Expectations in the Insurance Industry - InvensisInvensis
Read what Consumers want from their Insurers (http://goo.gl/wJxHKE) and how outsourcing can help insurers to satisfy customers in the insurance industry. Top Five Consumer Expectations in the Insurance Industry which will help to keep insurance companies agile and efficient, and make them ready to meet the changing demands of their patrons.
Invensis Technologies (http://www.invensis.net) a leading IT BPO company with more than 14 years of experience, specializes in providing customer care, document process automation and IT services to insurance industries which helps insurance companies enable to leverage the new opportunities.
Please contact us at sales {at} invensis {dot} net OR Call us Now from US +1 (302)- 261-9036, UK +44 203 411 0183, AUS +61 3 8820 5183, IND +91 80 41155233 or browse (http://goo.gl/xmCoeO) for more details on our services.
Harnessing the data exhaust stream: Changing the way the insurance game is pl...Accenture Insurance
Vast new data streams create opportunities for insurers to identify and act upon hidden insights, but they also open the door for new business models and competitors.
Data-driven insights make it possible to create new products and new revenue streams, typically in partnership with players from outside the industry.
Harnessing external data is a complex undertaking, but insurers can start by developing a comprehensive plan and then undertaking specific, high-return initiatives that build momentum and help transform the enterprise into a winning competitor in the new digital arena.
Harnessing the data exhaust stream: Changing the way the insurance game is pl...Accenture Insurance
Learn how external insurance data and analytics is changing everything, from pricing risk to interacting with customers. Read more: https://www.accenture.com/us-en/insight-harnessing-external-data-stream
This document discusses the challenges insurance companies face in keeping up with technological advances. It notes that only 15% of insurance businesses consider themselves technologically progressive, and that outdated systems and a generational gap are hindering modernization efforts. However, improving efficiency, customer experience, fraud detection, and mobile technologies could help companies better serve customers and gain competitive advantages if they are willing to invest in new technologies like smart machines and the Internet of Things.
The document discusses the key shifts underway in the insurance industry as it transitions to a digital model. Empowered consumers demanding personalized experiences, innovative competitors, and new technologies are driving insurers to move from a policy-centric model to one focused on the customer. Insurers must utilize data and analytics to develop new products that anticipate customer needs and can be purchased through any channel. They also need to build ecosystems of partners and modernize legacy systems to keep pace with these changes and remain competitive in the digital insurance landscape.
Building a Code Halo Economy for InsuranceCognizant
By finding meaning in the digital data that accumulates around people, processes, organizations and things, insurers can simultaneously reinvent how they operate and reshape their customers' experience.
Carriers have historically been backwards-focused and have tended to maintain established processes without question. They also have the propensity to be risk-averse. These characteristics need to change. Carriers must be willing to try new things without betting the ranch or subjecting the company to undue risk.
The property and casualty insurance industry has seen declining profits in recent years due to lower investment returns and high claims costs. Fraud represents a significant portion of claims costs, estimated at $30 billion annually in the US alone. Predictive analytics can help insurers more efficiently identify fraudulent claims, recover costs through subrogation, optimize staff scheduling, and improve loss reserving. Early adopters of predictive analytics in claims processing are seeing returns of over 100% and improved customer retention compared to companies that have not adopted these techniques.
Medical billing involves submitting claims to health insurance companies to receive payment for healthcare services. A medical biller is responsible for all paperwork related to patient records and works with insurance companies to ensure providers are paid for services. The medical billing process involves multiple interactions between healthcare providers and insurers that can take days to months to complete. Due to regulations like HIPAA, medical billing training and certification have become more important for medical billers to understand privacy rules and electronic billing standards. Many healthcare providers outsource their billing to third-party medical billing services in order to reduce costs and complexity.
Etude PwC "Insurance 2020" : dommage et digital (2014)PwC France
http://bit.ly/AssuranceEnLigne
Pour les compagnies d’assurance, multiplier les échanges numériques avec les clients est un élément essentiel pour les fidéliser et se différencier des concurrents. C’est ce que révèle le rapport de PwC "Insurance 2020: The digital prize – Taking customer connection to a new level". Le cabinet d’audit et de conseil a interrogé plus de 9 000 consommateurs dans le monde, dont 500 français.
The Work Ahead in Insurance: Vying for Digital SupremacyCognizant
Insurers expect dramatic changes to their work by 2023 as a result of adopting digital technologies and mindsets, according to our study. Speeding processes, harnessing data and forming new collaborations will be key to winning the digital arms race ahead.
McKinsey-Coronavirus impact on service organizations-Weathering the storm.pdfReadAndGain
Organizations providing services are facing unique challenges due to the coronavirus pandemic requiring physical distancing and limited contact. The document outlines three critical steps for service organizations to take: 1) Protect employees and customers through safety measures, clear communication, and redesigning processes for remote work where possible. 2) Stabilize a suddenly virtual workforce by providing tools, infrastructure, security protocols for working from home. 3) Manage fluctuating service demands and expectations through actions like payment flexibility, targeted pricing, and renegotiating service levels to prioritize customer needs. Looking ahead, organizations must also rapidly assess changing demand and match supply accordingly while building resilience and flexibility into their operations.
Key Takeaways and Recommendations for Claims Software Adoption: DataGenixDataGenix
DataGenix claims software, fostering a more efficient, secure, and adaptable claims processing environment. The software's capabilities, combined with strategic implementation and ongoing optimization, position insurers to navigate the evolving landscape of healthcare and insurance with confidence and effectiveness.
This document discusses how improving the customer experience is critical for insurance companies to drive growth. It states that customer experience, especially during the claims process, has become the new battleground for attracting and retaining customers. The document recommends that insurance companies implement "next practices" like automated claims processing using capture technologies to streamline the claims process and enhance the customer experience. This improves customer satisfaction and loyalty, reduces churn, and boosts the bottom line through increased revenue and customer retention.
Amid a drastically changed industry landscape characterized by choosier customers and tightening regulations, insurance companies are scrambling to sustain growth and profits.
This document describes a pilot program between CMS and National Government Services to test preventing medical insurance fraud related to Medicare durable medical equipment claims. The pilot tested verifying physician orders and patient visits using credit card networks and cards issued to physicians and suppliers. The pilot found the system could be implemented quickly and scaled nationally. It successfully verified physician and supplier transactions and matched claims to prevent duplicate billing, indicating it could reduce fraud. The document estimates that preventing just 5% of durable medical equipment fraud would produce a return on investment of 250% due to the high costs of fraudulent claims.
Describes a joint CMS/WellPoint voluntary project that demonstrates the effectiveness of Castlestone's VisitEye in preventing many forms of outpatient insurance fraud, in this case Durable Medical Equipment (DME)
The document discusses how digitization is transforming the insurance industry. It is putting pressure on life/pensions and property/casualty insurers to improve customer experience through digital channels. Customers now expect seamless, personalized experiences through mobile and online access. Insurers need to leverage new technologies like analytics, cloud computing, and the internet of things to meet these rising expectations and compete in the digital era. Data and digitization offer opportunities to better understand customers, price policies dynamically, and automate processes, but insurers must also address challenges of security, regulation and building customer trust.
As a key component of healthcare reform, web-based healthcare insurance exchanges are intended to make buying healthcare benefits easier and more affordable for individuals and smaller businesses. The exchanges will operate as virtual stores where heath plans can be compared; eligibility assessed and benefit plans purchased. They are a new, uncharted venue for insurance carriers, managed care and government healthcare interests!
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
This document discusses 10 trends shaping the life insurance industry landscape:
1. Steady industry growth, but underlying issues of underinsurance and lack of innovation persist.
2. Insurers are challenged to rationalize legacy systems while maintaining valuable historical business, constraining growth.
3. Some insurers are outsourcing administration and systems management to leverage partnerships and convert costs.
4. Regulatory changes increase need for flexibility but also interfere with modernization efforts.
Most healthcare payers are just beginning to use big data following other industries. Big data can help reduce costs through early fraud detection and optimized routing. It can also reduce the time spent on tasks like audits and claims processing. Additionally, big data allows for new product development through personalized services based on individual health data. However, healthcare data requires strong security and privacy controls for any big data initiative.
The document discusses how the fast pace of modern life has raised consumer expectations for quick services, but insurance companies have often lagged behind in promptly processing and paying claims. Waiting 30 days for a claim to be paid, as is typical in the insurance industry, can cause financial hardship for many. However, some insurers like Aflac have adapted by using new technology to process, approve, and pay out claims in just one day, meeting the needs of consumers in a fast-paced world. The document urges ensuring your insurer can provide money quickly when dealing with a serious illness or injury.
This document discusses the importance of identity protection in the age of widespread data breaches. It notes that data breaches are now very common across many industries and can compromise personal information like names, addresses, and social security numbers. While companies often offer free credit monitoring after a breach, the document argues this only provides limited protection and may only monitor one credit bureau. A more comprehensive identity protection solution is needed that includes identity monitoring, prevention services, resolution assistance if fraud occurs, and monitoring of the deep/dark web where stolen data is sometimes traded. Such robust protection is necessary given that the effects of a data breach on a person's identity can last for years.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Carriers have historically been backwards-focused and have tended to maintain established processes without question. They also have the propensity to be risk-averse. These characteristics need to change. Carriers must be willing to try new things without betting the ranch or subjecting the company to undue risk.
The property and casualty insurance industry has seen declining profits in recent years due to lower investment returns and high claims costs. Fraud represents a significant portion of claims costs, estimated at $30 billion annually in the US alone. Predictive analytics can help insurers more efficiently identify fraudulent claims, recover costs through subrogation, optimize staff scheduling, and improve loss reserving. Early adopters of predictive analytics in claims processing are seeing returns of over 100% and improved customer retention compared to companies that have not adopted these techniques.
Medical billing involves submitting claims to health insurance companies to receive payment for healthcare services. A medical biller is responsible for all paperwork related to patient records and works with insurance companies to ensure providers are paid for services. The medical billing process involves multiple interactions between healthcare providers and insurers that can take days to months to complete. Due to regulations like HIPAA, medical billing training and certification have become more important for medical billers to understand privacy rules and electronic billing standards. Many healthcare providers outsource their billing to third-party medical billing services in order to reduce costs and complexity.
Etude PwC "Insurance 2020" : dommage et digital (2014)PwC France
http://bit.ly/AssuranceEnLigne
Pour les compagnies d’assurance, multiplier les échanges numériques avec les clients est un élément essentiel pour les fidéliser et se différencier des concurrents. C’est ce que révèle le rapport de PwC "Insurance 2020: The digital prize – Taking customer connection to a new level". Le cabinet d’audit et de conseil a interrogé plus de 9 000 consommateurs dans le monde, dont 500 français.
The Work Ahead in Insurance: Vying for Digital SupremacyCognizant
Insurers expect dramatic changes to their work by 2023 as a result of adopting digital technologies and mindsets, according to our study. Speeding processes, harnessing data and forming new collaborations will be key to winning the digital arms race ahead.
McKinsey-Coronavirus impact on service organizations-Weathering the storm.pdfReadAndGain
Organizations providing services are facing unique challenges due to the coronavirus pandemic requiring physical distancing and limited contact. The document outlines three critical steps for service organizations to take: 1) Protect employees and customers through safety measures, clear communication, and redesigning processes for remote work where possible. 2) Stabilize a suddenly virtual workforce by providing tools, infrastructure, security protocols for working from home. 3) Manage fluctuating service demands and expectations through actions like payment flexibility, targeted pricing, and renegotiating service levels to prioritize customer needs. Looking ahead, organizations must also rapidly assess changing demand and match supply accordingly while building resilience and flexibility into their operations.
Key Takeaways and Recommendations for Claims Software Adoption: DataGenixDataGenix
DataGenix claims software, fostering a more efficient, secure, and adaptable claims processing environment. The software's capabilities, combined with strategic implementation and ongoing optimization, position insurers to navigate the evolving landscape of healthcare and insurance with confidence and effectiveness.
This document discusses how improving the customer experience is critical for insurance companies to drive growth. It states that customer experience, especially during the claims process, has become the new battleground for attracting and retaining customers. The document recommends that insurance companies implement "next practices" like automated claims processing using capture technologies to streamline the claims process and enhance the customer experience. This improves customer satisfaction and loyalty, reduces churn, and boosts the bottom line through increased revenue and customer retention.
Amid a drastically changed industry landscape characterized by choosier customers and tightening regulations, insurance companies are scrambling to sustain growth and profits.
This document describes a pilot program between CMS and National Government Services to test preventing medical insurance fraud related to Medicare durable medical equipment claims. The pilot tested verifying physician orders and patient visits using credit card networks and cards issued to physicians and suppliers. The pilot found the system could be implemented quickly and scaled nationally. It successfully verified physician and supplier transactions and matched claims to prevent duplicate billing, indicating it could reduce fraud. The document estimates that preventing just 5% of durable medical equipment fraud would produce a return on investment of 250% due to the high costs of fraudulent claims.
Describes a joint CMS/WellPoint voluntary project that demonstrates the effectiveness of Castlestone's VisitEye in preventing many forms of outpatient insurance fraud, in this case Durable Medical Equipment (DME)
The document discusses how digitization is transforming the insurance industry. It is putting pressure on life/pensions and property/casualty insurers to improve customer experience through digital channels. Customers now expect seamless, personalized experiences through mobile and online access. Insurers need to leverage new technologies like analytics, cloud computing, and the internet of things to meet these rising expectations and compete in the digital era. Data and digitization offer opportunities to better understand customers, price policies dynamically, and automate processes, but insurers must also address challenges of security, regulation and building customer trust.
As a key component of healthcare reform, web-based healthcare insurance exchanges are intended to make buying healthcare benefits easier and more affordable for individuals and smaller businesses. The exchanges will operate as virtual stores where heath plans can be compared; eligibility assessed and benefit plans purchased. They are a new, uncharted venue for insurance carriers, managed care and government healthcare interests!
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
This document discusses 10 trends shaping the life insurance industry landscape:
1. Steady industry growth, but underlying issues of underinsurance and lack of innovation persist.
2. Insurers are challenged to rationalize legacy systems while maintaining valuable historical business, constraining growth.
3. Some insurers are outsourcing administration and systems management to leverage partnerships and convert costs.
4. Regulatory changes increase need for flexibility but also interfere with modernization efforts.
Most healthcare payers are just beginning to use big data following other industries. Big data can help reduce costs through early fraud detection and optimized routing. It can also reduce the time spent on tasks like audits and claims processing. Additionally, big data allows for new product development through personalized services based on individual health data. However, healthcare data requires strong security and privacy controls for any big data initiative.
The document discusses how the fast pace of modern life has raised consumer expectations for quick services, but insurance companies have often lagged behind in promptly processing and paying claims. Waiting 30 days for a claim to be paid, as is typical in the insurance industry, can cause financial hardship for many. However, some insurers like Aflac have adapted by using new technology to process, approve, and pay out claims in just one day, meeting the needs of consumers in a fast-paced world. The document urges ensuring your insurer can provide money quickly when dealing with a serious illness or injury.
This document discusses the importance of identity protection in the age of widespread data breaches. It notes that data breaches are now very common across many industries and can compromise personal information like names, addresses, and social security numbers. While companies often offer free credit monitoring after a breach, the document argues this only provides limited protection and may only monitor one credit bureau. A more comprehensive identity protection solution is needed that includes identity monitoring, prevention services, resolution assistance if fraud occurs, and monitoring of the deep/dark web where stolen data is sometimes traded. Such robust protection is necessary given that the effects of a data breach on a person's identity can last for years.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
1. The insurance industry is a highly competitive and
regulated market. Insurance companies are consolidating
and merging while seeking any competitive advantage
they can find to reduce costs, increase efficiency, and
remain compliant with the myriad of 50 state statutes.
Companies must be vigilant and remain flexible to
identify new ways to manage margins and preserve
capital by implementing sound decision-making
processes and risk mitigation strategies. They must
consider everything from trends in investment strategies,
diversification, reinsurance, securitizations, and cyber-
security; to mergers, acquisitions, joint ventures, strategic
alliances, and investment in back office improvements,
e.g., claim operations.
As life claim professionals we must continually be
aware of changes and emerging trends within the life
insurance industry that may affect claim operations.
This article takes a high level look at a few of these
trends, focusing on three areas: technology, resources
and policies.
Trending in technology
E-forms
Simply providing printable claim forms online for
claimants to complete and return by mail or fax is
slowly becoming passé. Life insurance companies are
gradually beginning to implement web-based solutions
in pursuit of expedited claim processing and to elevate
the overall customer experience. This technology
provides claimants with a partially pre-filled death claim
form for verification of information and completion of
additional required details, such as location of death
and beneficiary information. Where possible, drop-down
lists are utilized to ensure the data provided is properly
formatted and can be automatically loaded into a
claim database.
The claimant is also provided the opportunity to scan
other required documents and proofs of loss, e.g.,
medical authorizations, death certificate, foreign death
questionnaire, or copy of the policy, directly into the
company’s mail server to be attached to the claim.
Companies continue to require a hard copy of the death
certificate be received by mail; however, the electronic
submission of documents allows the claim set-up
and adjudication process to begin immediately; thus,
enhancing the customer experience by simplifying the
process of filing the claim and decreasing the number of
days to adjudicate it.
Even though e-forms have been successfully utilized
in other lines of insurance, for example, auto, the
transformation to life insurance claims has proceeded
slowly and cautiously as companies systematically
monitor its effectiveness and to ensure proper controls
are in place to identify and mitigate the risk of fraud.
Currently, this process is primarily utilized for claims
on policies with small face amounts or low risk factors,
such as advanced age, domestic location of death, or
longer policy durations.
E-medical records
As the result of a federal government mandate, all public
and private healthcare providers were required to adopt
and demonstrate “meaningful use” of electronic health
records (EHRs). Failure to do so by 2015 resulted in
penalties beginning with a 1% reduction in Medicare and
Documents are signed via e-signature; however,
some companies are utilizing known information
from their systems, as well as alternative sources
of infor
mation, such as credit reporting agencies,
to verify the claimant’s identity.
Emerging Trends – What’s Next?
2. Medicaid reimbursements, with the penalty increasing
each subsequent year, up to a 95% penalty depending
on future adjustments. These penalties, along with
monetary incentives for completing implementation
of an EHR system, provided motivation for medical
providers to adopt the digitized formatting of medical
records. The utilization of EHRs will indirectly
impact the life insurance industry, specifically in the
underwriting and claims areas.
From an underwriting viewpoint, it is envisioned that
EHRs will feed into an underwriting data base and
provide improved integration for automated rules-
based underwriting. Properly implemented, automated
underwriting will increase efficiency, decreasing turn-
around-time from the date of application to the date
of an underwriting decision and policy issue. However,
there is some concern that including EHR data from
wearables like Fitbit, such as daily steps, heart rate, or
sleep quality, may result in data overload. In addition,
the use of diagnostic code sets and limited context,
may increase the need for underwriters to obtain more
detailed Attending Physician Statements.
In addition to underwriters, the implementation of EHRs
will have an important impact for claim professionals.
Digitized data is searchable; thus, identifying claim,
risk (biometrics) and fraud trends may become more
effective, reliable, and perhaps automated. In addition,
EHRs will eliminate the notorious issues with illegible
physician penmanship.
On the downside, both underwriters and claim
professionals are apprehensive that physicians will
become more cautious about documenting medical
records since patients and their families now have
increased access to view their records. This could cause
a physician to be less candid when documenting the file
or a patient may request a physician redact the records
to leave out pertinent information.
There is currently no standardized format nor dominant
platform for EHRs. Furthermore, there is no plan for
conversion of paper medical records to EHRs; thus, in
order to obtain a complete health history of an insured,
underwriters and claim examiners must request both
the EHRs and all paper medical records created prior to
EHR implementation. Privacy, general public awareness,
perception and acceptance also play critical roles on the
effect of EHRs to life insurance companies.
It is vital that claim departments work with underwriting,
and all other departments affected by EHRs, to ensure
consistency and efficiency and to maximize the utility of
EHRs within their company.
Data analytics aka “big data”
Data has always been vital to the insurance industry
as it provides the ability for companies to analyze
and evaluate the risk of insuring a particular industry,
event, or individual. The growth of big data through
data mining, in-memory analytics, predictive analytics
and text mining has enabled insurance companies to
more quickly recognize underwriting and claim trends,
develop pricing modules, administer policies, decrease
processing times, and to detect potential fraud in both
the claim and underwriting process.
Through improved systems and the increased
accessibility of big data, identification of behavior
patterns, utilizing social network behavior, risk scoring,
and live data streaming, insurance companies are
already initiating fraud detection in the early stages
of the application and underwriting process. These
methods assist companies to evaluate risk more
accurately to either rate the risk appropriately, request
additional information, or to reject the risk if it exceeds
their underwriting guidelines or if fraud is detected.
Trending in resources
The human factor
As discussed, with the onset of e-forms, e-medical
records, and big data, new technological advances
are forever changing the insurance industry. This
includes the ability to conduct business from virtually
anywhere in the world from a single location, including
an employee’s own home. According to Global
Workplace Analytics, the non-self-employed work at
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Insurance fraud has always had a high cost to
both insurance companies and consumers. The
Coalition Against Insurance Fraud estimates the
impact of claim fraud on the insurance industry
to be $80 billion dollars…each year. While claim
examiners must remain able to manually identify
red flags and indicators of fraud, big data may
assist examiners to detect fraud earlier in the
claim process and more accurately identify claims
requiring additional scrutiny. By detecting and
eliminating fraud more quickly and accurately,
these algorithms allow companies to decrease
the time necessary to review and pay legitimate
claims, as well as assisting to reduce the overall
cost of insurance to consumers.
3. home population has grown by 103% since 20051
. For
many insurers, the concept of working from home or
“telecommuting” initiated in their I.T. and underwriting
departments in an effort to recruit and retain critical
employees. This movement has quickly spread into
the claims arena as companies are concerned that
their most experienced individuals are approaching
retirement and they may have insufficient experience
remaining in the department. Attracting experienced
claim professionals who are willing to relocate is a
daunting challenge. In addition, millennials are difficult
to attract to the insurance industry; thus, offering the
ability to work from “anywhere” can be very appealing to
these demographics.
In addition to attracting new talent and improving
employee retention and job satisfaction, some
companies are able to significantly decrease the costs
of office space and related overhead by allowing call
center and claim employees to telecommute. This is also
an alternative to outsourcing these jobs to third-party
administrators or other countries.
The companies that have most successfully imple
mented telecommuting into their environment have
well-defined and written telecommuting guidelines
defining the expectations of all parties. This includes the
understanding that if the employee does not meet the
expectations or other requirements, then their privilege
to telecommute may be terminated or they may be
subject to other disciplinary action.
Many companies with a telecommuting policy
require employees to be present in the office at least
periodically. For the individual employee, this varies
substantially from one week per month, to 1-3 days each
week. These companies usually require all employees
to simultaneously be in the office for at least one day of
the required office time. This creates balance, allowing
the convenience of offsite time for concentrated
non-interruptive claim review and production, while
maintaining time for team camaraderie and interaction
for collaborative discussions.
If not properly planned and executed, telecommuting
may increase the risk of a potential security breach,
and privacy and confidentiality is also a concern. Strict
security and privacy guidelines must be established
and be included in the telecom
muting guidelines.
Each employee should be required to sign an
acknowledgment of receiving and having read the
guidelines.
Trending in policies
HIV positive
Until recently, individuals living with HIV/AIDS were
uninsurable by life insurance companies as being HIV-
positive was considered to be an early death sentence;
however, due to advances in medical technology and
treatment innovations, HIV life spans are increasing.
According to statistics by Healthline.com2
, a 20 year-
old-man with HIV, who begins treatment early, can
now expect to live to age 77. The increased rate of HIV
survival has not gone unnoticed by life insurers. In
2015, a major life insurer began offering life insurance
coverage to individuals living with HIV. In addition,
another major insurer launched a program to provide
financial and retirement planning to individuals living
with HIV.
As longevity increases for HIV positive individuals,
so will insurance and health care options. This is also
true for other medical diagnoses as further advances
in medicine are made. It is important for the claims
department to collaborate with the underwriting and
pricing departments to stay abreast of new products and
to collect data and provide important feedback about
the claim experience and the policy durations involving
these innovative insurance policies.
Critical illness
The U.S. market for critical illness coverage is growing
faster than any other insurance product. According to
a 2015 survey of 59 critical illness carriers representing
approximately 95% of the U.S. market, 43 companies
stated they were actively marketing 73 different critical
illness products3
. Of those already in the market, 59%
stated they plan to increase their focus on critical illness
sales. This market is being driven by the fact that people
are living longer and their chances of surviving a heart
attack, cancer or stroke are greater than even a few
short years ago. Escalating health insurance pressures
due to high deductibles and out-of-pocket expenses are
contributing to the need for individuals to have other
options to close the gap of paying for health care needs
and avoiding depletion of their retirement savings.
Critical illness coverage was initially referred to as
“Dread Disease” to pay a “living benefit” or lump sum
benefit to a surviving patient of a serious illness. The
early versions only covered four conditions: heart attack,
CAD requiring surgery, cancer and stroke. Total and
permanent benefits were subsequently added. Coverage
today often includes: cancer, heart attack, stroke, heart
transplant, coronary bypass surgery, angioplasty, kidney
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