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Technology: A Risk Professional’s Best Friend

Technology: A Risk Professional’s Best Friend. Using Technology to Enhance Claims Management. Session Presenters: Matt Thomson | Wells Fargo Insurance | Risk Consulting Leader

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Technology: A Risk Professional’s Best Friend

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  1. Technology: A Risk Professional’s Best Friend Using Technology to Enhance Claims Management

  2. Session Presenters: • Matt Thomson | Wells Fargo Insurance | Risk Consulting Leader • Since 1903, Wells Fargo Insurance Services USA, Inc.has been providing its clients with innovative and insightful insurance solutions that help protect assets and strengthen businesses • Frank Lott | FirstGroup America | Corporate Claims Director • FirstGroup America owns and/or operates thousands of school bus, transit, and maintenance locations in the United States and Canada, with over $5 billion in annual revenue from North American operations • Aaron Shapiro | Origami Risk | Executive Director • Origami Risk has emerged as innovator and leader in the marketplace for RMIS solutions : #1 RMIS by the 2013 RMIS Review

  3. What to Expect • After attending this session, you will: • Learn about the current trends in technology-related claims program consulting • Learn ideas for the practical application of technology to enhance your claims and risk management efforts

  4. Exploring the history and pace of technology advancement Environmental Assessment

  5. A Few Warm Up Stats • 2.4 billion Internet users • Google: 100 billion searches every month • YouTube: 24 hours of video uploaded every minute • FaceBook: 175 million connected every moment • 3.500.000.000.000.000.000.000 • 3.5 Zetabytes of unique new information will be created worldwide this year Source: Did You Know 2014

  6. Claims Technology Evolution

  7. Easy Button?

  8. Big Data – but is it Good data? • Unstructured v. structured • Carrier systems designed for underwriting/internal use • Claim characteristic code standardization • Lowest common denominator • Point in time valuation / lack of development factors • Location hierarchy • Acquisitions & divestitures • Departmental naming conventions

  9. Today’s Technology • Memory is cheaper • Processing is faster • Analytical programs are more sophisticated Are you equipped to take advantage?

  10. Analytics Platform Source: AllAnalytics.com

  11. SaaS/Cloud Computing • Data capacity implications • Data conversion • Psycho/social elements • Privacy/security • Speed

  12. Exploring practical ideas to transform your claims management efforts Claim Program transformation

  13. Claim Lifecycle + Technology Benchmarks  Balanced Scorecard  Claim Audit  Resource Management  Predictive Modeling  KPIs (Leading & Trailing) 

  14. ‘Similar’ Claim Characteristics

  15. Dashboard Management

  16. Need for claims professionals communication speed

  17. Claim Vendor Partner Connectivity • Sharing information to improve efficiency and outcomes • MSA vendor having access to RX program • Nurse case management • Minor damage photos coded to trigger IME assignments • Alert when PT is over guidelines (take action) • Alert when 12 PT visits that have not had a diagnostic test • RX utilization sharing with medical bill re-pricing to flag contra-indications and over-use • Early refill and/or if more than one MD is prescribing • Adjuster accountability

  18. Claims Key Performance Indicators (KPIs) • 2 Important Points: • #1 : It has a direct, bottom line impact on the success of the business; and • #2: It is analyzable and actionable.

  19. Leading Indicators • Focus onRisk Management QualityLeading Indicators • (Culture, engineering, training, etc.) to drive down trailing indicators (incidents, losses, etc.) • Choose Leading Indicators Carefully • Thorough causal analysis of past losses and potential exposures • Choose indicators that will drive positive behaviors and improvements • Make sure they correlate to the trailing indicators • Be comprehensive in approach (training w/out commitment is worthless) • Be Practical • Must choose approach that fits with culture and needs of organization • Measure the “big ticket” items – the ones that will cause the most change in trailing indicators • Be outcome focused • Measures should promote problem reporting and drive action

  20. Benchmarking

  21. Internal Benchmarking

  22. Balanced Scorecard

  23. Top Tech Priorities of Carriers & TPAs

  24. Final thoughts and recommendations CONCLUSIONS & Q&A

  25. Critical to your ROI • Data Analytics Resources • Skills/expertise of internal/external partners • Balancing Claims Quality & Efficiency • Are claim adjusters critical thinkers, or adjusting to activity-based ‘tech driven’ metrics?

  26. THANK YOU

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