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Enhancing Claims Management: Technology as a Risk Professional’s Best Friend

Discover the latest technology trends in claims management and practical applications to boost risk management efforts. Dive into the evolution of technology, big data challenges, and explore transformative ideas to optimize claims processes. Learn about analytics, SaaS/cloud computing, and key performance indicators for improved efficiency and outcomes. Get insights on communication speed, connectivity with claim vendors, leading indicators for risk management, and benchmarking strategies. Enhance your skills and expertise to leverage technology effectively in claims management. Engage in Q&A sessions and gain critical insights to maximize your ROI in claims operations.

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Enhancing Claims Management: Technology as 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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