Post on 17-Aug-2020
Mark Foerster
Vice President, Group
Operations & Claims,
Munich RE
Claims Management &
Technology in 2020
Agenda
• Claims Management Evolution
• Time for a Claims Revolution
• Claims Management Technology in 2020:
Improved service, outcomes & efficiencies
• Q & A
CLAIM
Claims Management Evolution
Claims Management Evolution –
Growing Sophistication
• Every claim is unique. Every claims assessor has good instincts.
• Claim proofs. Processing manuals.
• Job criteria. Selective hiring.
• Training. Best Practices.
• Metrics. Analytics.
• Predictive Modeling.
• Smart decision support.
Claims Management Evolution –
Management’s Changing View
• Administration
function only.
• Service orientation.
• Cost centre.
Efficiency.
• Risk management.
Claims Management Evolution –
Management’s Changing View
• Actual versus expected claims. Profit protection. Duration management.
• Feedback loop to product development, sales, underwriting and pricing.
• Return on investment.
Claims Management Evolution –
Key Success Ingredients
• Data & analysis
• State-of-the-art Technology
• Inter-department
connections
• Business savvy & visionary
leaders
D
Peter Maynard, Director, SelectX
Dave Nicolai, Senior Vice President, FINEOS
D
Mark Foerster
mfoerster@munichre.ca
416-359-2299
Thank-you for attending this session.
Time for a claims
revolution
Peter Maynard, SelectX
Introducing SelectX…
• Niche management consultancy specialising
in underwriting and new business process
for life and disability
• Core offerings:
– Creating modern, efficient processes
– Underwriting engines
– Underwriting manuals – RiskApps
Agenda
• The claims environment
• What insurers are doing
• The case for applying technology
• Vision of the future – how far away is this?
The claims environment
The claim is where you’re judged
• It occurs after – maybe long after –
application and acceptance but it’s where the
insurer stakes its reputation
Tough customers
• Don’t trust insurers
• Better informed than ever before
• Higher expectations than…
• More likely to complain
• Backed by consumer groups and
official advocates
• Connected like never before –
cell phones, email, blogs, social media
• (Bad news travels faster than ever before)
Tighter regulation
• A strengthening iron grip
• Closer attention to how business is done –
products, processes throughout
the policy lifetime, how customers are treated
• Sharper focus on financial stability
• (And in fairness, does any part of
financial services have a
great reputation?)
Emerging from the GFC…
• Recession over (not everywhere) but
economic growth still weak
• So is consumer demand in developed
countries
• Nevertheless there is more business
optimism and a greater willingness to invest
Technology (1)
• The connected global society
• Home computing
• Mobile devices, tablets
– Functionality+++ all in one place
People with access to information and the
ability to transmit it, almost anytime, anywhere
Technology (2)
What are insurers doing?
SelectX’s survey (2011)
• 132 insurers worldwide
• Processing on average per year:
– 4,000 life claims
– 900 disability claims
– 270 critical illness claims
– 260 total and permanent disability (lump sum) claims
– 370 long-term care claims
– 530 premium waiver claims
– 14,500 ‘other’ (eg hospital cash) claims
Use of technology
Technology that supports claim notification through to settlement
Don't have any
Currently implementing
Have technology; been in place for ≥3 years
Have technology; been in place for <3 years
Use for part of process only
Other
23%
27%
11%
10%
12%
17%
Technology implemented (1)
0% 5% 10% 15% 20% 25%
Own-design bolt-on module
Own-design stand-alone module
Bought-in bolt-on module
Bought-in stand-alone module
Remote access to external system
Fully-integrated own-design system
Fully integrated bought-in system
Other
Series 1
Can technology implemented…?
0% 10% 20% 30% 40% 50% 60%
Automatic status updates
Online submission of forms
Initial triage rules engine for stakeholder …
Track assessor productivity
Track assessor performance against …
Assessor authority limits by product
High fraud risk identifier
Key indicator tracking against b/marks
Reserve movement tracking
‘No, it can’t…'
Claim decision-making tools
0% 10% 20% 30% 40% 50% 60% 70%
Paper checklists
Electronic checklists
Paper worksheet
Electronic worksheet
Paper decision trees
Electronic decision trees
Paper guidelines
Electronic guidelines
Company intranet
Electronic benefit calculators
E-learning resources
Conclusions from survey
• Insurers have invested in underwriting but
not in claims
• Mixture of tools being used – much is very
simple
• Gathering and use of MI is relatively poor
• Claim processing very much based on
human judgment
• Claims teams want better
Contrast with new business
• On-line submission is almost the norm
• Underwriting engines increasingly used…
and growing on power and sophistication
• Quotation tools for intermediaries
• Streamlining further with predictive analytics
• Plenty of investment
OK, the numbers are bigger but this is regarded
as the sexy end of the business
Claim processing in future
For the customer
• Access on line
• Tele-claims
• Deal by e-mail
• Personal assessors
• Faster service
• On-line smart form
submission; e-attachments
• Guide customer through
process
• Engine-driven, at least for
initial triage
• Customer populates your
system…
• Manage customer
expectations
Leverage technology
• Smartphones:
– Camera
– Video
– Claim apps
• Medical apps; use of personal e-medicine data
• Modern computing (that helps make the IT department redundant)
• ‘Big data’ (so as to be able to predict rather than merely react)
Internal processes
• Workflow (of course)
• Claims management
system:
– Case triage
– Decision-making guidelines
– Case
monitoring/tracking/review
– Management information –
and use in conjunction with
‘big data’
• Engine-driven process
• Guidance for assessors
• Use of less-skilled staff
Benefits
• Happier customers/claimants
• Enhanced reputation (within industry and among
consumers)…
• … and reduced reputational risk
• More consistent decision-making and claim
management
• Cost savings
• Better management information
• Better understanding of the business
Understanding the business
• Relating cause of claim to:
– Underwriting actions/decisions
– Source of business
• More detailed and easier claims analysis
• Easier monitoring of claim process
performance
• More accurate reserving for disability claims:
lower reserves and/or earlier release
Really, it’s all a no-brainer
And you don’t have to be big…
… to do all this:
• Outsource
• SaaS
• Cloud computing
You don’t have to have a big, expensive system
sitting on your own servers. That makes the business
case easier.
Claims in 2020?
Most of this could happen
tomorrow.
The biggest limiting factors are
an insurer’s commitment to
customers and its vision of a
better-run business.
Thank you.
Peter Maynard
peter@selectx.co.uk
+44 1844 274069
Claims Management
Technology in 2020
David Nicolai, FINEOS
Improved service, outcomes, and efficiencies.
Agenda
• The typical claims department of today / Current Technical Challenges
• What’s possible already today
• The claims department of 2020
Typical Claims Department
of Today /
Technical Challenges
© FINEOS CORPORATION
World of the Claims Examiner
Claims processing typically supported by
a variety of technology, processes and
practices
How difficult is good customer service in this environment?
How easy is it to trace all that has happened to a
claim?
How comfortable are you with key
calculations on “Shadow IT”?
Can you enforce what happens and when it
happens?
Defining characteristic is
complexity
Provider databases
Letter templates
Policy admin
Expert systems File
notes
Work flow
Benefit calculations
Paper folders
Legacy systems
Scanned documents
Over payment calculations Indexation
Partial earnings
Tax, Interest Diary
Word docs
Post-its
Checklists
Transaction Claim form
Claims System Capabilities –
Still a Challenge
• Do not have the
necessary technologies
to be competitive
• Do not have integrated
solutions
• Do not have fully
implemented solutions
• Have non supportable
systems
• Inadequate training
Claims
Where You Could Be Today
Which Type of Model are you in Today?
Claim Capabilities
Efficient Claims Administration
Better Outcomes
Insight Improvement
Improved Customer Service
Emerging Business Model
Company 2 (Tooling Approach)
200 files per Adjustor
Company 3 ( Modernization Approach)
200-300+ per Adjustor
Company 1 (Legacy Approach)
100 files per Adjustor
Multiple loss reporting options available including self-service Inconsistent processes across reporting channels Automated assignment to field office or group based on claim characteristics Accelerated settlement options Primarily electronic claims files, resulting in claims portability Adjuster-set systemic diaries and alerts to drive workflow: also form-driven workflow Free-form notes in primary application Business rules coded into software Multiple systems in use involving rekeying Document generation at local level from templates and forms
Consistent experience in loss reporting, automated processes and self-service Automated assignment to adjuster based on claim dynamic and adjuster characteristics, including workload Real-time notification of coverage verification, claim set-up, and assignment STP Straight Thru Process ―once and done options Electronic claims files and claims portability Externalized business rules allowing updating by the business Automation of data-driven processing and workflow including alerts, diaries, fraud, voc rehab, reserves etc Sophisticated, outcome-based case management strategies Centralized document generation and imaging
Reporting through agent or call center Primarily manual assignment process requiring ―two touch‖ notification Limited point-of-service options Multiple requests for the same
claim data Physical claims files Manual activities and tribal knowledge‖ Multiple hand-offs in process Inconsistency across claim offices Local document generation and content management
© FINEOS CORPORATION
World of the FINEOS Claims Examiner
Expert systems
File notes
Work flow
Benefit calculations
Paper folders
Scanned documents
Over payment
calculations Indexation
Partial earnings
Tax, Interest
Diary Word docs
Post-its
Checklists
Policy admin Provider
databases Letter templates
Where Could you be Today?
Your Data. Your Way. Wherever You Need It - Web, Tablet or Phone
Company Web Site Employer/Employee Site Claim Handler Web System
Claim Analytics
Analytics makes use of rich, broad and deep data to provide claims insight
Analytics by set . . . or by individual claim
Dashboard-style dials
Socio-demographic details
Graphic reporting details
Embedding Best Practice
Ability to embed best practice…
How it looks with FINEOS Claims Segmenting New Claims
Implement / refine automatic
segmentation rules to ensure right-
tracking of new claims based on
evolving claims dept. profile
Random Reviews
Implement active, (as opposed to
retrospective) claim reviews of key
claim decisions based on each
claims examiner’s experience
Managing SLA’s
Can you be certain that all
processes are as effective as you
want? Identify bottlenecks?
Driving Performance & Outcomes How do I know I’m getting effectiveness and value from my service providers?
Managing third parties and experts Third party experts have a vital role to play in the claims process How well can you manage: • Cost • Effectiveness • Performance • Workload How well do you understand the relationship of all parties in the process?
How it looks with FINEOS Claims
Which claims has this provider worked on?
Complete Automation / Auditability
Superior Customer Service
• Case Summary Timelines
• Case Maps
• Claim Activity Feed
• Alerts
• Multiple Communication Channels
• Self-Service
Case Study
Customer Success
Background
Challenges
The Principal Financial Group (PFG) offers Retirement and
Investment Services, Insurance, Health and Wellness, and Banking.
FINEOS Claims is used to manage Group and Individual Disability
Insurance (DI) and Group Life Insurance claims and payment
processes. PFG went live in 2005 for individual DI claims and
upgraded in 2008 for group DI and Life.
• Legacy systems with ‘dismal’ speed to market for new products
• Existing mainframe system not user friendly - use of codes
• Intensive manual processes requiring lots of paper claim files
• Systems not positioned to accommodate future growth
“FINEOS Claims has helped to streamline our ability to bring new
products to market. By intelligently routing and monitoring tasks,
FINEOS Claims helps us manage standard work practices and improve
the capture of data for analysis of trends, plan designs, and risks”
Doug Fick, VP & CIO Specialty Benefits, PFG
• 5% fewer staff needed to handle same
claims volumes due to online
documentation, automated payments,
reduced steps
and print mail
• Improvement in claims payment
accuracy due to automated & recurring
payments for STD
• Use of work manager and task list
• Decreased time to deliver new products
• Faster training for new employees
• Improved employee morale and
retention
Claims
In 2020
Future: It’s a Lifecycle Health Model
Health Promotion
Increase Fitness of Workers
Fitness Baseline
Health
Motivational Programs
Protect Work
Capacity
Create a Productive Culture
of Health and Wellness
Full Work Productivity
Risk Reduction
Reduce Onset of Chronic Disease
Reduce Sudden
Death Cases
Reduce Work Related Injuries
Working but Productivity
Impaired
Disease / Condition
Management
Reduce Impairment
Ratings
Control Medical, Pharmacy, and Ancillary Costs
Reduce
Presenteeism
Intermittent and Cyclic Lost Time or
Productivity
Leave Management
Compliance with Regulatory Laws
Tracking and
Monitoring of Absences
FMLA
Lost time between 3-5 days
Disability Management
Reduce STD Incidence and
Duration
Reduce STD Conversion
Reduce LTD
Incidence and Duration
Reduce WC Medical and
Industry Costs
Lost time greater than 26 weeks
Future: New Solutions
• Insured profile – Understands more about the insurance process
– Multi-lingual and currency
– Is becoming more of a partner in the funding model
– Technology motivated
• Medical profile – Electronic medical record
– E-Billing
– ICD10 and other more detailed coding
– Gene Map and DNA tailored medicine
– New medical treatments and therapy solutions that can cure (not just treat) conditions
– Improved RTW and early intervention
Service Expectations Continue to Increase
We like to track patients (Radio Frequency Tracker)
We like to track pizza
We like to track packages
We like to track phones
Online Experience is Changing
The future online adjustor & consultation
Home Rehab Options
$300 Dollar Solution
Beyond the Conventional House Call
RP-VITA Remote Presence Virtual + Independent
Telemedicine Assistant
Approved by FDA, Currently in production at several hospitals
TV Presence
Funny but not real
Social Media
• Social Media : Policy Provisions – Policy language around access to electronic communications, including
texts or social media postings
– Authorization to access public social media postings and the duty of the claimant to provide access to private postings that may be relevant to an investigation
• Social Media: Adjusting Strategies – Are investigators asking if any texts were sent, postings made, or photos
taken at or around the time of the incident concerning the occurrence of the claim?
– An entire new industry exists to assist the insurance industry to monitor a claimant’s social media postings 24/7
– As part of an insurance investigation, ask whether social media or electronic postings have social media or electronic postings been altered or deleted relative to the claim?
• Reputation.com
• Reputation Builder
Conclusions
• Current market is creating many challenges and opportunities
• Service levels and delivery model expectation of today will be exponentially larger three years from now
• Access to information and the amount of data analysis will increase to rates we have never seen before
• It’s a technology evolution, keep actively enhancing your solutions
• It’s about better access, outcomes, management, efficiency, and ultimately improved financials
• At the end of the process is a person - remove barriers that impact the well being, hope and desire of the individual to go back to work or lead a more productive life
• FINEOS as a company is excited to help insurers navigate through it as a partner with proven solutions and a constant eye to the future