Integrated Claims Solutions

Chris CharltonJeff Ninowski

The Current State of Claims

• Solvency II, Dodd‐Frank, unclaimed life benefits, etc. are changing how carriers structure, price, sell and service their products

Worst economic environment since the Great Depression causing• High costs, high unemployment, high premiums• 70% of an organization’s cost –20% managing the claim

Legacy systems are old and difficult to maintain• No one system for core claims processing• Systems are rich with data that is both untapped and underutilized 

REGULATIONREGULATION

ECONOMYECONOMY

SYSTEMSSYSTEMS

DEMOGRAPHICSDEMOGRAPHICSMaintaining expertise while attracting new claim industry recruits has become a major issue• Thousands of industry professionals leaving as Boomers retire

Reduce leakage and claims costs

Prioritize, route and track activities with robust workflow or business process management applications

End to End integrated analytics for easy reporting

Integration of both core and non‐core functionality• Asbestosis claims • Disability management

Establish role based user interfaces with wizards and scripting to reduce errors and on‐going training costs

Increase staff productivity with better task management, automation and consistency

Benefits of the Modern Claim System

CSC is Claims

RISKMASTER Accelerator

Vendor Solutions Suite

Incident ReportingIncident Reporting

Claims

Claims

Data Interfaces

Data Interfaces

Integrated Disability 

Management

Integrated Disability 

ManagementMedical Bill ReviewMedical Bill Review

WebFormsWebForms

DataToolsDataTools

Media Content ManagementMedia Content Management

Medical CaseManagementMedical CaseManagement ServicesServices

RISKMASTERBusiness Analytics

RISKMASTERBusiness Analytics

Legal

Legal

EDIEDI

Web‐based software used for all your Claims Administration, Risk Management  and Incident Reporting Needs

Web‐based software used for all your Claims Administration, Risk Management  and Incident Reporting Needs

MobilityMobility MMSEAMMSEA

We Focus on Your Industry Drivers and GoalsOur ValueYour Drivers

• Web forms• Trending and analysis• MMSEA, HIPAA, SOX, and OSHA compliance

• Data security

• No reliance on vendor schedules• Data Analytics• Business Analytics• System flexibility

• 3rd party system integration• Straightforward data analysis • Easily configurable

TPA, Pools and Insurance• Automated reporting• Data Conversion/Tools• Easy personalization

TPA, Pools and Insurance• Automated reporting• Data Conversion/Tools• Easy personalization

Healthcare• Timely incident reporting• Data security and reporting• Regulatory compliance

Healthcare• Timely incident reporting• Data security and reporting• Regulatory compliance

Corporate Claims• Single source of data• Self‐sufficient data analysis• System flexibility

Corporate Claims• Single source of data• Self‐sufficient data analysis• System flexibility

Service Optimization

Bottom Line Impact

Process Stability

Application Outsourcing

Data Exchange

Business Analytics

Medical Bill Review

Legal Services Suite

Risk Management Information Services

Policy Tracking

Claims Management 

Incident Reporting

Media Management Services

Risk Analysis  

Self Insured/Self Administered

TPAs, Pools and Insurance Healthcare Manufacturing/Tra

nsportationRetail, Grocery,  & Service Industry

Chemical, Energy & Natural

Resources

Public Sector 

LEGAL SOLUTIONS SUITE

Matter Management

Web‐based software that simplifies the billing process, tracks counsel performance, and promotes best practices in managing legal matters.

What is Legal Solutions Suite?

Legal E Bill

Provides legal firms a method to submit invoices electronically

Legal Bill Analyzer Legal Matter Management

Provides companies a way to automate their billing guidelines.  As firms submit bills, LBA automatically checks the invoices against the guidelines and flags non‐compliant submissions

Provides companies a means for on‐line collaborative budgeting, staffing and case planning with it’s legal firms

Provides quick and robust 

reporting on legal expenses by firm, matter and line of 

business

Reduces the adjuster’s 

workflow by automating the bill review time

Controls legal expenses

Assist in managing your  legal expenses

Legal Solutions Suite

Measure firms’ performance against best practices

Automates and streamlines collaboration with outside counsel 

Improve vendor management by allowing the claims professional to make assignments, review work product, process invoices, and rate vendors from one system

VENDOR SOLUTIONS SUITE

Vendor Solutions Suite

• Vendor‐initiated registration

• Electronic vendor assignment

• Expansion of LSS platform to multiple vendor types

• Vendor ratings

• Total cost of claim reporting through Business Objects

Vendor Solutions Suite

Guideline Compliance

Why VSS?

Speed and Quality

Effective Vendor Control

Guideline Compliance

Decrease in processing 

times

Efficient automated process

FRAUD ANALYTICS SUITEAll fraud conditions, always checked, ALL the time, EVERY time

Why It Works

Fraud Analytics Suite

Fraud Analytics Suite Components

Business Rules

Predictive Analytics

• Customer Rules• Scoring & Referral

Identity Search

NCIB

CommercialMailbox

SanctionedDoctors

People/Vehicle Watch List

Organization Watch List

Customer Fraudulent Claims

The industry’s leading general damages assessment to assist adjusters in the evaluation of bodily injury claims

COLOSSUS

Thorough Evaluations Discipline ApproachObjective and In‐depth

Effective Negotiations Increased Confidence

Fair and Consistent Settlements Promotes Consistency

Training Tool Methodology for Best Practices

Business Value of Colossus

Using objective facts to determine recommended settlement offers for similar claim’s

2Work™ for Adjuster

•Consolidated devices and streamlined workflow offer more efficient operations

• Increased usability and ease of use increase adjuster satisfaction

•Field adjusters need fewer devices –and have choices (iPad, Android, Playbook)

•Application offers rich data capture (pictures, video, location, etc.)

• Light, agile, instant on devices with long lasting batteries

• Deploy on‐premise or  in cloud (hosted)

Claims

Operational Day to Day Analytics Strategic 

Analytics

ExplorerInternet‐style search capability

Dashboardsgraphs, dials, traffic light status

Dashboardsgraphs, dials, traffic light status

Report Enginecreation, distribution and 

analysis

CLAIMS APPLICATIONS

WHY CSC’S

6 to 8% savings with LSS

30% increase in SIU referrals with Fraud Analytics Suite

40% reduction in manual processes 

700 plus Claims Customers with over 500 on the RISKMASTER platform

Historical Matching Component in Colossus

45 day implementation times for tools

“With VSS, I can keep vendor profiles within the system including insurance,W‐9 and credential certificates” Rick Hayne, President Nexxus Solutions Group

“Fraud Analytics Suite increased my SIU referrals by 25% in the first 6 months of use”  John Sargent, Director MetLife Auto and Home

“With RISKMASTER Accelerator, we lowered our workers comp costs by 3M dollars”   Ginger Huskey, Risk Coordinator, City of Knoxville”

“Legal Solutions Suite saved us 15% in one year alone”  Stuart Bailey, VP of Claims Kemper Insurance

QUESTIONS???