pooling admin - data input - cajpacarrier / tpa internal / external systems self administered data...
TRANSCRIPT
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Pooling Administration
Data Input
Craig Bowlus
Managing Director, Risk Pooling
Dave Glende
CEO
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“Nobody goes there anymore …. it’s too
crowded”
Yogi Berra
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Carrier / TPA
Internal / External Systems
Self Administered Data
Workflow Integration –
SharePoint | Outlook
BUSINESS INTELLIGENCEDATA INPUTS STREAMLINE PROCESS
BROKER
RISK MANAGEMENT
LOSS CONTROL
ACTUARY
SAFETY
CLAIMS DEPTINCIDENTSCLAIMSEMPLOYEEFLEETEXPOSURE PROPERTYPROGRAM/POLICYINSURER RATINGS
SAFETY SURVEYSLOSS CONTROLRENEWALALLOCATIONTCOR
Pooling Solution
LEGAL
OPERATIONS
Typical Data Flow and Usage
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What Valuable Input is Often Missing
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Litigation Management Analytics
• Assignment date to closing date• Improve the hierarchy related to “type of loss” • Compliance with budgeting protocols?• Match the output with members, and deal with the
politics
▫ Litigation is Evil, A Proof Litigation requires time and money Time = Money, therefore Litigation = Money x Money = Money ² Money is the root of all evil √Money²=Evil
▫ We have proven that Litigation is Evil
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Improve Data Mining on Loss Drivers
• Add “Root Causes” on Police Liability
• Add “Root Causes” on EPL
• Track Special Needs involvement on school claims
• Plaintiff/Applicant Firms
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Improve Your Submission to the Markets
• Prove your data mining/loss prevention analytics
• Validate your litigation management protocols
• Reduce your Total Cost of Risk
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The Biggest Issues
• Business Issues▫ Data doesn’t meet needs (internal/external)▫ Data is replicated▫ Data is unmanaged▫ Systems are not integrated
• System Issues▫ Data Acquisition▫ Data Replication and Synchronization▫ Application Integration
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Exchange SharePoint SQL Server
LMS CRM RMIS Accounting
Single Sign On
Training
Contacts &Communication
RM/Coverage
Financials
Docs
Conferences
Member-facing Components
Typical System ArchitectureCarriers
TPANurse Triage
Other Agencies
Member Staff
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Examples
• Member moves to new Agency HQ▫ CRM (Primary/Contact Addresses), RMIS (Schedule,
Location, Recurring Certs)▫ Accounting (Address), Carrier, TPA, Nurse Triage
• Dual use of Risk Management contacts▫ Risk Management Bulletins (CRM)▫ Annual Renewal Questionnaire (RMIS)
• Communication Management▫ Distribution Lists in RMIS not accessible from
Exchange▫ Emails from RMIS not recorded in CRM
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Key Principles
#1: You must know where you’re going
in order to get there
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Information Architecture
ManagedConsolidated and Complete
AccessibleAudited and Secure
Historical
PoolInformation
Storage
Member QsRM SurveysTPACarriersAccountingClaims/Incidents
Contribution CalcsRisk Management
Claims/TPAsMember Services
CarriersNurse Triage
AccountingOther Agencies
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Key Principles
#1: You must know where you’re going
in order to get there
#2: Many feet cause much noise
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Exchange SharePoint SQL Server
LMS CRM RMIS Accounting
Single Sign On
Training
Contacts &Communication
RM/Coverage
Financials
Docs
Conferences
Member-facing Components
Typical System ArchitectureCarriers
TPANurse Triage
Other Agencies
Member Staff
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Data Synchronization
• Some data is “replicated”▫ Contact info▫ Property, Vehicles, …▫ Loss data
• Can be identical or “similar”• Choices
▫ Avoidance Eliminate duplicate storage Integrate with the “master” data system Don’t use particular features of a system
▫ Sync the data Real-time, nightly/weekly/monthly updates Need method of correlating the records and transforming the data
(if necessary)
• Choose solutions/vendors wisely
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Application Integration
• Sharing of processes and process information▫ Contact/Member demographics▫ Locations and Schedules▫ Billing information▫ Contacts and key functional roles▫ Records management
• Examples▫ Email sent/received via RMIS/CRM▫ Invoices generated in RMIS using CRM data▫ Questionnaire publication from RMIS uses Contact data from
CRM• Choices
▫ Can be built-in or custom (depends on vendors/solutions)• Choose solutions/vendors wisely
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Example: Pool info in Outlook via CRM
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Example: Member Portal
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Key Principles
#1: You must know where you’re going
in order to get there
#2: Many feet cause much noise
#3: Broken systems break systems
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Choosing an Architecture
• 5-yr Pool Strategy
• Operational Goals
▫ Member-facing
▫ Internal
• Budget guidelines
• Existing and planned systems
• Partner systems
• Leadership: Knowledgeable and available
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Choosing a Solution
• Verify that the solution and vendor meets your needs
• Talk with other JPAs or JPA administrators
• See the solutions in action AT A JPA
• Use an outside expert to facilitate/guide the process. Knowledgeable in:
▫ Pools
▫ Available pooling solutions
▫ IT Architecture and solution implementations
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Listen, Learn, Deliver
Customer Understanding
InsightInnovation
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Available Solutions
• CRM▫ Customized xRM via MS Dynamics CRM, Salesforce, …▫ “Integrated” into RMIS
• RMIS▫ Pool-specific: NavRisk, CHSI Connections, Crossmark▫ RiskConsole, Origami, … (See Dave Tweedy’s List)
• Surveys▫ Survey Gizmo, Survey Monkey, Survey System▫ KeyPoint, FluidSurveys, Snap Surveys▫ http://survey-software-review.toptenreviews.com
• Sync▫ File transfers/exchanges▫ Built-in “connectors” (i.e. Dynamics CRM GP, CVENTCRM,
ExchangeCRM)▫ Integration solutions (Scribe, MS BizTalk Server, MS Workflow)
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Vendor Selection
• Vendors should be experts in what they will be doing for your organization▫ Risk Pools are different and unique. ▫ The extent to which the Vendor lacks
experience/knowledge negatively impacts the risk/ability/quality of the solution and services provided.
▫ Mitigations must be put in place to compensate to the degree necessary. “Over-compensation” is wise.
• Vendors must commit to fully engaging in understanding your requirements▫ They must understand your pool so they create the
best solution
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Vendor Selection (cont.)
• You should have a person on staff or acting on your behalf who is knowledgeable and capable on IT projects, but who also understands the your business operations.
• Lower cost proposals (i.e. underbidding) should raise caution as to the expectations and ultimate success of the project. Beware of:▫ Cost overruns and unforeseen costs▫ Lower than expected quality▫ Missing deliverables▫ Long term health and stability of vendor
• As risk goes up, scrutiny should also go up:▫ More pre-screening▫ More proof of capabilities and proven success▫ Greater need to see similar system in production and interview
staff using it
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Executing for Success
• Allocate sufficient time for your staff▫ Requirements meetings and reviews▫ Testing
• As risk goes up, gates should also go up:▫ Schedules should have:
Smaller deliverables more often Finer grained schedules (each task being no more than 5 days)
▫ Enhanced escalation paths▫ Increased project schedule oversight
• Real Executive oversight on schedule and deliverables▫ Monthly meetings▫ Both teams (vendor/client) present together with
management (vendor/client)
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Risks and Red Flags
• No comparable systems in production• Percent of custom work moderate to high
▫ 0-20% - no issue▫ 20%-35% - moderate risk▫ >35% - high risk
• Inexperienced vendor and/or client team (especially for team leads/sr staff for both vendor and client)
• Shallow depth of interaction in extracting requirements▫ Do they ask the right questions▫ Do they understand the terminology▫ How much did they not ask▫ Can they repeat back (in their own words) the requirements (i.e. did they
really understand)• Lack of experience of vendor’s Executive Management in the
industry
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Risk and Red Flags (cont.)
• Willingness of vendor’s execs to commit to things without understanding the requirements
• Underbidding the contract in order to gain the business• Inability on the client team to recognize (and then take
action) when vendor doesn’t understand what they are building
• Lack of detailed schedule (no task > 5 days)• Repeatedly late on deliverables• Pattern of disregard for the schedule, meeting times,
follow up• Unexpected amount of rework (both in requirements
reviews and software deliveries)