technology: a risk professional’s best friend

Recording of this session via any media type is strictly prohibited.

Page 1

Technology: A Risk Professional’s Best Friend

Using Technology to Enhance Claims Management


Session Presenters:

Matt Thomson | Wells Fargo Insurance | Risk Consulting LeaderSince 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 DirectorFirstGroup 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 DirectorOrigami Risk has emerged as innovator and leader in the marketplace for RMIS solutions : #1 RMIS by the 2013 RMIS Review


What to ExpectAfter 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


ENVIRONMENTAL ASSESSMENTExploring the history and pace of technology advancement


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


Past5-10 years ago

PresentWhat technical capability exists

today that is ‘new’

FutureWhere are we

headed & how to prepare

Claims Technology Evolution


Easy Button?


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


Today’s Technology

• Memory is cheaper• Processing is faster• Analytical programs are more sophisticated

Are you equipped to take advantage?


Analytics Platform

Source: AllAnalytics.com


SaaS/Cloud Computing

• Data capacity implications

• Data conversion

• Psycho/social elements

• Privacy/security

• Speed


CLAIM PROGRAM TRANSFORMATIONExploring practical ideas to transform your claims management efforts


Claim Lifecycle + Technology

Notice of Loss

Investigation

Decision & Reserves

Cost Containment

Disposition

13


‘Similar’ Claim Characteristics


Dashboard Management


Need for claims professionals communication speed


Claim Vendor Partner ConnectivitySharing 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


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.


Leading Indicators

Focus on Risk Management Quality Leading 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


Benchmarking


Internal Benchmarking


Balanced ScorecardKey Performance Indicators

YTD Target Prior Year Based on Claim Type DefinitionACPC $18,000 $23,000 $25,000Pending Duration 650 640 650Pending Attorney Rep 50% 42% 40%Pending Litigated 21.7% 22% 25% Pending $250K+ 48 50Pending $500k+ 6 5Cash Spend in thousands $xx $xx Pending Begin 4,850 5,000New 9,800 10,000Closed 10,000 10,250Reopened 150 100Pending End 4,800 4.850

SubrogationYTD Recovery In thousands $xx $xx $xxDuration 307 355 423 Based on Unit Group Number of Pending Files 4,800 4,850Number of Active Staff 30 31 Average Pending Per Staff 160 160 156

Quality AssuranceInternal Total 83.8% 85% 80%External Total 90.8% 90% 88%


Top Tech Priorities of Carriers & TPAs


CONCLUSIONS & Q&AFinal thoughts and recommendations


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?


THANK YOU

technology: a risk professional’s best friend

Documents

media type

claims management page

session presenters

rmis review page

risk management efforts

rmis solutions

insurance industry

claims activity notes