260 likes | 382 Views
Technology: A Risk Professional’s Best Friend. Using Technology to Enhance Claims Management. Session Presenters: Matt Thomson | Wells Fargo Insurance | Risk Consulting Leader
E N D
Technology: A Risk Professional’s Best Friend Using Technology to Enhance Claims Management
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
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
Exploring the history and pace of technology advancement Environmental Assessment
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
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
Exploring practical ideas to transform your claims management efforts Claim Program transformation
Claim Lifecycle + Technology Benchmarks Balanced Scorecard Claim Audit Resource Management Predictive Modeling KPIs (Leading & Trailing)
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
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 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
Final thoughts and recommendations CONCLUSIONS & Q&A
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?