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PLUS: When It Comes to Claims Data, Size Doesn’t Matter p.5 Record-Setting CAT Claims Require Special Handling p.7 An Inside Look at One Carrier’s Decision To Replace Its Legacy Claims System p.9 How a Modern Claims Platform Can Put You Back in Charge p.17 Meet Fraud-Fighting’s Dynamic Duo p.19 Table of Contents p.3 Next Business Innovation Powered By Technology April 2012 6 The best way for insurance companies to win and retain customers is to deliver on the claims promise across all channels, says Chubb SVP and Claims CIO Owen Williams. p.11
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Page 1: Ist digital issue_2012_04

PLUS:When It Comes to Claims Data, Size Doesn’t Matter p.5

Record-Setting CAT Claims Require Special Handling p.7

An Inside Look at One Carrier’s DecisionTo Replace Its Legacy Claims System p.9

How a Modern Claims Platform Can Put You Back in Charge p.17

Meet Fraud-Fighting’s Dynamic Duo p.19

Table of Contents p.3

Next

Business Innovation Powered By Technology April 2012

6The best way for insurance companies to win

and retain customers is to deliver on the claimspromise across all channels, says Chubb SVP

and Claims CIO Owen Williams. p.11

Page 2: Ist digital issue_2012_04

www.insuranceandtech.com

SPECIAL ADVERTISEMENT

Insurers have many opportunities to touch customers, and the claims process is one of the most important touch points. Those who provide a superior customer experience by being more responsive to policyholders in their time of need will benefit from happier, more loyal customers. Today, consumers expect an accelerated and uncompli-cated claims process from start to finish, facilitated by accurate and timely communications that are delivered via electronic channels or through an insurer’s app. Gen Y consumers in particular indicated in the 2011. J.D. Power and Assocs. Insurance Shopping Study that they want more electronic communications and resources from their insurers, but many of them are not receiving it.

As customers increasingly demand intelligent, person-alized claims communications, it is vital that insurers create claims correspondence through new and cus-tomer-preferred channels in addition to traditional print communications. Web, SMS, mobile apps and email chan-nels are catalysts for not only attracting and acquiring new customers but also growing and servicing existing customers, which increases their loyalty.

Insurance carriers seeking a competitive advantage should upgrade their legacy systems to a robust customer communications management (CCM) solution that can empower the claims staff to expedite the claims process from first notice of loss, to estimates and appraisals, to communicating acceptance or denial, and ultimately settlement amounts and payments. The CCM solution should also support electronic delivery formats. Automat-ing the claims process not only saves time and reduces labor costs, but also speeds the time-to-settlement and lessens the risk of a negative experience.

Studies show that by providing a satisfying claims set-tlement experience, insurers can significantly increase customer retention. An insurance provider typically spends five to seven times less to retain a customer than to capture a new customer, so carriers that optimize their claims experience and subsequently accelerate settlements will be rewarded with low customer churn, increased customer satisfaction and long-term loyalty.

HP Exstream is the CCM software solution that empow-ers agents and brokers to make the most of every customer touch point throughout each stage of the cus-tomer life cycle. Today insurance carriers worldwide are personalizing quotes and proposals, policies and policyholder notifications with HP Exstream — sav-ing millions of dollars annually, building loyalty, forming long-lasting customer relationships and driving top-line revenue growth. Recognized by Forrester Research, Inc. as a leader among top vendors in The Forrester Wave™: Document Output for Customer Communications Management (DOCCM), Q3 2011, HP Exstream is the most flexible and intuitive way for insurance carriers to create insightful, impactful, real-time customer communi-cations that are proven to fuel profitable business growth.

The “Exstream” Advantage to Optimizing the Claims Experience

Amidst the proliferation of Web usage, smartphones, tablets and other mobile devices, consumer expectations about

claims are rising.

Let the CCM leader turn your customer communications into a competitive advantage. Get the Forrester Wave Report.

Visit www.hp.com/go/ExstreamV8 for more information or contact us at [email protected] or 866-318-5925 to set up a free communications consultation.

By Tom ClaytonInsurance Industry Specialist, Enterprise Software, HP

MATTERCUSTOMER COMMUNICATIONS

ExstreamEffective communications. Multiple channels. One solution.

You know customer communications matter. Fortunately, HP is here to help. When claims correspondence, quotes and proposals, and new policy generation are more efficient, it pays off—in lower costs, reduced risk, and greater customer loyalty. And combining automation with multichannel, personalized customer communications gives you a competitive edge.

HP Exstream is customer communications management software that empowers business users to make the most of every customer touch point throughout every stage of the customer lifecycle. Join the many other insurers already using HP Exstream to save millions of dollars annually, form long-lasting customer relationships, and drive top-line revenue growth.

The industry is taking note:• HP Exstream customers have won 56 DALBAR awards for outstanding customer communications.• Forrester Research, Inc. recognized HP Exstream as a leader among top vendors in The Forrester Wave™: Document Output For Customer Communications Management (DOCCM), Q3 2011 report.• For the sixth year running—Celent named HP Exstream a leading vendor for Document/Content Management in the “Insurance Software Deal Trends” report.• 8 of the top 10 Fortune 500 insurers use HP Exstream.

Find more information at:www.hp.com/go/ExstreamV8

Page 3: Ist digital issue_2012_04

CONFIGURE IT OUT

YOURSELF

Solve the claims challenges puzzling your organization with RISKMASTER, CSC’s easy-to-customize claims management system. You can easily configure our software to make your business more e�cient and quickly put every piece in place — from first notice of loss to final payment, including bodily injury evaluation, fraud detection, litigation management and Medicare reporting. It's the perfect fit. CSC.COM/CLAIMS_MANAGEMENT

BUSINESS SOLUTIONS TECHNOLOGY

OUTSOURCING

April 2012 3

COVER STORY

11The ClaimsAdvantageCreating a superior customer experience by delivering on the claimspromise may be carriers’surest path to retaining and winning customers.

UPDATE5 Size Doesn’t MatterWhen it comes to managingclaims, it’s not the size ofyour database that matters; it’s what you do with it that’s important.

7Don’t PanicDespite a record-setting yearfor catastrophe claims in

2011, carriers should stick toproven claims best practices.But that doesn’t meanclinging to old processes.

CASE STUDY17 In the Driver’s SeatA modern claims platformallows FBD Insurance to drivethe claims process, ratherthan react to customers.

INDUSTRY VOICE19 Dynamic DuoPredictive analytics and busi-ness rules management are apowerful fraud-fighting team,says FICO’s Russ Schreiber.

4 FROM THE EDITOR

21 EDITORIAL AND BUSINESS CONTACTS

ONE ON ONE 9 Behind theLegacy CurtainAuto-OwnersInsurance SVP BobBuchanan takes I&Tinside the company’scalculated decisionto replace its legacyclaims system.

Previous Next

April 2012

Contents

www.insurancetech.com

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mong the many lessons insur-ance companies have learnedover the past decade of deal-

ing with catastrophe claims, perhapsthe most significant is that these kindsof claims are not seasonal. Disaster canstrike at any time. While hurricane season may be particularly dangerous,communities can experience blizzardsin October, and earthquakes, fires andfloods can occur at any point on thecalendar. Carriers have channeled thishard-earned knowledge into produc-tive investments in interactive call cen-ters, tracking and scheduling systems,mobility, modeling tools, geographicintelligence, flexible staffing models,social media and other technology solutions that have made claims pro-cessing more efficient and accurate. It all appears to have come together

in 2011, the worst year on record forcatastrophe claims losses (for relatedarticle, see page 7). For all the news

about unusual, untimely events, onefamiliar theme from past disasters didnot emerge — widespread criticismof insurers’ claims practices. No doubtthere are (possibly legitimately) un-happy policyholders who sufferedlosses and who are dissatisfied withthe ways their insurers handled theirclaims. But the lack of a global chorusof complaint — from policyholders,politicians and regulators — suggeststhat there are vastly more customerswho were reasonably happy withtheir claims experiences. That repre-sents a quiet revolution of sorts.It’s not that claims transaction pro-

ficiency has become less important;rather, now it is coupled with an in-tense focus on the claims experience,and this progression is the subject ofthis digital issue of Insurance & Tech-nology. If anything, capabilities —such as analytics, channel integrationand geographic intelligence — that

are helping insurance companiesprovide a more customized, informa-tive and interactive claims experienceare simultaneously helping makeclaims adjustment more speedy andaccurate while reducing fraud. Despite the freakishly mild winter

most of us in the Northeast and Mid-west have experienced, it’s inevitablethat insurers’ next-generation claimsprowess will be tested in 2012 — therecent spate of severe thunderstormand tornado outbreaks representhigher-than-normal activity, accord-ing to CAT modeling firm AIR World-wide. Let’s hope the quiet revolutioncontinues to grow in power. �

www.insurancetech.com

FromTheEditor

Katherine Burger, Editorial Director

@kburger

The Quiet Revolution in Claims

A

Page 5: Ist digital issue_2012_04

uzzwords can gain momentum quicklyin IT, and the latest technology buzz is around “Big Data.” Netflix’s Jeremy

Edberg, in an article for InformationWeek (aUBM TechWeb brand), recently defined bigdata as “the tools and processes of managingand utilizing large datasets.” But for insurerslooking to build smarter claims organizations,the tools are much more important than thesize of the datasets themselves, experts say.“There really is a ton of data in insurance,”

points out Aaron Fidler, VP at Applied PredictiveTechnologies, a Washington, D.C.-basedprovider of analytics software and consultingservices. But, “There’s always that question: Is

more information going to be more valuable?Given what we’ve seen, it’s critical to understandwhat is going to be helpful and what is noise.”To gain that understanding, most U.S. insur-

ers are building proprietary data collection,storage and analytics capabilities, adds CraigBeattie, a London-based analyst with Celent.“Certainly big data has a role to play here,” hesays. “In the U.S., there’s a little bit more pro-prietary analysis because insurance companieshave invested in the infrastructure to do that.”Mike Cesinger, VP of claims for Plymouth

Rock Assurance ($1.2 billion in claims expensereserves, 2010), speaks with pride about hiscompany’s in-house analytics unit. The Boston-based carrier, which offers personal lines autoand home insurance, evaluates claims not bybolting on new data sources to its existingones, he explains, but by proactively looking

for the information that most accurately rep-resents the profile of a claim.“There’s a shifting set of data elements that

we look at,” Cesinger says. “We’re proud of thefact that we looked at not just the nature of theclaim, but the nature of the risk — not just theinsured’s claims history, but garaging locationsand undeclared operators, among other things.We’re taking a more holistic approach to eval-uating individual claims and not just triagingthem based on the description of loss.”

An Accurate Bucket ListAt Plymouth Rock, claims are processed intoone of three buckets, Cesinger adds: One bucketcontains claims headed for the special investi-gations unit (SIU); another contains those thatare potentially problematic, but don’t necessar-ily need the SIU’s attention; and the third is for

With Claims Data, Size Doesn't MatterINSURERS’ CLAIMS ORGANIZATIONS GAIN MORE BENEFITS FROM FLEXIBLE, AGILE ANALYTICS THAN FROM SIMPLY HIGHER VOLUMES OF DATA, EXPERTS SAY.

By Nathan Golia @NateG_InsTech

B

April 2012 5www.insurancetech.com

Update BIG DATA

“We’re taking a more holistic approach to evaluating ... claims.”—Mike Cesinger, Plymouth Rock Assurance

Page 6: Ist digital issue_2012_04

claims that are unlikely to cause any problems. As data and an-alytics tools have proliferated outside of the IT department, hesays, it has become easier and faster for the insurer to get aclaim into a specific bucket — or move it from one to the other.“The ability of our analysts to massage our data and let it

take us where it needs to in a short period of time — but stillbe nimble in what our response might be — has been a hugeboon,” Cesinger says. “In the past, when you had your IT de-partment write a query, you only got an answer to that querya couple weeks later. Now you’ve got the ability to go in andidentify visual patterns and use neural networks to identifyassociations of data immediately.”Like many companies, Plymouth Rock has been applying its

new analytics capabilities to social media data, Cesinger re-ports. Policyholders can expose a surprising amount of infor-mation via social networks, he notes. “It’s interesting when youhave someone who reports that their car was hit while unat-tended in the supermarket, but at the same time that was sup-posedly happening, they’ve got a Facebook post about howdrunk they are,” Cesinger says. “Young people have much moredesire to be totally forthcoming in their social media posts, andthat sometimes can be gold for an insurance investigation.”But that doesn’t mean that the only use for analytics is to

police policyholders, Applied Predictive Technologies’ Fidlerstresses. “Right now there’s a focus on how we reduce fraud,but also on retention and interaction, as we think of ways tointeract with our customers at the point of a claim,” he says. �

www.insurancetech.com

Update

The Select Amenity Prepaid MasterCard is issued by Central Bank pursuant to a license by MasterCard International Incorporated.

[email protected]

800-881-1945

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BIG DATA

Page 7: Ist digital issue_2012_04

he year was barely half over when Munich Re began to speak of record catastrophe losses in 2011. In an early-

July press release, the global reinsurer notedthat losses already were $45 billion higher thanthe previous record, in 2005. And that was be-fore flooding overtook Thailand and a hurricanethreatened the major U.S. megalopolis betweenBoston and Washington, D.C. By the time 2011

ended, Munich Re reported in January 2012, to-tal catastrophe losses eclipsed those in 2005 bymore than 70 percent, hitting $380 billion com-pared with the previous high of $220 billion.2011 was so severe that at the 2012 P&C Joint

Industry Forum in January, Liberty Mutual pres-ident and CEO David Long referred to it as “Theyear of non-modeled CATs.” This reaction isn’tsurprising, says Ryan Ogaard, SVP of model man-agement for RMS (Newark, Calif.). “Non-modeledrisk is something people are talking about now,”he says. “The potential for accumulation insteadof one big event is getting highlighted.”In the wake of 2011, insurers should redouble

efforts to manage their risk profiles, Ogaard adds.But, “We don’t see that so much as an exposureissue,” he explains. “It’s more that they weren’tlooking at the full potential of loss from this kindof peril. Companies ... may not have been awareof the entire spectrum of exposures.”One area in which insurers on the whole are

revising their risk models is flooding, accordingto Howard Botts, EVP and director of databasedevelopment for CoreLogic Spatial Solutions

in Santa Ana, Calif. FEMA flood zone maps havelong been the standard for establishing flood-ing risk, but with so many communities hitwith flooding this year, carriers are looking fora more nuanced solution, he says.“Almost every community in the country is

revisiting their flood zone boundaries,” Bottscontends, and that is leading insurers to lookfor more of a continuum of risk, he adds. “Because it’s [traditionally] been an arbitraryboundary, there’s no way to establish whatthe true risk is.”

A Good Ground GameBut preparing for the barrage of claims fromcatastrophe events — and creating the capac-ity to handle them — goes beyond trying toanticipate the events themselves and includeshaving a plan in place on the ground. Los

Keep Calm and Carry OnAFTER 2011 SOCKED THE GLOBE WITH CATASTROPHES — AND INSURANCE COMPANIES WITH THE RESULTING CLAIMS— SOME CARRIERS MIGHT BE TEMPTED TO OVERREACT. BUT PRUDENT PLANNING SHOULD ALREADY BE IN PLACE.

By Nathan Golia @NateG_InsTech

“We try to do a lessons-learned afterthe event and try to evaluate whatdidn’t work as we expected.”—Joanna Moore, Mercury Insurance

T

April 2012 7www.insurancetech.com

Update CATASTROPHE MANAGEMENT

Page 8: Ist digital issue_2012_04

Build loyalty and elevate your customer experience with intelligent customer communications from EMC Document Sciences. It’s time to get personal. Learn how at www.EMC.com.

PERSONALIZE& ENGAGE

Angeles-based Mercury Insurance ($79.5 million in Q4 2011net income) has built flexibility into its claims organization sothat employees can respond not just to the wildfire and earth-quake risks in the carrier’s home state, but also to the tornadoand hurricane events that it encounters in the East Coaststates in which it also writes business.“After the hurricanes in Florida about five years ago, we didn’t

really have a very effective way to manage CATs in our sisterstates,” says Mercury chief claims officer Joanna Moore. “Theprocedures were more regionalized, and it was difficult for people trained to handle California claims to transfer thoseskills to Florida. At that point, we said we need a basic frame-work of how we can all help each other out in any of our states.”Mercury’s loss team was pushed to the limit this year due

to windstorms in California, tornadoes in Georgia, and Hurricane Irene-related claims in Virginia and other North-eastern states, Moore reports. But the company’s plan “reallyworked very efficiently,” she adds.“When we have a CAT event and claims resulting from it,

we try to do a lessons-learned after the event and try to eval-uate what didn’t work as we expected,” Moore continues. Forexample, “We had claims from Hurricane Ike in Texas [in2008], and what you discover is getting your team on theground and getting gas in the rental car is a challenge. Welook to partner with providers that can help us function onthe ground, communicate with each other and travel fromone location to the other.” �

www.insurancetech.com

Update CATASTROPHE MANAGEMENT

April 2012 8

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April 2012 9

What is the claims processing model at Auto-Owners Insurance?BUCHANAN: We write business in 26 states,and we currently have 87 claims branches.Branch and field claim representatives — whoprimarily handle all lines — manage claims dayto day with support and leadership from theirlocal office, their regional office and the homeoffice [corporate headquarters in Lansing]. Ourindependent agents are important partnersas well — they get involved in the claims

handling process, especially during the initialfirst-notice-of-loss (FNOL) stage.

What claims technology and infrastructuredoes Auto-Owners currently have in place?BUCHANAN: We currently have a mix of tech-nologies supporting our claims handling. Atthe core, we have a Cobol batch/CICS-basedsystem to administer claims. We started build-ing the CICS [customer information controlsystem] in 1992; the batch code hs been

running since 1947. In all we have 12,142 programs and 77 CICS transactions.We have web-based FNOL and claims in-

quiry to make it easy for our agents to partic-ipate in the claims-handling process. Webegan an effort to go paperless a couple ofyears ago, and we should complete thebranch-by-branch conversion from paper toelectronic images by the end of this year.

You have said that you didn’t set out to replace your claims system simply becauseit was legacy technology. What promptedAuto-Owners to look for a new platform?BUCHANAN: There are four main business rea-sons that prompted us to take on this initiative:We want to be able to continue enhancing ourservice by improved automation; we want ourclaims representatives to take advantage of theadvances we see in mobility and tablet com-puting so they can be better, faster and moreefficient in taking care of the customer; wewanted to give our claim representatives thesame kinds of tools they are used to in their

Inside a Claims System RevampIN TODAY’S COMPETITIVE ENVIRONMENT, P&C INSURERS MUST PROVIDE A TOP-OF-THE-LINECLAIMS EXPERIENCE. ACCORDING TO AN ERNST & YOUNG SURVEY, MORE THAN 70 PERCENT OFCONSUMERS WHO FILED A CLAIM IN THE PAST FIVE YEARS RATED THE EXPERIENCE AN EIGHT OUTOF 10 OR HIGHER. “PEOPLE EXPECT TIMELY SERVICE, COMMUNICATION AND FAIR PAYMENT,” SAYSDAVE HOLLANDER, E&Y’S GLOBAL INSURANCE ADVISORY LEADER. “IT'S NOW THE STANDARD.”LANSING, MICH.-BASED AUTO-OWNERS INSURANCE CO. ($4 BILLION IN 2010 WRITTEN

PREMIUM) PRIDES ITSELF ON A SUPERIOR CLAIMS EXPERIENCE, HAVING WON MULTIPLE J.D.POWER & ASSOCIATES AWARDS FOR SERVICE EXCELLENCE. BUT SVP OF INFORMATION SYSTEMSAND TECHNOLOGY Bob BuchananDECIDED IT WAS TIME TO UPDATE THE TECHNOLOGY UNDERLYING THAT EXPERIENCE. BUCHANAN RECENTLY TOOK INSURANCE & TECHNOLOGYASSOCIATE EDITOR Nathan Golia THROUGH AUTO-OWNERS’ ARDUOUS DECISION TO REPLACEITS LEGACY CLAIMS SYSTEM WITH GUIDEWIRE’S (SAN MATEO, CALIF.) CLAIMCENTER.

OneOnOne BOB BUCHANAN, AUTO-OWNERS INSURANCE

Bob Buchanan, Auto-Owners

www.insurancetech.com

Page 10: Ist digital issue_2012_04

personal lives — smartphones, tablets, web, etc.— and yet make it as transparent as possible,enabling them to focus on the customer andnot the technology; and we wanted to equipour claims associates with tools that enhanceour capture of claims information.In addition, from an IT perspective, we wanted

to implement a technology foundation to helpincrease our agility and im-prove our time to marketfor claims system enhance-ments. We’ve been No. 1

according to J.D. Power for the auto claims experience four years in a row, but we alwaysneed to be looking for ways to get better.

You ultimately selected Guidewire’s Claim-Center, but not until after first embarkingon a custom-built system. What happened?BUCHANAN: We did go through an assess-ment of our options and decided a couple ofyears ago to begin custom building some as-pects of claims handling, such as our FNOL forQuick Claims [a proprietary process for evalu-ating if claims can be handled in 24 hours], andimproving our agency inquiry system. We im-plemented these recently, and they have been

received well by our agents. As we completedthe first phases, however, we asked ourselves ifwe should continue our current approach andbegin development of other core claims admin-istration capabilities, such as claims assignment,claim financials and post-settlement activities.We also looked at the demands that would beplaced on our IT and business people. When we evaluated our options, we recog-

nized that claims administration systems avail-able today have come a long way since we firststarted looking at them — products are moreadvanced; they are highly configurable andbring a lot of ready-made capabilities for inte-gration. In other words, they have become “plat-forms” — sort of like toolkits on steroids todevelop functionality. At this point we decidedthat licensing a product made more sense thancontinuing down our current build path.

What distinguished Guidewire and theClaim Center solution in your evaluation ofclaims platforms?BUCHANAN: We brought in a company thatspecializes in architecture and strategy of enter-prise applications and integration focused onthe insurance industry. After a thorough review

of our various choices, we decided to licenseGuidewire for our claims administration platform[for auto, home and business lines]. We spent lesstime on a broad search, and more time on adeeper evaluation to find the best fit. We quicklynarrowed our choices from about eight to 10vendors down to three, and we asked ourselves:• Is the solution proven? Does the vendor

have substantial working installations?• Does the system have all the configuration

and integration capabilities to meet our needs?• Does the company have strong leadership?• Is there cultural compatibility?• Doe the vendor want to add Auto-Owners

as a client and make us successful regardlessof the number of other clients it has?• Does the vendor have a philosophy of

promoting self-sufficiency in their clients?While all three of the companies scored well

in these areas, Guidewire had a slight advantage.

What is the status of the implementation?BUCHANAN: Once we made the selection, welost no time in getting things off the ground.The project has already started and is well under way. We expect to implement our firstlines of business in about 12 to 18 months.�

April 2012 10

OneOnOne BOB BUCHANAN, AUTO-OWNERS INSURANCE

“We always need to be looking for ways to get better.”

www.insurancetech.com

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April 2012 11

wen Williams, SVP and claims CIOfor Chubb, describes the Warren,N.J.-based P&C insurer’s claims serv-ice as best-in-class and asserts thatcustomers who go through Chubb’s

claim experience are prone to become customersfor life. “Claims handling is a key differentiator forus in the marketplace, and so we continue to investin the kind of people, process and technology thatyields customer service that exceeds our competi-tors’ performance,” he says. Maintaining that performance edge today

requires adapting Chubb’s ($11.8 billion in 2011net written premium) customer- and agent-facingclaims capabilities to consumer adoption of mobile computing, which, Williams says, is drivingthe need to deliver real-time information withina personalized service offering. This means pro-jecting the claim experience onto multiple plat-forms and devices in any context. “Today’s insureds want the flexibility to choose

the level and type of interaction that makes themost sense for them,” Williams explains. “For ex-ample, someone might choose to initiate a claimthrough their agent but receive status updates onthe claim via a mobile device.” >>

O

Photography : Tony Vecchioni

Previous Next

Table of Contents

CoverStory OPTIMIZING THE CLAIMS EXPERIENCE

www.insurancetech.com

By Anthony O’Donnel @AnthODonnell

“Claims handling is a key differentiatorfor us in the marketplace,” says OwenWilliams, SVP and claims CIO for Chubb.

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While rapid technology change is inevitable, insurers shouldn’t assume too much about how it will manifest itself in future customerinteractions, Williams suggests. “I don’t think anybody really knowshow technology is going to change the way people interact,” he cautions. “However, it will be different than it is today, and it is verylikely that insureds will dictate the way they interact with Chubb,rather than the other way around.”Chubb, which underwrites a variety of personal and commercial lines

products, is known for its high-end homeowners and other prestigepersonal property coverage. The carrier’s adaptation is part of a largertrend of insurance companies shifting their competitive focus to theclaims battlefield, indicates Richard Pankhurst, an Austin, Texas-based

director with PricewaterhouseCoopers (New York). Variousprice-focused marketing strategies have been “done todeath,” Pankhurst says, and a focus on the claim promisehas taken hold in the past six to 12 months.

Claims: Delivering on the Promise“Many insurers understand that they can’t compete onprice, but that they don’t need to. They realize that theycan win new customers and retain existing ones if theycan deliver on the promise,” Pankhurst reports. “This is anarea that is cracking wide open. It’s pivotal to the industryand will be the driving force of claims operations and tech-nology investment over the next five years.” Insurers in the vanguard of claims improvement are taking

responsibility for proactively and quickly guiding the claims

process and pushing out relevant information to claimants rather thanforcing claimants to pull it from the insurer, according to Donald Light,a Palo Alto-based senior analyst with Celent. “It’s a matter of makingprocesses happen more smoothly and of giving claimants the ability tohave a sense of where they are in the entire process,” he says. Insurers need to deliver key claims information to policyholders

through their channels of choice, Light affirms. But enabling thosefront-end connections depends on more flexible back-office tech -nology. “The essential technologies to make sure that adjusters aredoing the right thing at the right time are workflow and businessprocess management,” he says. “Modern core claims systems havethese capabilities built in.” PwC’s Pankhurst adds to the list consistent data capture, scripting,

integration of external data sources and integration to other core systems as elements making modern claims system the “No. 1 ingre-dient” in delivering a customer experience comparable to the oneprovided by other industries. “The key to a satisfactory experience issetting expectations,” Pankhurst asserts. “Modern core systems facilitate the assembly of a work plan composed of the right activities

April 2012 12

“Many insurers ... realize that

they can win new customers

and retain existing ones if

they can deliver on the

promise.”—Richard Pankhurst, PricewaterhousCoopers

Owen Williams, SVP and claims CIOfor Chubb, reveals his six keys todelivering a superior claim experience: 1.Simplify claim reporting.2. Clearly set expectations.3. Improve information sharing.4. Keep all parties informed.5. Provide options.6. Issue payment promptly.

6 Secrets to a Superior Claim Experience

www.insurancetech.com

OPTIMIZING THE CLAIMS EXPERIENCECoverStory

Page 13: Ist digital issue_2012_04

and guide adjusters and other participants through them.” Insurers also must shift from a process mentality focused

on executing steps, to a people-focused paradigm emphasiz-ing communication and aimed at keeping customers happy,Pankhurst advises. “The emphasis must shift from masteringprocedure to empowering people to do a good job by train-ing staff and giving them the best tools,” he says. “We’ll see asignificant up-skilling in adjusters themselves with regard tocustomer management skills.”Carriers need to focus on keeping adjusters happy, too.

Much thinking has gone into making these professionalsmore effective through structuring their roles, Pankhurst says.But more attention has to be paid to the quality of their workenvironment, and recruiting and retaining talented new professionals to the job will require equipping them withleading-edge tools, he insists. As part of a people-and-communications approach to claims,

Pankhurst recommends what he calls integrated communica-tions management, which unites the back-end system capa-bilities with all of the preferred channels of interaction foragents, adjusters and customers for any given communication.

Powering the Retention EngineGrange Insurance (approximately $1.1 billion in 2011 revenue)took aim at this type of communications strategy with its moveto HP Exstream as the carrier’s single system for the creation and delivery of claim correspondence. The Columbus,

April 2012 13www.insurancetech.com

CoverStory

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OPTIMIZING THE CLAIMS EXPERIENCE

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April 2012 14

Ohio-based carrier, which offers auto, home, life and business insurance,implemented HP Exstream in 2011 for enterprise document creationand distribution, and went live for claims-related purposes in February2012. The software supports Grange’s “System of One” platform consolidation strategy and the carrier’s goal of driving growth and retention through claims excellence, according to CIO Michael Fergang,who notes that the carrier received 160,000 claims in 2011.Grange constantly reviews customer satisfaction using the Net

Promoter Score (netpromoter.com), Fergang says, and the companyrecords all customer calls, em-bedding them in the relevantclaim file. By evaluating thesesources of intelligence on an on-going basis, he adds, Grange candetermine individual claimants’preferences and shape trainingfor professionals interactingwith policyholders. “There’s a direct correlation

between customer satisfaction and retention,” Fergang observes. “NetPromoter is our vehicle to evaluate that very quickly.” HP Exstream fits perfectly with Grange’s focus on the service and

satisfaction feedback mechanism, according to Andy Hellard, Grange’sapplication development supervisor, who ran the HP Exstream implementation. “Today we have many manual processes, and wehave lacked consistency in form and voice in our customer commu-nications,” Hellard acknowledges. “This was an opportunity to

consolidate to a single platform and deliver a consistent customerexperience across all claim correspondence.” HP Exstream enables the business to centralize control of corre-

spondence and give the business the ability to customize communi-cations to many customers or to a single customer — without IT intervention. According to Hellard, “The software takes the relevantoutput from core systems and enables you to format it to any com-munication channel or device. It provides us with the architecture tomove to multichannel communications.”Grange initiated use of HP Exstream within claims in medical payments

and subrogation, reports Beth Rickard, the carrier’s senior project man-ager on the initiative. Potential efficiency gains flowing from increasedpaperlessness and retiring redundant systems have justified a large program around document creation centered on HP Exstream, she says. The implementation has already produced speed and efficiency

dividends, including reducing letter production time from about 11minutes to 1.5 minutes, Rickard notes. “We’ve seen immediate results,and the efficiency gain is huge,” she says. “It means getting more con-sistent communications out to our customers more quickly.”At least as important, adds Fergang, “We will be able to communicate

within the channel that the agent or policyholder desires in the future,which is very powerful.”

The Agent AllianceChubb’s policyholders expect a high degree of coordination betweenagent and carrier, a reality that has shaped the company’s investmentin and creation of applications that provide agents with real-time claim

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CoverStory OPTIMIZING THE CLAIMS EXPERIENCE

—Andy Hellard,Grange Insurance

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information, according to Chubb’s Williams. The insurer has providedclaim reporting and inquiry capabilities for several years but introduced“game changing” improvements in 2010 with ClaimAlerts, he says. Built on an existing personal lines application called MyAlerts,

ClaimAlerts provides agents with real-time alerts on events affectingthe status of a claim, Williams explains. The capability also provides

quick-link access to Chubb’sClaimView, which providesdetailed information on claimstatus, including adjusternotes. Chubb also providesdownload services for agencymanagement systems. In 2011, Williams adds, Chubb

launched Upload, a service thatallows agents and insureds todirectly attach important claim

documents, such as photographs, estimates or invoices, directly to theclaim file. In the past, these attachments needed to be sent to email in-boxes, fax machines or via traditional mail. While Chubb still accepts doc-uments through those channels, he notes, they require human interven-tion to review, sort and post the documents to the correct claim file.“This was a huge win for us,” he says. “It cuts out significant time from

the process and enables us to adjudicate claims in a much faster andmore efficient manner.” During 2012, Chubb will revamp its E-Loss claim reporting application

for increased agent ease of use, Williams reports. The carrier also will begin

extending ClaimAlerts to personal lines policyholders and commerciallines, beginning with agent access. Williams places all of the enhancements to Chubb’s claims service

within a set of six imperatives required to deliver a superior claim experience in today’s world: simplify claim reporting, clearly set expectations, improve bilateral information sharing, keep all partiesinformed (insured, agent, etc.), provide options (e.g., method of communication, service provider, etc.), and issue payment promptly.While some of the items on Williams’ list reflect perennial features ofa superior claim experience, today’s insureds want the flexibility tochoose the level and types of interaction that make the most senseto them, he stresses. “The mass consumer adoption of mobile technology,” Williams

continues, “is driving the need for a claim experience across multipleplatforms in any context, and the same degree of intimacy needs toprevail across all channels in a consistent manner.”Other technologies also are driving key enhancements to Chubb’s

customer claim experience, according to Williams. “We’re currently exploring the potential impact of big data, mobile platforms and themanagement of the legacy systems burden,” Williams says. [For moreon how insurance companies are leveraging analytics in the age of BigData, see related article, page 4.]Chubb’s efforts are calculated to maintain a service-excellence lead be-

tween the carrier and its competitors, Williams says, asserting that Chubbhas enjoyed “phenomenal” results. “In 2011, 97 percent of insureds re-sponding to our property claim survey were ‘highly satisfied’ with theiroverall claim experience — our highest score to date,” he says. �

April 2012 15www.insurancetech.com

OPTIMIZING THE CLAIMS EXPERIENCECoverStory

—Michael Fergang,Grange Insurance

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www.insuranceandtech.com

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April 2012 17www.insurancetech.com

ith its legacy claims system“creaking at the seams,” Dublin, Ireland-based FBD Insurance faced

a refresh, recalls Michael Whelehan, head ofclaims operations for FBD, the country’s third-largest insurer. “With our old system, cus-tomers drove the process whenever they contacted us to inquire about the status oftheir claims,” he says. “We needed to automateand become proactive in settling claims.”FBD set out in early 2008 to modernize a host

of claims-related processes for its auto, home,small-business and agriculture lines, and in2009 it began centralizing renewals away from

local representatives and into the company’sfirst call center. Around the same time, Whele-han notes, the insurer also launched a new on-line, no-frills homeowners and personal autobrand. “We needed a claims system that wouldsupport all of these initiatives,” he says.After evaluating six vendors, FBD — a division

of FBD Holdings (US$1.3 billion in total assets)— focused on Dublin-based FINEOS. “FINEOShad a proven record in the life market and waskeen to develop a P&C solution,” Whelehan re-counts. “FINEOS’s answers to our RFP were aheadof the others, and their timelines to implemen-tation were very positive, which was critical.”FBD first piloted FINEOS Claims as a call cen-

ter-only application. “We figured we could dis-engage if we weren’t happy,” notes Whelehan.But when the project proceeded smoothly, FBDdecided to roll out FINEOS enterprisewide. Preparations began in late 2009, including

establishing a Linux-based virtualized hard-ware environment using IBM (Armonk, N.Y.)System x servers, DB2 and WebSphere. This al-lowed FBD to run approximately 12 virtual ma-chines per physical device, Whelehan reports.The insurer also assembled a cross-functionalcore implementation team, including about adozen executives, with plans to draw in signif-icant IT and claims resources as needed. Tominimize the business drain and enable an ag-gressive timeline, Whelehan says, FINEOS sug-gested utilizing an agile development process.

Stalled Kick-Off After kicking off in January 2010, the initiativestalled briefly, Whelehan acknowledges, not-ing that the effort came too close on the heelsof the call center deployment in late 2009.“Key team members kept getting pulled intopost-project clean up,” he says. “This delayed

WBy Anne Rawland Gabriel

Shelter From the Claims StormFBD INSURANCE REPLACES IT LEGACY SYSTEM AND AUTOMATES THE CLAIMS LIFE CYCLE— JUST IN TIME FOR A BLIZZARD OF NEW CLAIMS.

CaseStudy CLAIMS SYSTEM MODERNIZATION

“We now proactively drive the claimslife cycle, rather than reacting to customer inquiries.”—Michael Whelehan, FBD Insurance

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the larger deployment by about two months.”Fortunately, the new system went live just in time for the

region’s harshest blizzard in 30 years, in late November 2010. “Weregistered as many freeze claims following the event as in theentire nine months previous,” Whelehan says. The new claimssystem withstood the challenge. “Four months later, we knew ex-actly where our book stood,” he reports, adding that previously,the situation would have been unclear for much longer.Yet, Whelehan admits, a few kinks remained, including chal-

lenges centered on a lack of summary screens. “FINEOS’s greateststrength is capturing and managing mountains of data,” Whele-han says. “The downside is that this creates many layers of screens— document screens, notes screens, contact screens, etc.” As aworkaround, FBD built a custom summary screen. Meanwhile, FI-NEOS developed a long-term solution that is now available in

the claims platform’s most recent version. Still, Whelehan says, the ongoing benefits

are tremendous. “We’re facing new SolvencyII regulations and a new Irish consumer pro-tection code,” he says. “We’ll be able to buildmost of the necessary tasks into the system.And we’ll be able to engage with our third-party partners to automate data transfers between their systems and ours.”He adds, “Best of all, we now proactively

drive the claims life cycle, rather than reactingto customer inquiries.” �

April 2012 18www.insurancetech.com © 2012 Perceptive Software, LLC. All rights reserved. ImageNow is a registered trademark of Perceptive Software. All product and company names may be trademarks or registered trademarks of their respective owners. PS_ad_Insurance_Technology-Digital_1203

www.perceptivesoftware.com

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International Medical Group

CaseStudy CLAIMS SYSTEM MODERNIZATION

Company: FBD Insurance, a division ofDublin, Ireland-based FBD Holdings (US$1.3 billion in total assets).

Lines of Business: Auto, homeowners,small-business and agriculture.

Vendor/Technology: The FINEOS (Dublin)Claims platform.

Challenge: Replace legacy claims systemto drive proactive claims management.

Snapshot

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nsurance claims fraud, waste and abuse(FWA) constitutes a staggering financialproblem in the U.S. The Coalition Against

Insurance Fraud estimates that in 2006 a totalof about $80 billion was lost in the U.S. due toinsurance fraud. Insurance companies estimatethat 10 to 20 percent of all claims today arefraudulent, and less than 20 percent of thosefraudulent claims are even detected, let alonedenied. At the same time, competitive pres-sures are requiring insurers to develop fasterclaims processing cycles, balance operationalefficiencies against reduced claim leakage andimprove customer retention strategies. Technology designed to manage FWA has

evolved a great deal in recent years, but thereis much room for improvement. Incorporatingautomated business rules into a fraud man-agement program that anticipates certaintypes of suspicious claim activity based onpast fraud, for example, is a start. This alone is not sufficient, however, because

it is rare that even a chronic, predictable fraudproblem can be solved simply with one black-and-white rule. Often the rule can cause prob-lems for similar, legitimate claims, which arethen delayed, causing customer frustrationand leading to increased expenses. Addition-ally, even when a certain type of fraud isstemmed, another will inevitably arise.Detecting problematic claims before pay-

ment is a payer’s strongest protection againstFWA — and also the most efficient approach.But fraud is elusive, and patterns may not berecognized until after many payments havebeen made. That is where predictive analyticsenter the picture. Analytics are a powerful

weapon in fighting FWA — before or after pay-ment, detecting billing errors, and identifyingsystemic weaknesses and vulnerabilities suchas oversights in provider contracts and loop-holes in benefit policies.

Why Current Practices Fall ShortMany insurers handle claims processing andfraud identification in a reactive manner, oftendependent on the experience of individualson the processing team. Trends and patternsusually aren’t obvious, and subtle exposuresusually aren’t visible. The approach that’sneeded is one that combines the power of an-alytics to detect unknown fraud, both new andunique, along with business rules manage-ment to block fraud earlier in the process. Predictive analytics and business rules have

a synergistic relationship. As predictive analyt-ics algorithms identify emerging and increas-ingly routine sources of waste, they can helpinsurers develop new rules. The artificial intel-

A Powerful CombinationCOMBINING BUSINESS RULES MANAGEMENT AND PREDICTIVE ANALYTICS CREATES AN INTELLIGENT FRAUD MANAGEMENT SYSTEM THAT MANAGES CLAIMS PROACTIVELY, SAYS FICO’S RUSS SCHREIBER.

I

April 2012 19

IndustryVoice CLAIMS FRAUD

www.insurancetech.com

Russ Schreiber is vice president of the healthcare practice at FICO. He has more than 24 years of experience in the insurance industry.

About the Author

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ligence learns from the new data patterns afterthe rules have filtered out the known fraud tocontinue to monitor for new fraud schemes.In some cases, FWA is not obvious. One payer

discovered an issue with an injectable cancerdrug only after cross-referencing dosageswith patient weight. Each patient would havehad to weigh 700 to 800 pounds to merit theamount of the drug they were allegedly re-ceiving. Building intelligence into the systemwith analytics and business rules manage-ment allowed the payer to have an automatic

check in place todistinguish reason-able claims from un-reasonable ones.This intelligent ap-

proach also helps tomanage the problem of false positives, wherea claim matches the profile of an anomaly butis actually legitimate. False positives some-times occur because particular authorizationsare different according to various group plansand providers. What is normal or reasonablefor one plan may represent FWA for another.With intelligence built into the system, thesedifferences can be accounted for ahead of

time and the system can identify a claim as a“known” false positive, avoiding delays in pay-ment for legitimate claims.

Analytics + Rules = Measurable Impact Payers in the healthcare industry are alreadyembracing this approach. In one case study, apathology group had been adding a profes-sional services modifier for automated bloodtests — but automated blood tests do not require professional interpretation. An analyticsystem identified the discrepancy and enabled the payer to implement a rule thatprofessional services modifiers would not beallowed on an entire set of tests, resulting inmillions of dollars in savings.This intelligent approach, with the addition

of link analysis (a data analysis technique usedto evaluate relationships or connections between nodes), lends itself especially well tothe P&C sector. P&C insurers are minimizingloss accumulation by spotting fraud rings andassociated claims earlier, and they are increas-ing recoveries by finding more new fraudcases as well as additional instances of fraudon existing cases. Accordingly, they are ableto focus their investigative resources where

they produce the greatest financial impact. Analytic models “learn” from every new claim

and improve their performance and ability toidentify fraud. Predictive models that instantlyanalyze claims prior to payment have helpedinsurers identify as much as 50 percent morefraud, and combining those models with tradi-tional rules-based systems enables carriers tolocate aberrations in claims faster and more accurately. The speed at which claims can beprocessed also increases, as the analytics caneasily identify which claims should be paid automatically and which should be reviewed.FWA is unique for every payer organization

— issues can be contained to one procedureor to one provider. With business rules man-agement technology built in, specific procedurecodes for specific providers can be flagged forreview while letting the others flow through.Curbing FWA within the insurance space is

a complex process, but combining businessrules management and analytics makes for apowerful combination. It creates an intelligentsystem that is constantly learning, and it manages claims proactively, enabling payersto stop FWA ahead of time rather than chasinglosses after the fact. �

www.insurancetech.com

IndustryVoice

April 2012 20

The approach that’s needed combines thepower of analytics to detect unknown fraudalong with business rules management to

block fraud earlier in the process.

CLAIMS FRAUD

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April 2012 21

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