Digital Platforms

Columbus, Ohio - Healthcare Transaction Processors Inc. (HTP), Columbus, Ohio, announced it is integrating claim overpayment protection services (COPS) into its HTP Transaction Manager suite, which serves health insurers, HMOs, TPAs, IPAs and other medical payment organizations. COPS leverages ClaimsGuard technology from Bloodhound Inc., a Research Triangle Park, N.C., software company. The enhancement will enable real-time editing of claims before they are entered into the client's claim system. Through a series of business and clinical rules and other algorithms, COPS identifies anomalies in clients' claims data, such as potential overpayments, overutilization, duplicate claims and questionable provider billing practices.

Boston - At the National Association of Insurance Commissioners (NAIC) meeting held here this weekend, the NAIC Property and Casualty Reinsurance Study group approved enhanced disclosure requirements for insurers that utilize reinsurance with limited risk transfer features, also known as finite reinsurance. The use of finite reinsurance has received considerable attention over the past several months, because of its misuse by some high-profile insurers. State insurance regulators, working in a coordinated fashion through the NAIC, have been evaluating existing relevant statutory financial reporting since last year. NAIC Property and Casualty Reinsurance Study Group approved enhanced disclosure requirements for insurers that utilize reinsurance with limited risk transfer features, also known as finite reinsurance. The use of finite reinsurance has received considerable attention over the past several months, because of its misuse by some high-profile insurers. State insurance regulators, working in a coordinated fashion through the NAIC, have been evaluating existing relevant statutory financial reporting since last year. The latest proposed disclosures would require an insurer to report to state insurance regulators any finite reinsurance agreement that has the effect of altering policyholders' surplus by more than three percent, or representing more than three percent of ceded premium or losses. Additional reporting requirements regarding contract terms and management's intention in entering the contract have been included to improve transparency. Study Group members also approved a standard attestation form to be signed by the insurer's CEO and CFO attesting that there are no side agreements and that risk transfer has occurred.

Hartford, Conn. - The Innovation Group (TIG), a UK-based provider of policy, claims and conversion technology products and services, will partner with Document Sciences (DocSci), a provider of real-time content publishing products, to automate claims reporting.

Dublin, Ireland - Claims management will be the largest IT investment made by US property & casualty carriers looking to improve operational processes this year, growing to $4.5 billion by 2007, according to a report issued by Research and Markets, a market research firm based in Dublin. The report indicates that carriers' objectives will be automating first notification of loss, the initial customer/claimant touch point reducing manual processes, and streamlining workflow throughout the process.

Austin - United Teacher Associates Insurance Co. (UTA) is launching an initiative to Web-enable Medicare supplement insurance enrollment as well as routine agent services. The company recently signed with Cleveland-based IdeaStar Inc. to design, develop and host a state-of-the-art Web site for UTA-appointed agents. The site is targeted for launch this Fall. The site represents UTA's first foray into online, electronic signature-based enrollments for senior health and life products. Top producing UTA agents are eager to obtain online processes as they seek to stay competitive with market forces. The vision of UTA's President Billy Hill is to automate agent enrollment, agent servicing and the Medicare supplement insurance education and enrollment process. The new Web site is expected to process several thousand Medicare supplement applications per month in a paperless fashion. Senior life enrollment and other products will be added in the future.In addition, the new capabilities will help attract other agents into UTA's fold. "Site design and architecture, creating an enjoyable yet efficient and accurate agent experience, are critical in the effort to recruit and retain agents," says Mike Wise, vice president of IdeaStar Insurance Technologies. "The seamless integration with Lifepro, UTA's back-end administration system, will complete the workflow and enable high-speed policy issuance."

Anaheim, Calif. - At the 77th Annual IASA Educational Conference and Business Show held this week in Anaheim, Calif., IASA announced a technology education initiative that will involve a vendor collaborative approach. It has joined forces InsureWorx, an Emeryville, Calif., provider of modular software, to develop and deliver a specialized insurance technology program for IASA member companies. The initiative will be launched with a series of InsureWorx-sponsored Webinars to provide in-depth presentations and discussions on critical topics currently affecting insurance company information technology departments.

Simsbury, Conn. - The Hartford Financial Services Group Inc., appointed Terry Walker as senior vice president and chief information officer (CIO) for its Hartford Life Inc., subsidiary.

Southfield, Mich. - Proforma Corporation, a business process modeling and analysis software company, announced it has joined with business process management (BPM) providers to answer industry demand for interoperability between business process analysis (BPA) and BPM. The consortium agreed to support a common interchange format (CIF) that will facilitate the exchange of business process models between BPA tools, such as Proforma's ProVision BPMx, and other BPM solutions.

Zurich, Switzerland - Swiss Re is aligning its management structure to its strategic objectives, the company reported today. Focusing on profitable growth and the efficient use of capital, Swiss Re will structure itself into three separate business units to be named Client Markets, Products and Financial Services.

New York -- Folksamerica Reinsurance Co. has promoted Brian Kensil to the position of Chief Operating Officer.Folksamerica's claims, information technology, human resources and administration departments will report to Brian in addition to his current responsibility for contracts, underwriting services and risk management.

In part as an industry response to legislation passed this session mandating that insurers give consumers more information regarding insurance policies to help Florida residents better prepare for hurricanes, the Florida Insurance Council announced a Hurricane Central Web site (www.flains.org).

Washington D.C. - The National Association of Insurance Commissioners' (NAIC) plan to apply Sarbanes-Oxley (SOX) corporate disclosure and accounting rules to non-public carriers will take center stage at the National Conference of Insurance Legislators' (NCOIL) Financial Services & Investment Products Committee meeting, which will convene on July 7 from 1:45 to 3:00 p.m., during the NCOIL Summer Meeting in Newport, Rhode Island.

Austin , Texas - To improve its policy management business processes, Aflac is implementing a business process management (BPM) platform. The Columbus , Ga. , carrier, which insures more than 40 million people worldwide, said it plans to use TeamWorks software, from Austin, Texas-based Lombardi, to gain new insight into process performance through business activity monitoring.

Addison, Texas - Universal Conversion Technologies (UCT), an Addison, Texas provider of data analysis and conversion services, today announced that Cincinnati-based Great American Financial Resources, Inc. (GAFRI), a subsidiary of American Financial Group, completed its conversion project. The project included the conversion of 30,000 fixed annuity policies from a recent acquisition, to the PDMA LifePRO system, GAFRI's primary administration system for all lines of business. UCT provided consulting expertise for the data mapping and project management, as well as its data conversion architect conversion.

You've driven the winding road to ERP. You've navigated the bumpy journey to CRM. Now, it's time to rev up your engines for the next big technology race: the race to the newest enterprise goal: CPM.If you haven't already heard the term, it stands for corporate performance management-also known as enterprise performance management (EPM) or business performance management.

A growing number of insurers are harnessing technology to improve services to customers victimized by identity theft.Some have established outreach programs that give policyholders access to third-party identity theft restoration services. One of them, Columbus, Ohio-based Nationwide Insurance Co., is providing other capabilities as well.

A national life settlement broker is taking an eBay-like approach to the secondary life insurance market, linking cash-strapped policyholders with institutional investors.In April, Life Settlement Insights drew a handful of institutional investors online to test the open-forward auction format of a new venture called LifeX, an electronic communications network that runs on a proprietary auction platform from HedgeHog Inc. Executives with Cleveland-based Life Settlement Insights claim they've created the life settlement industry's first online exchange and are considering extending the capability to other life settlement brokerages.

Carriers have been addressing Internet security ever since they realized the public network exposed them to denial of service attacks and theft of policyholder information. Firewalls, intrusion detection, encryption, virus scanning, access management-all these tools are staples in carriers' IT operations.But what about insurance agencies? Carriers exchange customer data with agencies via the Internet daily, and agents regularly access policyholder data within carrier systems.

When online insurance marketplaces first appeared on the Internet horizon more than five years ago, they filled an important gap in carriers' online business strategies. At that time, most insurers had Web sites that industry experts mockingly referred to as "brochureware" to describe their informational, non-transactional qualities.Insurance marketplaces attracted the attention of consumers who were surfing the Web to comparison shop for auto, home and even life insurance. Typically frequented by young, Internet-savvy Generation Xers and baby boomers, these online insurance marketplaces provided participating carriers and independent agents with hundreds of leads from consumers who were patient enough to wade through screen after screen of questions before they received their prize: multiple quotes from brand-name insurers.

ZURICH UPDATES SURETY EXPRESSZurich North America, the Schaumburg, Ill.-based commercial property/casualty insurer, has launched Surety Express Release 2, an updated version of its free online surety bond processing system. Offering a number of key enhancements, including improved screens and time-saving features, Release 2 enables agents in all 50 states and the District of Columbia to rate, underwrite, quote, obtain and issue commercial and contract surety bonds directly from the Zurich Web site at www.zurichna.com/surety.

What are the most important IT considerations for complying with Section 404 of the Sarbanes-Oxley Act of 2002? By July 15, all U.S. companies under $75 million in annual revenue must demonstrate they know the answer to that question, because that's the deadline for complying with Section 404.However, due to the lack of specific directives and knowledge, many companies are struggling with how to reach compliance by that date-let alone wondering how they will afford continued compliance year after year.

Avon, Conn. - The traditional business model used by carriers in the benefits arena is about to be challenged, according to Eastbridge Consulting Group Inc., a marketing advisory firm serving insurance and financial services organizations in the United States and Canada .

Hartford, Conn. - ACORD XML standards are going a long way for The Hartford Financial Services Group Inc. The Hartford, Conn. carrier has harnessed the standards to provide its agents with the ability to speed up placement of midsize commercial accounts.

New York - Helping members better analyze and report their returns on standards investments, ACORD released a return on investment (ROI) analysis toolset at the 2005 ACORD LOMA Insurance Systems Forum, held in Orlando on May 22-24.

Andover, Mass. - State National Companies, Fort Worth, Texas, has chosen CGI Group Inc., an independent information technology and business process services company, to provide full regulatory and statistical reporting services for their property and casualty book of business. Privately held, State National Companies includes three affiliates: State National Insurance Company, National Specialty Insurance Company and Texas-based State and County Mutual Fire Insurance Company.

Brookfield, Wis. - Fiserv Customer Centered Solutions (CCS), the customer relationship management (CRM) arm of Fiserv, launched its Enterprise Relationship Management Suite (ERM Suite), an integrated product line designed to address service and sales issues facing CEOs.

El Segundo, Calif. - Computer Sciences Corporation (CSC) announced that five carriers in the life insurance industry have joined CSC's Next-Generation Automated Underwriting Platform Strategic Technology Program (STP). Through the program, CSC will develop a new automated underwriting software component based on Swiss Re's Life Underwriting System (LUS).

Boston - John Hancock announced a new turnkey marketing program called Key Employee Excess Enhancement Plan (KEEEP) to help producers sell deferred compensation cases and maximize sales in the business market. The program enables producers to present, sell, implement, service and administer a deferred compensation plan, including business owner and employee brochures on how the plans work and their benefits, as well as a sample client presentation. The package also contains executable documents needed to implement the plan that are ready for sign-off by the plan sponsor's legal counsel, and a producer guide offering a comprehensive program overview.

St. Paul, Minn. - Through aggressive health care fraud investigations and coordination among other states' Blue Cross plans, the Special Investigations Unit (SIU) of Blue Cross and Blue Shield of Minnesota stopped payment on more than $3 million of suspect claims last year, reducing the impact of fraud on premiums in that state. By comparison, Blue Cross stopped $8.7 million in claims in 2003, most of which was due to the rent-a-patient scams now being investigated and prosecuted in Southern California."We saved millions of dollars of our members' premium dollars, because we were able to identify the scam early and stop payment on fraudulent claims," says Dave Bohnenstingel, SIU manager. "In fact, Blue Cross and Blue Shield of Minnesota was integral in bringing the scam to light and the perpetrators to justice," he added.

San Francisco - InsureWorx Inc., a provider of modular software solutions to the insurance industry and the workers' compensation carrier market, has launched its new Web site, located at www.insureworx.com. The site introduces the look and feel of the newly formed InsureWorx organization which resulted from the January 2005 acquisition of Taliant Software by WorldGroup.The new InsureWorx Web site includes information about the company's PowerComp products, the company, and the insurance software market. Of particular interest to existing InsureWorx customers is the client services area. These pages are designed to become a primary source for customer information and communications/

Kansas City, Mo. - The National Association of Insurance Commissioners (NAIC) met last week to discuss steps to amend disclosure requirements for insurers that utilize reinsurance with limited risk transfer features, also known as finite reinsurance.

Kirkland, Wash. - The National Association of Insurance Commissioners (NAIC) has selected Ubmatrix, a Kirkland, Wash., supplier of software and services, to provide technical support and training in the development of an XBRL demonstration project for use with NAIC's insurance statutory financial reporting data.

Hartford, Conn. - Aetna has entered into an agreement to acquire ActiveHealth Management, a New York-based health management and health care data analytics company. Aetna will acquire privately held ActiveHealth for approximately $400 million and expects to finance the transaction from available cash. The transaction is subject to customary closing conditions and federal Hart-Scott-Rodino anti-trust regulatory approval. Aetna expects to close the transaction during the [second] quarter of 2005 and that it will become accretive to earnings within 12 months following the closing. Aetna places strong emphasis on medical management," says John W. Rowe, M.D., Aetna chairman and CEO, "and ActiveHealth's ability to provide practical, timely, clinical decision support to physicians and members can improve patient safety and medical quality and reduce medical costs." Aetna has been a customer of ActiveHealth since 2002, and has private-labeled the CareEngine-powered services it uses under the name MedQuery. Other health plans also have placed the services they purchase from ActiveHealth under private labels.Source: Aetna

Cleveland - The Compliance Consortium, an international membership organization formed in June 2004 to promote effective governance, risk and compliance management (GRC), has published its operational approach for managing GRC requirements within the enterprise. Applicable to both public and private companies, the framework is designed to assist senior management and boards of directors in setting objectives for managing a wide range of compliance-related activities and instituting the programs needed to attain those objectives. This initial version is a "public draft" and is intended to invite constructive criticism and ultimately to build a broad consensus within the hundreds of companies that have registered as part of The Compliance Consortium community over the past year. Leveraging the guidelines set forth by the U.S. Sentencing Commission, the Consortium has defined seven operational concerns to serve as a framework for organizing and managing GRC operations. These range from clearly assigning responsibilities at all levels of the organization to establishing incentives and discipline to promote compliance The Consortium has developed a list of 12 questions that board members and senior management should ask to help ensure organizations are on track with their GRC objectives."Unquestionably, the passage of the Sarbanes-Oxley Act has increased the focus for public companies on the areas of corporate governance, risk management and compliance," says Ted Frank, chairman of the Compliance Consortium advisory committee and president of Axentis. "It's important to remember that, for many companies, Sarbanes-Oxley is just one of hundreds of mandates from the SEC, FDA and other regulatory bodies that they must manage. Our goal with the creation of this framework is to help all organizations define, execute and ultimately profit from low risk and efficient governance, risk and compliance management, regardless of the specific regulation or statute."

Sarasota, Fla.- Kirk A. Sexton will take the reins as chief information officer of Unisource Administrators Inc., a workers' compensation third-party administrator that provides workers' compensation products, claim management, managed care and payroll services, to more than 15,000 employers in the southeastern United States.

Kansas City, Mo. - The National Association of Insurance Commissioners (NAIC) is taking steps to amend disclosure requirements for insurers that use reinsurance with limited risk transfer features, also known as finite reinsurance. The use of so-called finite reinsurance has received considerable attention over the past several months, because of its misuse by some high-profile insurers. State insurance regulators, working in a coordinated fashion through the NAIC, have been evaluating existing relevant statutory financial reporting since last fall. The latest proposed disclosures would require an insurer to report to state insurance regulators any agreement that has the effect of altering policyholders' surplus by more than 3%, or representing more than 3% of premium or losses. The new disclosure is also designed to identify any reinsurance contract that has been accounted for differently under statutory accounting principles compared to general financial statement purposes. Additional reporting requirements regarding contract terms and management's intention in entering the contract have been included to improve transparency. The provisions include that there are no separate agreements between the insurer and the reinsurer that could serve to modify the actual or potential losses under the contract, and that the insurer complies with all requirements of NAIC's statement of statutory accounting principle (SSAP) No. 62, "Property and Casualty Reinsurance."Source: NAIC

Peoria, Ill.- RLI, a property and casualty carrier and provider of surety bonds to niche or underserved markets, established a strategic information services department to manage and develop RLI's strategic and management information services. The newly formed department's goal will be to create accurate and consistent information that can be efficiently delivered to RLI managers and executives to enable them to react to potential problems and opportunities.The new business unit "will be essential in managing our growth and achieving greater profitability," says RLI President & COO Michael J. Stone.

Fireman's Fund Insurance Co. Novato, Calif., has taken a third major step in its total IT transformation by awarding IBM a ten-year $94 million contract to modernize a major portion of the property/casualty insurer's application, development and maintenance software into an On Demand infrastructure that could reduce the number of major applications by 70 percent while improving customer service. When completed, the work could save Fireman's Fund $200 million, more than double the project's actual cost.With IBM's assistance, Fireman's Fund will shift its IT operations to an Internet-based computing model known as a "service-oriented architecture" (SOA) that enables consolidation of costly, redundant applications. Under Fireman's Fund direction, IBM will sift through mission-critical applications using a unique IBM Business Consulting process called Component Business Modeling to determine which applications deliver the most value to the business and which processes can be refined, consolidated or eliminated.

Nashville, Tenn.- HealthLeaders-InterStudy, a provider of managed care industry intelligence, finds that CIGNA HealthCare has turned a corner in North Carolina. According to the latest issue of the North & South Carolina Health Plan Analysis, the national insurer's North Carolina HMO license tripled its net income in 2004 yet decreased premium revenues by 21%. It was the most dramatic turnaround among North Carolina's HMOs. CIGNA's HMO posted 2004 net income of $18.7 million on revenues of $277.5 million, says Jane DuBose, HealthLeaders-InterStudy analyst. "That's a 6.8% profit margin." All of the state's HMOs were in the black in 2004, although UnitedHealthcare and Aetna Inc., two other national insurers, had lower net income than in 2003, DuBose says.Source: Decision Resources Inc.

The Lawson Firm, a Cleveland-based law firm providing legal services to the insurance industry, is offering a two-part paper examining the business and legal risks associated with business-process outsourcing (BPO) and the strategies used to manage those risks. The paper is in response to recent studies showing that roughly half of all insurers currently outsource one or more business processes, or are planning to do so within the next 18 months.

COLUMBUS, Ohio--Nationwide Financial Services, Inc., a leading provider of long-term savings and retirement products, today reported first quarter 2005 net income of $160.5 million, or $1.05 per diluted share, compared with first quarter 2004 net income of $119.6 million, or $0.78 per diluted share.

Insurance revenue reported to the Federal Reserve by the nation's bank holding companies grew by $7.3 billion in 2004 to $40.8 billion, 22% higher than 2003, according to an analysis by the American Bankers Insurance Association (ABIA), Washington, D.C.

The National Association of Insurance Commissioners (NAIC) May 2 launched pilot project with five states to store electronic fingerprints of licensed insurance producers.

Quincy, Mass.--eStudentInsurance.com, a service of the Edvisors Network announced this month a new partnership with Worldwide Insurance Services. The Edvisors Network, a multi-national education services company, teamed up with Worldwide Insurance Services, a global leader in travel insurance, to create a new insurance policy for students traveling anywhere in the world. Global Student Health plans from eStudentInsurance.com are designed specifically to benefit international and domestic students by offering optimal affordable coverage, anywhere in the world.

Moncton, N.B. Canada--Whitehill Technologies Inc., a provider of document composition and data transformation software, has acquired the technology assets of Metaserver Inc. With this deal, Whitehill now owns the patented technology platform behind Metaserver's suite of business process integration (BPI) software and solutions for the insurance industry.

As director of MetLife Auto & Home's special investigations unit, John Sargent knows that eliminating fraud is an unachievable goal. But that hasn't stopped his company or other industry leaders from trying."Our goal is to pay what we owe, and not a penny more or a penny less," Sargent says. "The more efficient we are at identifying and preventing fraud, the better we can be at writing business at a more competitive rate."

In some ways, insurers' fraud-fighting efforts are similar to this nation's so-called war on drugs: Both endeavors require the right mix of people, technology and information to identify the criminals. Also, public awareness campaigns are part of the effort to change consumer behavior, whether it's to prevent drug use or prevent policyholders from filing bogus claims. And both involve elements of organized crime that use sophisticated tactics and technology to perpetrate their crimes.However, despite all of the resources that have been dedicated over the past decade to fighting drugs and fraud, we're no closer today to eliminating either problem. There have been many high-profile successes for each campaign, whether it's the seizure of a ton of cocaine on a ship at sea, or the combined work of insurance fraud investigators and law enforcement officials to uncover a multi-state, staged-accident fraud ring. But the fact remains that insurance fraud continues to cost the insurance industry $30 billion a year-and that's just counting fraud perpetrated against property/casualty insurers.

With industry research indicating that many individuals don't understand their annuity and life insurance needs, the responsibility falls on insurers to provide product research and needs-analysis to customers.While meeting with a financial advisor is one way to educate customers, many carriers, such as New York Life, are enhancing their Web capabilities to reach customers directly. And their efforts are being noticed.

In a move to strengthen the services it provides to sponsors of defined contribution plans such as 401(k) plans, Nationwide Financial Services Inc. in April purchased a company that provides third-party money management services to plan participants.The company, Registered Investment Advisors Services Inc. (RIA), which is based in Dallas, has been providing investment management services since June 2002 to plans that are part of Nationwide's Best of America Group Pension Series programs. Based on that experience, Nationwide executives say tighter integration with RIA Services will provide plan participants with expert advice on how to manage their retirement funds, and it will enable Nationwide to expand these services to other plans.

Industry experts often criticize insurers as being "laggards" in adopting new technologies. But carriers are leading most other industries when it comes to adopting scanning and imaging technologies, a new study concludes.For example, 86% of insurers surveyed by AIIM, an enterprise content management association based in Silver Spring, Md., are using scanned documents and images to answer inquiries from customers, compared with 73% of companies across all industries. Furthermore, 60% of carriers use scanned documents to respond to litigation, compared with 45% of all survey respondents.

The Contracts Update section includes announcements of contracts insurance information technology companies have signed with customers in recent weeks. Contract news can be faxed to Insurance Networking News magazine at (312) 913-1366 or by electronic mail to Stephen.Dwyer sourcemedia.com Apres Systems Inc.

At Erie Insurance Group, the foundation for fighting fraud is a business strategy that defines objectives, quantifiable goals, and tactical and operational plans: What is the company trying to accomplish? Does the company have enough resources to react to instances of fraud? How is Erie going to get better referrals to its special investigations unit and become more proactive in identifying fraud?"Erie is keenly aware that our experienced people-our claims adjusters, field investigators, intelligence analysts and information specialist-coupled with our use of fraud detection technology and investigation tools, have made our anti-fraud program so successful," says David Rioux, assistant vice president and manager, corporate security and investigative services for Erie Insurance Group, Erie, Pa.