Data and information management

Washington – The Office of Management and Budget has released a “statement of administration policy” threatening a presidential veto of legislation aimed at extending the Terrorism Risk Insurance Act (TRIA).

Needham, Mass.–A new research report from TowerGroup Inc. says insurers should go above and beyond current regulatory requirements when dealing with the issue of annuity suitability.

New York - New York Life Insurance Co. announced that Craig Merdian has joined New York Life International (NYLI) as executive vice president and chief financial officer. Meridian reports to Chairman and Chief Executive Officer of New York Life International Joseph Gilmour.In his new role, Merdian is responsible for managing several core functional areas, including all financial, accounting, investment and actuarial matters for NYLI. Additionally, he is a member of NYLI's Senior Leadership Team, which is responsible for establishing management policies in all areas of the NYLI's business and affairs.

Branchville, N.J. - Selective Insurance Group Inc. announced that its principal subsidiary, Selective Insurance Company of America, made several management changes as part of its leadership development process that created new roles for existing officers.

Lansing, Mich.–A new Web-based sales and training tool from Jackson National Life Insurance Co. (Jackson) is designed to help simplify the process of selecting an optional living benefit within Jackson’s family of variable annuities. The Living Benefits Selection Center (LBSC) enables registered representatives to get instant, client-approved output based on a client’s profile information after answering a handful of qualifying questions. The tool also features multimedia presentations, fact sheets and side-by-side comparisons of Jackson’s optional living benefits.

Menlo Park, Calif.—Fourteen percent of chief information officers polled for the Robert Half Technology IT Hiring Index and Skills Report expect to add IT staff in the fourth quarter of 2007, while 2% anticipate cutbacks. The net 12% hiring increase compares to net increases of 15% projected last quarter and 10% projected last year. The majority of respondents, 83%, foresee no change in fourth-quarter hiring.

Stamford, Conn.—A recent release from Pitney Bowes Inc. announced its Pitney Bowes Group 1 Software and Pitney Bowes MapInfo business units, acquired separately, will combine into a single software company. The move is effective immediately, and the businesses will merge operations over the next several months.

London - Karen Clark, considered the founder of modern day catastrophe risk modeling, has received the Review Worldwide Reinsurance Awards' Lifetime Achievement award for outstanding long-term contributions to the reinsurance industry.

New York - Insurers of all sizes hoping to take a proactive approach to cracking health claims fraud seem to understand the stakes: According to estimates from the federal government and issues-based groups such as the National Health Care Anti-Fraud Association, as much as 10% of all healthcare expenditures in the United States, or $170 billion, may be lost each year to fraud, waste and abuse. Carriers still struggling to keep up with claims fraud may also do well to recognize that there is yet another piece of ammunition available. From its research laboratories in New York, IBM has pooled data mining and analytics technologies to create a software-as-a-service product designed to identify potentially fraudulent and abusive behavior before a claim is paid, or retrospectively analyze providers' past behaviors to flag suspicious patterns. Non-profit provider Excellus Blue Cross Blue Shield in Rochester, N.Y., which counts two million members, is the latest carrier to contract with Big Blue to thwart fraud. The company will use IBM's on-demand Risk Identification Analysis Service to review pharmacy-related claims to uncover complex schemes. Some of these schemes may include collusion, inappropriate billing practices, prescription forging, prescription pad theft and members who are "doctor shopping." "Make no mistake about it-someone who knowingly commits insurance fraud is no different than any other person who steals," says Flora Allen, corporate director, special investigations unit, Excellus BlueCross BlueShield. "Fraud affects everyone's bottom line, so we aggressively and proactively pursue recoveries and convictions because we are protecting our members' premiums." Although the stakes are high for Allen and her organization, which processed somewhere between 51 and 52 million claims in 2006, there is no real way to calculate the hard and soft costs, she says. "We are only as good as what we can find," she told Insurance Networking News. "Adding the Risk Identification Analysis Service from IBM to our existing investigative arsenal improves the analytical capabilities we need to find and identify the most egregious offenders." That arsenal includes a fraud hotline, which is available to all members, and a link on the company's Web site where anyone can provide anonymous tips. The insurer also participates with law enforcement task forces, and shares that information the U.S. attorney's office. Based on IBM's Fraud and Abuse Management System (FAMS) technology, which was developed by IBM Research and consultants in collaboration with leading healthcare organizations, the Risk Identification Analysis Service uses a combination of data mining capabilities, visualization techniques and reporting tools to identify questionable behavior before a claim is paid. It replaces traditional manual processes by sorting though tens of thousands of providers and tens of millions of claims in minutes-ranking providers as to their degree of potentially fraudulent, wasteful, abusive or questionable behavior. Allen says their company does not consider whether, as a whole, fraudulent claims are on the rise or may be decreasing. "When it comes to fraud, it's an issue that always appears larger than life and we are getting better at discovering it." IBM hopes that by designing the offering as an on-demand service, it will appeal to insurers of all sizes. "By providing these powerful data mining and advanced analytical capabilities as an on-demand service, we are able to offer this investigative capability to smaller healthcare payor organizations, or government healthcare insurance entities, which may prefer to use this advanced analytic capability as a service, because of the lower demands on their staff and IT capabilities," says Mark Ramsey, global data analytics leader, IBM Center for Business Optimization. "It can also easily be used by larger, private payors looking to use this capability as a service instead of implementing the FAMS solution internally." In addition to pharmacy claims, the service can analyze approximately two dozen other specialties such as cardiology, home health care, gastroenterology and durable medical equipment suppliers. Sources: Excellus Blue Cross Blue Shield, IBM

Columbia, S.C. - BlueCross BlueShield of South Carolina plans to electronically integrate personal health records with medical care plans and make these available in real time to BlueCross members and their health care professionals.

Needham, Mass. - As the insurance industry becomes more immersed in service oriented architecture (SOA) technologies, few outside organizations are available that provide peer review, guidance and cross-industry advice. Penn National Insurance, a Harrisburg, Penn., mutual company that provides a wide range of insurance, however, seems to find such an organization. Penn is among 31 others joining the newly formed SOA Consortium since it's inception on May 1, signaling the onslaught of business organizations across vertical markets requiring SOA-related information.

The Hartford P&C Co. built a single consumer view for both its new business and its renewable policies, including a customer application that gives it instantaneous information about its customers. Its personal lines business also has been able to bring together some 30 different third-party data sources in the company and put them into one source.The Hartford's personal lines now has a single manner in which it processes motor vehicle reporting (MVR) across the entire company. The insurer built a single service that enables The Hartford to get immediate access to data across the company and work real-time with the states provided to gather MVR information. That service is now used in six different places across the firm, for everything from renewal purposes to billing purposes. Meanwhile, The Hartford's commercial lines business has made great strides in automated decisioning, improving its billing and creating new automated underwriting. The carrier's agents are now able to receive information in real time and provide quotes to commercial customers quickly.

This is the third in a series of INNovators Award Winners.

Some things change; some don't. A 2002 report from Boston-based Celent LLC, stated, at that time, within insurers' IT budgets, expenditures on internal staff consumed the lion's share, roughly 44% on average, with another 11% spent on consultants. Software licensing and support formed the next largest block, with a 20% share, followed by hardware with 15% on average. Connectivity and bandwidth consumed about 8% of budgets five years ago.What probably did not change in the five years between these findings is that CIOs' decision-making plays a big role in how these numbers come about. INN's first-ever issue in 1997 contained the article, "The New Breed of Insurance CIO," which concluded that more is being requested of the insurance company CIO than ever before. CIOs are not only being asked to have more business savvy, but also to be a communicator to senior management and an agent of technological change for the organization and its information systems.

The editorial mission statement from our 1997 inaugural issue of Insurance Networking and Data Management reflected the industry's overarching requirements: "Every issue promises you, our readers, comprehensive and credible information on the most important data access, electronic networking and electronic commerce issues that are revolutionizing the nation's insurance industry."At a time when e-commerce was dawning, IT spending on these technologies was a mandate: Carriers were charged with keeping pace in order to remain competitive.

AGENTS DEMAND REAL-TIME SERVICEIndependent insurance agencies are poised for a major service breakthrough with the proliferation of real-time transactions, says a prominent participant in the industry-wide push to double real-time transaction volume in a year.

WHETHER ON PAPER OR ONLINE, TEN YEARS LATER, THE PERSONAL TOUCH STILL MATTERS

PPS SOFTWARE SUITESkywire Software, a Frisco, Texas-based provider of software products for the insurance industry, announced the availability of a reporting tool for PPS, its policy production system for managing general agencies and wholesalers.

Over the last 20 years, the advances enabled by financial modeling are impressive. Insurers have made improvements in risk management, capital optimization, product development and other important aspects of their business with the help of financial models. The critical importance of financial models has never been more evident.Products today are increasingly complex, and the pressure to manage, measure and report risk continues to grow. As a result, models viewed as highly sophisticated just a few years ago are now inadequate to meet today's needs. However, keeping pace with these demands is becoming increasingly difficult.

How can carriers capitalize on the convergence of service-oriented architecture (SOA) and business intelligence (BI)? Insurance Networking News asked Mark Gorman, strategic research advisor, insurance, and David West, research area director, insurance, for TowerGroup Inc., Needham, Mass.INN: More and more carriers are seeing the value of SOA for BI (i.e. business intelligence services). Why? What are the drivers?