Claims

What do Carriers Need to Increase Market Share?

TOOL HELPS EMPLOYEES MANAGE THEIR BENEFITSPlanAdvisor, a benefits management tool from Milwaukee-based Zywave Inc., features a Plan Selector module to enable employees to review their own health costs. PlanAdvisor generates management reports without carrier data feeds, analyzes the effects of changes in the plan design and calculates projected plan costs, based on trend and claims information. It also offers benchmarking, modeling, and analysis to allow brokers to deliver information based on industry comparison data and actuarial factors, which can help clients make informed decisions.

Chinese insurance companies were bracing for an onslaught by global competitors last month when a commitment to the World Trade Organization dictated opening the borders to foreign competition."Almost all insurance business is opening to foreign insurers," says Xiaolin Li, a dean at Beijing-based Central University of Finance and Economics. "The exceptions are group insurance and life insurance, which requires a foreign insurance company to set up a joint venture with a local partner."

CAPITOL SELECTS STG BILLING SYSTEMMiddleton, Wis.-based Capitol Insurance Cos. chose Renaissance Billing Solution from New York-based Systems Task Group International Ltd.'s (STG) to support billing and accounts receivable operations. The system will replace Capitol's existing billing systems and will enable the consolidation, centralization and the streamlining of Capitol's cash management and accounting operations. It will provide Capitol with advanced technology support, flexibility and configurability.

The ability to launch products in record time and manage them over their entire lifecycle gives insurers a decisive advantage over competitors that can translate into increased revenue and above-average growth.So, how do insurers realize those benefits? They can begin by using "best practices" in three areas: organization, process and technology.

Boston - As helpful as technology can be, insurers are not immune to technology glitches. One such case, as reported by The Boston Globe, hit Blue Cross Blue Shield of Massachusetts. The Boston-based insurer found itself sending out automated phone calls to Massachusetts senior citizens with Medicare drug benefits, asking them to repay up to $1,400 because the monthly premium automatic deduction from their Social Security checks failed to work.In March, The Tampa Tribune reported that hundreds of thousands of seniors received inaccurate Social Security payments because of problems with Medicare Part D drug coverage premiums, according to The Boston Globe. Most were overpaid because the premiums were not being deducted. Others received accidental refunds that averaged $215 and were asked to return the money.

Boston - Senior insurance IT executives are increasingly focusing on strategic spending to meet market demands and showing some concern over a softening property/casualty market, according to Celent LLC's new report, "Insurance CIO/CTO Pressures, Priorities, Projects, and Plans for 2007 Survey Results.""There is continued focus on meeting market demands for speed to market and ease of doing business, and on new projects involving core systems, data mastery, and distribution," says Matthew Josefowicz, manager of Celent's insurance group and author of the report. "Budgets and staffs are generally flat or growing modestly, but strategic investments continue. However, there are some indications that large property/casualty insurers may be keeping their powder dry until they can gauge the impact of the softening market."

Hartford, Conn. - Claims effectiveness is fast becoming a differentiating competitive feature among property/casualty companies as new measurement and process controls change the way claims are quantified, according to a new study by Hartford, Conn.-based Conning Research & Consulting Inc.The study, "Property-Casualty Claims Management: Unlocking Value" is based on a survey of senior property/casualty claims executives and on statutory data analysis. It examines changes in the insurance environment, and particularly in claims, including technology, staffing, outsourcing, regulatory and catastrophe issues.

Needham, Mass. - In 2007 and beyond, the global financial services industry will increasingly grapple with three major strategic shifts: reinventing financial services at its core; repurposing financial services relative to the global diversity of a changing customer base; and helping restore confidence in an uncertain world, according to a series of research reports from Needham, Mass.-based TowerGroup.The reports examine the top business drivers, strategic responses and technology priorities that will fuel core sectors of the global financial service industry in 2007.

Washington - The U.S. Department of Justice recovered a record $3.1 billion in fraudulent claims in fiscal 2006, with 72 percent of the recoveries in health care. A single hospital chain, Dallas-based Tenet Healthcare Corp., paid back $920 million in one of the year’s largest settlements with the federal government, according to the Justice Department.

Philadelphia - With a focus on customer service, Philadelphia Insurance Companies launched a new corporate Internet site, www.phly.com. The Philadelphia company, which designs, markets and underwrites specialty commercial and personal property and casualty insurance products for select target industries or niches including nonprofit organizations; the health, fitness and wellness industry; select classes of professional liability; the rental car industry and more, says the new Web site will provide self-service functionality to all agents and policyholders. The project quickly evolved into an Internet "program," reports the company. The creation of a program provides the framework to efficiently and strategically prioritize and bundle enhancements that will ensure alignment with business goals. The new Philadelphia Insurance Web site is designed to make doing business easier for a select group of "preferred agents" and a broader network of independent agents, which consists of 38 regional and field offices across the United States. The new site includes enhanced menu navigation, and updated search functionality. Also enhanced is the site's login authentication, now featuring one login per agent or customer. Visitors to the site can browse policies, view claims, invoices, active lists, quotes, and auto ID cards. The carrier also added an online payments feature. The project goals included an aggressive timeline, and the carrier's IT department and automated services division (project management/business requirements group) collaborated using in-house tools to manage information. The ultimate goal, says a company representative, is to provide feedback capabilities that enable a two-day response to any incoming question. Source: Philadelphia Insurance Companies

Cincinnati - A technology overhaul is continuing at Cincinnati-based Great American Insurance Co. with the decision to replace the company’s policy and customer system of record.

Sydney, Australia - Insurance Australia Group Ltd. (IAG), announced its intention to make its global operations carbon neutral within five years."As an insurance company we have been very concerned about the risks and impact of climate change on our community for a number of years," says Mike Hawker, IAG's CEO. "We have been working on ways to reduce our own CO2 emission footprint, alerting the community about the risks of climate change, and researching opportunities for our customers to benefit from CO2 reducing activities. We are furthering our efforts, by announcing our intention to be carbon neutral within the next five years."

El Segundo, Calif., - Insurers feel the need to develop original approaches to attracting and retaining customer in various market segments. During a two-day conference hosted by Computer Sciences Corp. (CSC), a few insurers gave examples of these approaches.Panelists at the conference noted that insurance marketing programs must appeal to three distinct generational groups: Generation Y (ages 18-29), Generation X (ages 30-40) and baby boomers (ages 41-59). Each group has distinct demands for service; therefore, insurers must offer different Web-based services that address their consumers' varying levels of comfort with technology.

Hartford, Conn. - Aetna Inc. is offering an interactive voice response (IVR) system called Voice2Form to enable members with both Aetna disability and medical insurance to provide consent to participate in the insurer's Integrated Health and Disability (IHD) program. Aetna's integrated informatics studies show that the IHD program may reduce short-term disability durations by as much as 10.7% or 5.6 days per claim.

Orlando - The latest release of ISO HomeValue, a residential replacement cost estimator, now allows personal lines insurers to assess catastrophe risk for individual properties using Boston-based AIR Worldwide Corp.'s (AIR) industry standard catastrophe models. The goal, says the companies, is to provide access to essential catastrophe risk data from a single web-based application, ISO HomeValue enables improved underwriting decisions. "After the large hurricane losses of 2004 and 2005, companies were reminded of the importance of assessing a property's catastrophe risk as part of the underwriting process," says George Davis, vice president at AIR. "However, most personal lines insurers have historically had very limited and inefficient ways to assess the catastrophe risk for individual properties. Now, ISO HomeValue provides residential underwriters with immediate catastrophe risk information at the individual property level in a seamless manner." By accessing AIR's catastrophe models from within ISO HomeValue, underwriters can generate real-time estimates of catastrophe risk, as characterized by the estimated average annual loss. Insurers can use this assessment of the catastrophe risk to automate, for example, simple issue/decline decisions, rating plan selection, and price adjustment under consent-to-rate procedures. ISO HomeValue captures a variety of property characteristics necessary for catastrophe modeling, including location, construction, building type, and year built. Additional property characteristics that may mitigate damage-such as storm shutters for hurricane risk-can also be entered to assess rate credits for such structures. In many cases, basic property data can be automatically pre-filled using the ISO PushPin database. ISO PushPin contains specific and detailed data on key building features for more than 50 million residential properties in the United States. Agents, underwriters, and inspectors can enter additional property information into ISO HomeValue to enhance the completeness of the data. "By employing ISO HomeValue to gather and maintain high quality property data, insurers can obtain more reliable estimates of an individual property's catastrophe loss potential, in addition to its replacement cost," continued Mr. Davis. Source: AIR Worldwide Corp.

New York - More than three-quarters (77%) of life insurance CFOs cite the growing level and complexity of regulations as their biggest concern for the market and economic environment in 2007, according to the latest CFO survey from the New York-based Tillinghast business of Towers Perrin. Interest rates were a close second, with 70% of respondents citing concerns about potential volatility in rates as a key challenge.

Minneapolis - Thanks to the combination of rules-based management and mobile healthcare technologies, patients with long-term health conditions may be on the road to a faster recovery based on receiving early detection, continuous remote care, prediction of care demands, and quality of life improvement.Swedish technology company Kiwok AB is integrating Blaze Advisor business rules management technology from Fair Isaac Corp., a Minneapolis provider of analytics and decision management technologies, to enable intelligent out-of-hospital monitoring of patients via Kiwok's mobile healthcare monitoring network.

Springfield, Mass. - Massachusetts Mutual Life Insurance Company (MassMutual), Springfield, Mass., is setting a best practice example that may not have a technology angle or result in increased premium revenue, but it has a long-term business benefit just the same. The company is bringing its LifeBridge Free Life Insurance Program to the Tucson, Arizona area. MassMutual's LifeBridge is a national philanthropic program in which the company issues 10-year term life insurance policies to eligible working parents to help pay for the cost of their children's education in the event they die. Through LifeBridge, $50,000 life insurance policies are issued to a trust on the life of qualifying parents or legal guardians to help pay for the education of their eligible children who -- in the event of a parent's death during the policy's term -- may not be able to afford to complete their schooling. All premiums are paid entirely by MassMutual, with no fees for qualified parents or their children. MassMutual has provided more than 5,800 10-year term life insurance policies since launching the now popular LifeBridge program in 2002, representing more than $290 million in free life insurance coverage. Louise Orozco, CLU, of Generational Wealth Strategies, LLC, a MassMutual Agent based in Tucson, teamed up with the Women's Foundation of Southern Arizona to offer the LifeBridge Program to eligible families. "We are extremely excited to bring LifeBridge to the Tucson area," says Louise Orozco. "We want to help ensure that access to educational opportunities exists for children of working families and not just those who are lucky enough to have parents with adequate financial means. There is absolutely no cost to the insured for a policy under the LifeBridge program." To be eligible to apply for a term life insurance policy under the LifeBridge program, applicants must be: * Between the ages of 19-42; * A permanent, legal U.S. resident; * The parent or legal guardian of one or more dependent children under the age of 18; * Currently employed -- either full- or part-time -- and have a family income between $10,000 and $40,000 on their most recent income tax return; * The only family member who has applied for the LifeBridge program; and * In good health, as determined by MassMutual's underwriting guidelines. The money will be paid to a trust administered by The MassMutual Trust Company, FSB on behalf of the children. The trust will pay the educational expenses of the children directly to the educational institution they attend. Various types of schools qualify, including, but not limited to, pre- school, private school, vocational school, community college, universities, art and music schools or graduate schools. Some of the educational expenses covered include books, tuition, and room and board. Source: MassMutual

Phoenix – Six of every 10 Arizona school principals believe their students don’t get enough exercise, but help has arrived from Blue Cross Blue Shield of Arizona (BCBSAZ).