Claims

Kansas City, Mo. - The National Association of Insurance Commissioners (NAIC) warns that significant market disruptions could develop with the Federal Terrorism Risk Insurance Act's (TRIA) expiration on December 31, 2005, the law's current sunset date. The economy's current strength reflects the ability of businesses to cover affordably catastrophic terrorism risks.

El Segundo, Calif. - Ohio Mutual Insurance Group, a Bucyrus, Ohio, insurance company, has experienced a 13 percent increase in staff productivity over the previous year, thanks in part to software from Computer Sciences Corp. (CSC), El Segundo, Calif. Previously known as the Ohio Mutual Tornado, Cyclone and Windstorm Insurance Assoc., Ohio Mutual today provides auto, home, farm and business insurance. The implementation of CSC's property and casualty insurance software follows its move last year to replace its legacy system with CSC's POINT IN policy administration and claims components. The POINT IN policy administration component provides Ohio Mutual with an integrated, paperless system for rating, underwriting, reinsurance, and billing and collection. The advanced claims component automates claims assignment and tracking. The company, which writes more than $120 million in premiums each year, reports a surplus of more than $67 million. CSC reports that the carrier also achieved the largest annual net operating profit in the company's 104-year history.

San Diego, Calif. - Abovehealth, a healthcare information technology company, has founded The Dolphin Group, a "think tank" comprised of industry peers who wish to discourse on the unique problems facing IT executives in the healthcare information industry. The group held its inaugural event in Las Vegas in conjunction with last month's America's Health Insurance Plans (AHIP) Institute 2005.

Minneapolis - UnitedHealth Group will acquire Cypress, California-based Pacificare Health Systems, Inc., the company announced today. The acquisition, expected to be financed 27% in cash and 73% in shares of UnitedHealth common stock, is valued at $8.1 billion in stock and cash plus $1.1 billion in PacifiCare debt to be retired at closing. The deal would close in late 2005 or early 2006, pending approvals from federal regulators and shareholders of PacifiCare. Minneapolis-based UnitedHealth, one of the nation's largest managed-care companies, plans to expand its West Coast presence and its involvement in the Medicare market. According to Chicago-based Fitch Ratings, approximately 1.8 million, or 57% of Pacificare's 3.2 million members are located in California, which is a state where UnitedHealth has historically lacked a competitive market share. In addition, UnitedHealth will be acquiring the largest player in the Medicare Advantage program, reports Fitch. Pacificare will add approximately 720,000 Medicare Advantage members to UnitedHealth's existing Medicare Advantage membership of approximately 345,000 and will give an additional boost to UnitedHealth's plans to participate in the Medicare drug benefit beginning in 2006, says the ratings firm.

Salt Lake City - GE Healthcare, a $14 billion unit of General Electric Company that is headquartered in the United Kingdom, and Intermountain Health Care, a Salt Lake City-based integrated health care system, announced the organizations' joint project to develop a new advanced electronic medication administration record, also known as an eMAR, which will better enable collaboration among a patient's care team.

Hartford, Conn. - Personal automobile and homeowners market leaders are employing a new mix of tactics as they compete for growth, according to two new publications by Conning Research and Consulting Inc., Hartford, Conn."Personal lines market leaders are more aware now than last cycle of the price points that damage profits," said Bruce Hale, analyst at Conning Research & Consulting Inc. "Modest price cuts are common in personal automobile, while the homeowners line is showing flat to minimal rate increases in most states. These measured actions are affordable for insurers because of recent strong profits. The aggressive competition is occurring in data modeling and branding. Market leaders are outsmarting their rivals in risk selection and staking a superior position in the mind of the consumer."

New York - MetLife Inc. reports completion of its $11.8 billion acquisition of New York-based Citigroup's Travelers Life and Annuity Co. and nearly all of Citigroup's international insurance businesses. The New York carrier paid Citigroup $10.8 billion in cash and about 22.4 million of its own shares, which are valued at roughly $1 billion. Travelers Life and Annuity Co., which is based in Hartford, Conn., reported 2004 sales of $822 million. Once the deal is closed, Citigroup says it will record a $2 billion gain in the third quarter.

Two primary trends are emerging that are impacting the state of underwriting in the P&C market. The first is the drive to reduce complexity. New technology is simplifying systems and reducing the amount of manual document-handling between carriers and agents. The second trend is an increased use of data-driven decision-making for more predictable underwriting results.This is the conclusion of research conducted by TowerGroup, a Needham, Mass.-based research and advisory firm to the financial services industry.

Washington - The Terrorism Risk Insurance Act (TRIA), a temporary program introduced after the Sept. 11 terrorist attacks, has served its purpose and is probably stunting the development of the private insurance market, Treasury Secretary John Snow wrote in a letter to the Senate Banking Committee summarizing the agency's conclusions regarding TRIA.

Genworth Financial is streamlining its operations. The $103 billion company, which serves the lifestyle protection, retirement income, investment and mortgage insurance needs of more than 15 million customers, operates in 22 countries, including the U.S., Canada, Australia, the U.K. and more than a dozen other European countries.

San Mateo, Calif. - Siebel Systems Inc. is stepping up efforts to tackle the rise in fraudulent claims, the San Mateo, Calif., provider of customer-facing solutions reports. Analysts estimate that fraud in the U.S. has jumped 63 % in the past four years, and more than 25% of current U.S. insurance claims contain some element of fraud, contributing to an annual cost of at least $44 billion.

It's a great time for P&C carriers to be considering a new policy administration system, as features critical to return on investment, such as customer relationship management and data mining, become relatively standard features in these systems, according to Boston-based Celent Communications. In a report released this week designed to help insurers understand the marketplace, Celent cites additional incentives: a drop in prices, faster implementations, and more plentiful vendor options.

Jupiter, Fla. - If life and health insurers maintain their chokehold on technology spending, it shouldn't be a case of pleading poverty. Just-released figures from Weiss Ratings show that profits in that sector climbed nearly 30% last year, the second consecutive year of growth.

Oakland, Calif.-A review of hurricane trends by EQECAT Inc. shows a more than a one in three chance of large hurricane catastrophe losses in the United States in the current season, based on current forecasts by the National Hurricane Center (NHC)."Although the current season might not be as severe and unusual as the 2004 season, the potential for large losses in 2005 is likely to be troubling to insurers and reinsurers, which will have to cover the potential hurricane damage claims," says Tom Larsen, senior vice president of EQECAT.

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.

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.

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.

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.

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.