Claims

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.

For insurers, handling claims is not only costly in terms of paying for damages, it ultimately can cost them customers: A poor claims experience will motivate angry policyholders to switch carriers.Processing paper-based claims creates bottlenecks that prevent effective communication between the affiliates in the claims value chain, a condition that inflates claims cycle time and impairs customer relations. As business leaders of claims departments huddle with their information technology counterparts, automating claims to more effectively assign, manage and close claims files has become the order of the day.

From the highest executive to the lowest-level associate, business people in corporate America are creatures of habit-often to a fault.Take paper processing. The reliance on paper documents might represent a drag on day-to-day workflow, but to business people accustomed to traditional processing methods, paper provides a comfort zone-inefficiencies and all.

When executives for MetLife Retirement & Savings were considering how to make retirement planning easier for customers to understand, Chris McCloy decided to take matters into his own hands.In late 2004, the New York-based insurer had its eye on technology developed by San Francisco-based Macro-media Inc. Using Macromedia's Breeze technology, MetLife could offer plan sponsors and their employees customizable, online multi-media presentations-supported by Flash Player and delivered in a high-impact PowerPoint presentation.

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 .

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.

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/