Claims

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/

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

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.

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.

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.

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.

U.S. property/casualty insurers are expected to pay homeowners and businesses an estimated $2.1 billion for insured property-loss claims from eight catastrophes in the first quarter, according to preliminary estimates by ISO's Property Claim Services (PCS) unit.

Newark, Calif.--As Florida's annual hurricane deductible law goes into effect on May 1 for the state's residential policyholders, Risk Management Solutions (RMS), the world's leading provider of products and services for the management of catastrophe risk, released the results of an analysis exploring the insurance industry impact of using the new deductible instead of a single event hurricane deductible.

COLUMBUS, Ohio--Nationwide Insurance and Washington D.C.-based ID Theft Assist are joining forces to offer ground-breaking identity theft protection and recovery service that surpasses IDtheft policies currently on the market.

MISSOULA, Mont.--RemoteScan Corporation, the makers of network connectivity software for document scanners and digital cameras, today announced the release of RemoteScan for Insurance Agents.