Policy adminstration

Humana needed to replace its outdated billing system that relied mostly on paper and snail mail. Today Humana offers its employer-group customers an easy-to-use e-billing alternative that's available in real-time on the Internet.Back in 1999, Humana Inc. began to implement a wide-ranging e-business strategy that would include customer self-service features across its spectrum of business lines.

At the recent ACORD technology conference, keynote speaker Larry Downes offered a theory that information technology spending shouldn't be curtailed just because operating conditions are poor.Downes, a technology strategist, noted that technology should not be perceived "as an obstacle within a business," adding that insurers "can't save their way to success" by scaling back on IT investments.

As legacy applications move through their life cycle, they frequently evolve from assets that manage key processes and information to liabilities that drain time and resources. As a result, these applications become increasingly more difficult to maintain.At the point when an organization's legacy assets no longer serve its goals for financial management, customer intimacy, regulatory compliance, and operational effectiveness, management must decide whether to rebuild key systems, replace them with third-party applications, or modernize aging applications to extend their useful life.

Michael Galvin knows more about disaster recovery and business continuity than most of us care to know. That's because the vice president and chief infrastructure officer of Empire Blue Cross and Blue Shield has first-hand experience with the worst catastrophe this country has ever endured: September 11, 2001.The New York-based health insurance company occupied 10 floors and 480,000 square feet in the North Tower of the World Trade Center. And, although the company tragically lost 11 people that day and several employees were injured, most of the 1,900 employees and consultants escaped from the building unharmed.

The mere mention of a data warehouse has often caused even the most unflappable insurance carrier executive to break out into a cold sweat.In recent years, the failure rate of data warehousing projects in the insurance industry has been a dubious distinction, owed in no small part to insurers' inability to effectively plan and execute such projects. Considered "data rich yet information poor," insurers have struggled to create data warehouses that can truly tap into the power of their customer data.

Using Global Positioning Satellite (GPS) and cellular communications technology to gather information about when and where a motorist is driving, United Kingdom-based insurer Norwich Union is launching a pilot study this summer that could play a role in transforming the way auto insurers underwrite policies.Called "Pay As You Drive," the two-year study will involve retrofitting the cars of 5,000 Norwich Union policyholders with a "black box" that will gather and transmit vehicle and driving data to the insurer's back-end systems. Norwich Union statisticians will then analyze the data to determine which variables affect risk and claims, and those results will be used to calculate usage-based premiums.

At this time of economic and operational uncertainty, many global insurers are scurrying to identify-and then rectify-vulnerable components of their operations.In April, executives at Boston-based John Hancock Financial Services Inc. believe they made a key decision to help restore stability to the operation when the carrier inked a multi-year agreement to implement IBM Corp.'s e-business on-demand solution.

Already on the defensive about the use of credit scores for underwriting, property/casualty insurers now face another assault on one of their prime data tools in the nation's largest market for homeowners insurance.In late April, California Insurance Commissioner John Garamendi all but banned carriers' use of the main data source to underwrite and rate homeowners insurance policy. For 11 years, the Comprehensive Loss Underwriting Exchange (CLUE) has tracked claims on properties and property owners supplied by carriers of the nation's homeowners insurance policies.

Balboa Insurance Group Inc. needed to integrate its legacy-based customer data with an enterprisewide CRM system. Executives considered a costly systems conversion project, but opted for a middleware solution instead.Balboa Insurance Group Inc. faced a modern-day information technology conundrum. It had critical customer information locked away in its siloed host applications and couldn't get it out to support new Web-enabled business processes.

When insurers examine business intelligence systems, industry observers say, data warehousing capabilities sit at the forefront of the effort."When it came to data warehousing, most insurers saw it as massive projects driven by IT and not business," says Matthew Josefowicz, senior analyst at Celent Communications Inc., Boston.

The task of turning data into an operational asset rather than a liability can be a complicated process. Sometimes it's the simple and common themes that resonate best in times of uncertainty.The concept "less is more" is regarded as a driving principle to developing a data warehouse for the purpose of enhancing a business intelligence strategy. "Building a huge data warehouse does not work if the idea is to obtain an enterprise-wide, 360-degree view of customers," says Bill Sinn, vice president, insurance healthcare marketing for Dayton, Ohio-based Teradata Corp., a provider of enterprise data warehouse solutions. "The question of 'how do you eat an elephant' certainly applies in this instance. The way you eat an elephant is, of course, one bite at a time."

An increasing number of carriers are taking advantage of the cost savings of software development using geographically disparate teams, including those located offshore. And with good reason: the economic benefits of doing so can be exceptional.Most approaches to outsourced development are best-suited for traditional maintenance and system evolution projects in which requirements are static and well-documented. From my experience, these projects can run largely on autopilot and don't require a lot of structure and management time.

We are living in interesting times. The U.S. insurance industry is in a state of transformation as the competitive landscape changes. This transformation presents a significant upside market opportunity for insurance companies.The industry is very mature, has rich customer information, established distribution channels, favorable product positioning, and years of sound business practices and solid investment reputation.

Let's face it. During an economic downturn, every dollar earned, spent or saved seems to carry more weight than it does when the economy is growing. With more financial pressure on carriers these days, IT departments are under more scrutiny to rationalize projects and expenditures.Rationalization translates into greater discipline in measuring and managing the costs of IT hardware, software and projects-and the desire to get a more comprehensive, enterprisewide picture of those assets.

The potential savings for agents and carriers using real-time interfaces amounts to thousands of hours-and dollars-each day.A billing inquiry initiated through an agency management system takes two minutes, whereas the same inquiry takes eight minutes by phone, and nine minutes by carrier Web site. Those are the results of an agency workflow study conducted last year by Applied Systems Client Network (ASCnet), the user group for Applied Systems Inc., University Park, Ill.

Everyone knows the numbers by heart: Insurance fraud costs property/casualty carriers an estimated $27 billion each year, or roughly 10% of premiums collected.The tricky part is detecting fraud so that some of those losses can be redirected to the bottom line. In the world of auto repair, fraud rears its head higher during dicey economic times like now when folks are hurting for money.

Fraud can be subtle and complex. It can be hidden among voluminous amounts of data. New schemes are always emerging. Insurers understand the impact of fraud and consider it a serious problem.Fraud management technology that uses predictive modeling to identify suspicious claims can accurately cull out high-risk claims and label them at the earliest possible moment. It not only makes it practical for insurers to process and close the vast majority of claims faster, it focuses the adjusters review on claims that require the most attention. Lastly, it provides higher quality referrals to investigative units.

The quiet catastrophe of insurance fraud is gaining more attention as insurance executives continue to look to operational efficiencies-rather than investment income-to protect their bottom lines.With the Coalition Against Insurance Fraud (CAIF) estimating an annual fraud cost of $80 billion dollars, the industry has realized that the harmless fudging of a million here and a million there is adding up to real money.

As a direct writer of homeowners and automobile insurance, Electric Insurance Co. doesn't rely on a network of independent agents to regularly interact with policyholders.Instead, Electric's call center agents interact with customers for everything from delinquent premium payments to claims-related inquiries. While this arrangement often suffices, CSRs typically lack the customer relationship skills that local agents have.

At Cincinnati Equitable, Web services have opened up new avenues of connectivity. Agents can now access rating applications housed within the Cincinnati-based carrier's Windows-based servers to look up territory and verify policy status.This is not remarkable news, since agent portal Web sites have been around for years. What is remarkable is the fact that this new application took two hours to set up and deploy-a process that usually took several weeks, according to Terry Brown, vice president of information systems for Cincinnati Equitable Insurance Co.