FINEOS Claims Summit 2013 - Daily Blog 3

Graham Newman, Product Marketing Manager, FINEOS

The second full day of the conference dawned bright and crisp here in Toronto.

FINEOS has always tried to ensure that the solutions we develop for the world’s insurance markets are tuned to real needs and will solve pressing problems and provide opportunities for claims processing that claims handlers will welcome.  Our choice of development and the planning that goes into our Product Roadmap is fully evidence based; we don’t make choices based on convenience or ease of build. To this end we not only make use of industry research but are heavily involved in producing our own.  We were very pleased to welcome Gen Re for the opening session to discuss their findings from their CustomerConnect Disability Claimant Satisfaction Research.  Drew King, Senior Vice President, Group & Specialty Reinsurance, at General Re Life Corporation told us about the on-going research they have been doing in this field which comprises a survey of disability claimants to determine their level of satisfaction, across a wide range of risk management, financial, and service related dimensions.  The results of the survey enable insurers to understand the level of satisfaction across the industry, rather than against an internally established standard.

One of the main lessons to be taken from Drew’s analysis of the evidence is that communication with claimant is absolutely vital.  Echoing much of what was said during yesterday’s speeches, Drew highlighted the complaints claimants continually voiced over lack of contact, poor information and the need to keep repeating the same information they had already supplied.  Strong evidence, yet again, that this is above all a people business and people like to understand what is happening to them and to feel they matter.  My colleague, Guy McClintock has dealt with Drew’s speech in his blog so I will leave it here except to mention Drew’s recommendation that insurers:

  • Communicate often and manage expectations
  • Remember there is no substitute for the human touch.

Our second customer case study followed with Andy Beardsall from the Manitoba Teachers’ Society bringing to the delegates the story of how they have transformed their claims operation.  MTS provides long term disability insurance for the state’s teachers.  It’s a small organisation with relatively few staff so efficiency is highly important to them.  Andy outlined the constraints their project had: mainly a tight budget and a need to go live quickly to coincide with the school year.  Their need to update their system was driven by a set of pain points: a heavy reliance on paper claim case files, a lot of manual calculations and an old system with no upgrade path.  Their goals were to achieve greater efficiency, employ fully electronic claim files and introduce new features such as being able to update medical diagnosis codes and improve reporting and invoice tracking.

Andy highlighted some key decisions that underpinned their success:

  1. A commitment to training.  They did as much as possible.  It took time but Andy felt this was fully justified.  He called it “exposure therapy”, and noted that the time that the whole team spent on training during the project meant that they were all keen to get started on the new system by the time of go-live.
  2. Customisation – they kept it to a minimum.  This not only shortened the project timelines but simplified all future upgrade paths.  Andy said they have built into their planning an upgrade every year.
  3. Using all the tools available.  They made full use of all the assistance and services FINEOS had to offer.  The training they received was first-class and Andy noted that it had been impossible to stump the FINEOS team on-site.  He also said that “the FINEOS documentation site was fantastic”, a great compliment to all the effort that has gone into it.
  4. Mid-project decision to upgrade.  Part way through the project MTS decided to upgrade to the latest version.  They had seen the new user interface and new features such as the Activity Feeds and decided they were too good to wait for.  Andy noted that this decision cost them extra time on the project – but as this was only five days it was well worth it.

Manitoba Teachers’ Society have been live for just over a month now with greatly increased efficiency and a very high level of staff satisfaction.

Predicting the Unpredictable – Who is Most Likely to Return to Work?

After the break Dr Jason Busse, Assistant Professor in the Department of Anesthesia and Department of Clinical Epidemiology & Biostatistics at McMaster University in Hamilton, Ontario shared some of his considerable expertise with the delegates on the question of: “Who is most likely to return to work?”.  Dr. Busse is a recognised expert in his field on disability management and predictors of recovery.  We firmly believe in FINEOS that given the right tools and sufficient time professional claims handlers in all fields of disability and bodily injury claims are able to make intelligent and timely interventions and provide evidence based advice that can make substantial differences to claimants’ outcomes, improving recovery times and hastening return to work and resumption of normal life.  This is a classic win-win situation: the claimant gets their life back sooner and the insurer pays out less in claims and reduces their indemnity liability.  At FINEOS we are fully committed to providing claims professionals with the right tools so they can use their expertise to maximum effect and make real differences to people’s lives.

Dr. Busse talked of how over a third of Long Term Disability claims fail to resolve within two years. Of these, many will go on to result in enormous socioeconomic costs. Researchers are attempting to identify the predictors of recovery so claims at higher risk of prolonged recovery can be identified and targeted at the earliest stage to maximise rehabilitation efforts. The research Dr. Busse has been heavily involved in reveals the importance to recovery of predictors such as patient beliefs and attitudes. He showed how developing a standardised approach to identify claims at highest risk for prolonged recovery can be a significant aid to claims handlers in targeting their skills where they will have most benefit.  This is exactly the sort of intelligence that has informed the FINEOS drive to create a working predictive analytics framework that can identify such cases.

The morning session concluded with Driving Innovation and Business Agility with PureSystems, a fascinating talk from Savio Rodrigues of IBM on the rise and expanding capabilities of cloud computing and how it and the ubiquitous Big Data and analytics are redefining client engagement.  Savio Rodrigues is Program Director of product management for PureApplication System and IBM Workload Deployer.

After lunch Eoin Kirwan, VP Product Management, gave a presentation on the new work FINEOS has been doing in the field of claims analytics.  This is a hot topic, an area that we recognise as being critical to gaining improvements in claims handling – improvements not just in efficiency, although they are of course very welcome, but in making real strides in gaining better claims outcomes and aiding recovery times.  The prize is a big one: real-time risk assessment using the predictive power of past experience to allocate the right resources at the right time for optimal claims outcomes and superior customer service.  As with all prizes worth having it’s not always easy, you don’t just sign up for it and very few insurers or schemes have managed to win it.

All that is set to change though and become a lot easier.  Eoin described our new Predictive Analytics module that simplifies the whole deal and makes it easy for our clients’ claims operations to become analytics-driven and realise the benefits inherent in such a business model.

Steve Dorn, Senior VP in the Strategic Product Group gave a talk on FINEOS Viewpoints: A Next Generation Service Model Framework.  There is a significant trend in many areas of commerce now towards some form of a distributed processing model, where tasks that would once have all been done in-house are now opened up to various stakeholders in the process, from customers to third party service providers and employers.  The Claims process is an ideal activity to benefit from such an opening up.  There are several participants – in disability claims there may be many participants, and each has a vested interest in the same outcome, that is, a rapid and successful return to health and to work.  The typical claims operation will depend for all activities on the claims handlers, all activity has to go through them and all system updates are their responsibility.  This makes them a bottleneck in the process and many claims departments spend an inordinate amount of time simply answering queries from outside about a claim’s progress or status.

This is an area in which claims operations stand to gain much and FINEOS has developed its Viewpoints for various stakeholders such as claimants and employers that allow the workload to be distributed naturally to those participants who stand to gain most from active involvement.  Steve talked about how this is a critical element of any claims operation’s planning and explained the market vision and scope of Viewpoints.

We then had a new type of session we had not used before in the FINEOS Claims Summits.  The ‘Birds of a Feather’ session, (Birds of a feather flock together – geddit?), was an organised networking session with set topics and the facility to sign up for different focus groups.  This proved to be a busy and productive session and talking to several clients afterwards it was felt to be extremely useful allowing a number of important topics to get an airing and have questions answered and suggestions considered.

The afternoon concluded with the invitation-only Customer Advisory Groups, one for North American clients and one for Government clients.  These are customer groups, run by the customers and for the customers.  FINEOS facilitates the venues but FINEOS staff only attend by invitation from the groups themselves.

The evening was something of a celebration.  2013 is the 20th anniversary of FINEOS and therefore a significant milestone in our history.  FINEOS hosted a celebration dinner for our clients at Malaparte in the Tiff Bell Lightbox in Toronto.  This was a special occasion for FINEOS and we believe for our clients as well, many have been with for a long time and we are pleased to welcome new clients this year to a growing and successful claims community.

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