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Vive La Difference

Eoin Kirwan, VP Product Management, FINEOS

It is the sharing of knowledge and experience with other practitioners of claims management from different sectors and geographies that makes events such as the FINEOS Claims Global Summit so important.

This year, I noted a lot of collaboration between the government and the private sector camps in particular.  These groups don’t often have the opportunity to interact in this way, moving as they do, in different industry circles, attending different events and even speaking somewhat different languages!  Our FINEOS community brings them together in a unique way.

Each claims operation has its own distinct culture and practices.  There are evident similarities too, such as in the incidents and events covered, the compensation categories and the fact that they work with the same health sector service providers.  It is the subtle differences in emphasis that provide a great opportunity for collaborative learning and improvement.

The government ethos of societal good, welfare and fairness has, in some institutions, fostered a managed care culture, centred on the claimant as a person and their rehabilitation needs.  Some private insurers, on the other hand, have traditionally taken a more detached view, minimising costs while paying the contracted benefits until the claimant is healthy or back at work.

In our FINEOS Claims product, we make it a priority to capture best practice capabilities from all points on the spectrum and can point to some really tangible examples of sharing successes:

  • To help optimise outcomes for the claimant, we have added a powerful Rehab Planning module that captures socio-economic information about the claimant, then tracks the phases, goals and milestones along the road to the claimant’s recovery.  It co-ordinates the activities of all contributors, including the external service providers but also the claimant himself or herself, who can access and update their Rehab Plan online via tailored screens in the FINEOS Claimant Viewpoint.
  • To deliver efficiency gains we have added features such as an extensive Automated Calculations module and the “single cockpit view” that removes the need for the claims examiner to interact with disparate systems and a “shadow IT” to get their job done.

What has been most interesting recently is the growing level of cross-over interest:

  • Subject to the political cycle, all government schemes are experiencing a renewed focus on scheme viability, liability reduction and cost containment.  Value for tax-payer dollars.
  • Private insurers  are increasingly persuaded of the bottom-line rewards of smart intervention and proactive case management.  Invest early to save later.

We see ourselves as collaborators on the front lines with clients, looking for innovative thinking and ideas which can be enhanced by sharing ideas so that everybody can work better and smarter.

There is no one-size-fits-all and practical insights and ideas coming from several markets, even unrelated industries, can combine and deliver faster processing, better outcomes, lower cost and better service to the people impacted by loss.