InDUSTRy SPEAkS
Q
CLAIMSA&
What types of technologies and tools are insurers using to improve fraud detection?
A claims administration system such as FINEOS Claims provides a powerful tool in the fight against insurance fraud just
by virtue of strong business rules capabilities. Certain defined characteristics in a claim can create a warning that a claim
merits additional investigation, thus reducing the chance of a human failure to recognize fraud potential.
Predictive Analytics is a tool which is taking claims handling to new heights and fraud is one of the first areas in claims
to gain broad acceptance. A predictive tool can read multiple demographic, injury, historical, occupational and accident
factors in a very sophisticated way to create an accurate score.
Predictive Analytics in conjunction with business rules can trigger notification to the Special Investigation Unit (SIU) and drive
certain tasks, actions, and notifications to ensure timely action at the inception of the investigation and greatly improve not
only the recognition of an issue but effective resolution as well by ensuring actions occur before ‘the trail gets cold’.
How can insurers best take advantage of Web-based technologies to improve claims processing?
Where will they see the greatest ROI?
A good example of this is when insurers give their customers greater access to the claims process via Claimant Portals.
For example, FINEOS Claimant Portal:
• Provides automated online claim submission, reducing
manual effort
• Reduces paper submission of claims and other information
• Offers more innovative claimant interaction
• Improves turnaround times and reduces the possibility
of errors by applying instant validation for new claims
• Provides a single view of existing claim and
payment information
• Allows you to tailor the application to meet the specific
needs of your organization and your customers
• Improves agility by allowing you to modify initial claim
validations centrally
• Allows constant access to services removing the
restriction of call center hours
• Provides greater customer satisfaction by enabling them
to access and co-manage information
£
Randall Day
Head of Claims Solutions,
FINEOS Corporation
What is being done to improve the accuracy and timeliness of claims reporting?
In order for carriers to become more efficient with claims they need immediate access to claims information from FNOL
to claim closing. This data needs to be accurate and reported to all parties in a timely and accurate manner. Through
modern technology advancements, carriers can now run real time reports and get current data within their technology
infrastructure. Ad hoc reports that used to take hours to create and distribute can now be created in real time. Rules
engine type validations help to insure that the data entered is valid and that the system captures the data that is
required to create the necessary reports. By configuring data capture for specific lines of business, states, and user
types, carriers are able to capture better data which results in more accurate reporting. Modern web based technology is
improving the speed and accuracy of claims reporting by providing agents and consumers with the ability to submit FNOL
to carrier adjusters and claims handlers. The ability for customers, third parties, and internal users to interact in a rapid
and precise claims process improves overall customer satisfaction, profitability and retention. £
Tom Westhoff
National Sales Manager,
Insuresoft
How can BI projects be improved to ensure completion and ROI?
BI implementations can be complex and may require working with a partner or team that understands the scope and
business requirements of the carrier. Successfully completing a BI project will require the organization to agree with the
scope and work cohesively to deliver the solution. When evaluating the BI project, it is imperative that the carrier pays close
attention to the quality of the data to ensure the intelligence they are looking to attain is valuable. The solutions initial
scope should be to deliver on the problems that are currently facing the carrier today. Being able to quickly implement a
solution that targets the key issues concerning an insurance carrier’s existing limitations will result in immediate positive
impact on ROI. As the market and carriers needs change, the solution, in order to be successful, must be flexible enough
to allow the carrier to make modifications to the BI solution in order to quickly gain access to the information they need
without relying heavily on IT. In a competitive market, insurance carriers rely on accurate information about their business
which enables them to conduct business smarter and remain ahead of the competition.
