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Insurance

Insurance. Bhuvanalakshmanan Ramanathan WW Industry Technology Strategist - Insurance Microsoft Corporation. Claims Servicing Solution. Agenda. Claims Servicing overview Analysts review Claims Servicing architecture Claims Servicing – closer look First Notice of Loss

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Insurance

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  1. Insurance Bhuvanalakshmanan Ramanathan WW Industry Technology Strategist - Insurance Microsoft Corporation

  2. Claims Servicing Solution

  3. Agenda • Claims Servicing overview • Analysts review • Claims Servicing architecture • Claims Servicing – closer look • First Notice of Loss • Rules, tasks and workflows • Microsoft IVC and partner solutions

  4. Claims ServicingSimple 3 Step Process Overview 2 3 1 • Claims • Workflow • Settlement • First Notice • Of Loss • Collaboration Claims Servicing represents a major opportunity for insurers to improve profitability and achieve meaningful differentiation

  5. Claims focus

  6. Solution support • First notice of loss (FNOL) functionality • Collaboration, workflow, automation • Rules engine integration • Business intelligence • Claims performance • Adjuster performance • Predictive analytics • Web access • Others: • Feedback into underwriting • Fraud detection • Litigation support • Subrogation

  7. Buy vs. Build • Buy examples • Accenture Claims Components • CSC Advanced Claims • Hyland Onbase • Injury Sciences • Insurity • K2 • Moore Stephens • Process Claims • Towers Perrin • Salentica • Symbility • Build components • SharePoint for collaboration & workflow • SharePoint + PerformancePoint for BI presentation layer • Dynamics CRM for claims processing + BI • Silverlight for Web 2.0 claims front-end • Unified Communications for collaboration • CCF for call center • Windows Phone 7 for mobile claims applications

  8. Business & technology needs Business Technology

  9. Technology trends

  10. Importance of claims efficiency • Streamlining and improving claims processes: Claims processes are often disconnected, paper-based, manual and error-prone. • Reducing the costs of claims:Claims costs continue to rise, including the costs associated with claims personnel. • Improving customer satisfaction: Quality of claims handling continues to be a problem and challenges strategies targeted at improving customer experiences and settlement. • Controlling losses and leakage: most P&C insurers face both losses and leakage, such as fraud and inefficiencies due to inadequate processes, inaccessible data and the inability to build strong models to detect and analyze data.

  11. Importance of customer service Trends to Watch: Insurance TechnologyTop priorities and technologies for insurers “Consumers’ reliance on the Internet has outpaced the industry’s investment into the channel. … a great number of customers would prefer using online resources to execute simple tasks, such as changing an address or tracking a claim. Insurers, however, have not adapted.” “89% of the CIOs said they had adopted at least one of six prominent Web 2.0 tools - blogs, wikis, podcasts, RSS, social networking, and content tagging - and a remarkable 35% said they were already using all six of the tools.

  12. Claims workflow

  13. Conceptual architecture Client Applications AMS Internet Portal Call Center Claims workstation Reporting System ACORD XML Messages IVC Software Factory for ACORD Claims Services Portal Frameworks Payments Architecture Services Logging FNOL Claims Specific XML Messages Performance mgmt. Valuation /Pricing Caching Platform Services Activity Mgmt Lookup Reporting Fraud Evaluation Search Security Geo Mapping Services Adjuster Assignment Adjudication Subrogation Lookup Codes Content/Records mgmt Exception Mgmt Workflow Email Services Claims Specific XML Messages Service Bus/Services Layer Data Services Partners Reporting/ Actuarial DW Claims Database Finance Policy CRM

  14. Logical architecture Client Services Monitoring and Management Message Translation Services Portal Services Architecture Services Platform Services Claims Components Services Service Bus/Services Layer Data Services

  15. Claims workflow: Msft alignment • With Microsoft Silverlight, Insurers can build a more intuitive UI, which in turn can enable true customer self service. Things like address changes, uploading photos or files and claims tracking can all be handled via the web. • Microsoft Office SharePoint Server serves as a central repository for documents related to the Claim and with it’s built in workflow capabilities assigns tasks to relevant parties. It can also take information from the customer via a multiple sources and store it centrally. This includes e-forms, email, office documents and other rich content like pictures or scanned in documents. • Microsoft BizTalk Server’s adapter framework and host integration capabilities can integrate disparate systems to allow STP workflows to be processed without manual intervention. • Microsoft Dynamics CRM gives Insurers a single view of the customer via Outlook while Microsoft’s Customer Care Framework can tie together the legacy systems into one interface giving the agents and CSR’s a single tool to access all systems. • Microsoft’s Business Intelligence suite of products is a complete data-mining platform to probe into vast amounts of data and extract the salient points for rapid business decision-making and action. This allows you to gain real-time visibility of your entire claims process function at the system, operational and overall business levels.

  16. Simplified communications • Click to Communicate within Applications • Find the right person at the right time with “Presence” • Transition seamlessly between email, IM, voice, and video conversations • Deliver email/voicemail/fax into a single inbox with unified messaging • Extend LOB applications with integrated presence “Anywhere access” from Mobile Devices • Use a familiar Outlook experience on mobile devices (Exchange ActiveSync, OWA, OVA) • Provide “VPN-less” access to e-mail, IM and SharePoint Enhance Collaboration with Conferencing • Collaborate with audio/video/web conferencing from within Office • Bring together geographically dispersed teams • “With presence awareness, I don’t have to call someone five times just to see if he is there. This is a huge benefit. Companies often underestimate how much time is lost in trying to initiate communications.” • Infineon - Ralf Kohl, Director of Information Technology

  17. BI suite of products DELIVERY 4 COLLABORATION CONTENT MANAGEMENT Collaboration SharePoint Server SEARCH Reports Dashboards Excel Workbooks Analytic Views Scorecards Plans END USER TOOLS & PERFORMANCE MANAGEMENT APPS Dynamics Duet ISV OBAs Custom OBAs Apps 3 Claims Visibility Excel PerformancePoint Server Optimization BI PLATFORM SQL Server Reporting Services SQL Server Analysis Services 2 SQL Server DBMS Policy & Claims Information SQL Server Integration Services BIZTALK SERVER Business Process Automation Business Process Management 1 Data (Structured /Unstructured)

  18. First Notice of Loss

  19. Silverlight for FNOL

  20. Claims workflow

  21. Analysts on workflow TowerGroup By Karen Pauli, Senior Analyst US Property and Casualty Insurance Agents: A View from the Trenches “Attracting new insurance agents is a high priority for the associations that represent and support the agents. . . Technology is woven into the fabric of daily life for those under the age of 40. Independent insurance agencies must be able to provide that same level of technology to support workflow processes or risk losing the bright, enthusiastic workers to banks or brokerage firms that have the latest technology.” by Jean-Pierre Garbani, Tech Horizons: Sizing The Emerging Market For IT Process Automation Software “While IT process automation is by itself a significant moneymaker, it also presents the advantage, from a product standpoint, of pulling point solutions together, simplifying integration between silos, and creating a synergy between disparate solutions. Because it will bring strong upselling opportunities, IT management software strategists should consider acquiring or developing an IT process automation technology.”

  22. Enterprise search products Entry-levelSolution Infrastructure Solution High-endSolution Enterprise search tightly integrated with a business productivity infrastructure Best-in-class enterprise search for the most demanding applications Enterprise search available as a free download

  23. CSC – Advanced Claims • Web-based UI • FNOL • Claims query • Reporting component • Primary coverage verification • Solution attributes • Flexible claims handling process with electronic files • Document adjusters' analysis of coverage application, liability and damages exposure • Attach and manage multimedia documents • Control workflow with manual and automated diary process • Establish and modify reserves and generate payments • Manage claims data • Define access, reserve and payment authority by individual user or user group • Analyze data for trends in policy/claim activity • Implement company-defined best practices • Create standard and customized reports easily to provide underwriters, as well as senior management, with critical claims data • Technology • Features DNAFs-based architecture using COM object program architecture (supported by Microsoft Visual Studio 6.0) • Supports system extensibility through all tiers • SQL Server database • Supports electronic data interchange (EDI) for first report of injury (FROI) • Browser-enabled FNOL/FROI enables easy claims reporting by agents and customers • Fully integrated with Microsoft Office to support generation of forms, extraction of data and integration to e-mail.

  24. Insurity– Claims Decisions • Rules-based, integrated design helps adjudicate and communicate through claims process: • Initial claims input • End-to-end workflow • ACORD information • Coverage verification • Diary and note system • Adjuster integration • Medical bill review & case management • Real-time reporting • Litigation management • Auditing • Regulatory compliance • Rapid time to market for new products • Technology • Microsoft SQL Server • Microsoft SQL Server Reporting Services • Microsoft .NET

  25. Hyland OnBase • Provides all necessary information to process a claim and handle exceptions in one place at one time - and often automatically. • Fight fraud • Handle exceptions • Ensure consistent claims handling • Provide instant  access to the right documents  • Know instantly what documents are missing • Take advantage of information in existing claims application • Technology • Microsoft Office SharePoint Server • Microsoft’s IIS Web Server • ASP.NET • SQL Server database

  26. Injury Sciences • Engineering- and science-based claim technology (WrExpert) for the objective evaluation of: • Accident causation • Injury causation • Integrator of OEM “black box” data into claims technologies and related processes • Near term implications • Casualty claims • Liability evaluations • Longer term • Underwriting • Pricing

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