Iasa 2013 technology session: 5 things your claims system should do for you Claims has never been called the “fun” part of insurance. Let’s face it, it’s when those hard-earned premium dollars take a hike back out the door. And, while there’s no way to change the fundamental premise behind paying claims, there are ways technology can overhaul the claims management process, making it more efficient, and less painful, for everyone. Today’s modern claims technologies can differentiate you from competitors and give you control of your claims management process by helping you to leverage critical loss data, eliminate leakage, accelerate resolution, reduce loss adjustment expenses (LAE), speed claims processing times and improve customer service. However, it is important to understand some of the basics that your company should be able to do with your claims system now. This session will discuss the requirements that constitute a suitable, comprehensive claims management system, and one that fits your company-specific needs and style of business.

2. 5 Things Your Claims System Should
Do For You
Session Number 471

3. John Roblin
John Roblin, Chairman & CEO– Cover-All Technologies
John Roblin has served as Chief Executive Officer of Cover-All
Technologies since December 1999, and as a director since March
2000. He was named Chairman of the Board of Directors in
February 2001. He served as President of the Company from
December 1999 to November 2008. Prior to joining the company,
Mr. Roblin was CIO and Senior Vice President for CIGNA Property
and Casualty since 1998. From 1994 until 1998, he was CIO and
Senior Vice President for Advanta Corporation. Prior to 1994, he
was the CIO Chubb & Son, USF&G and Traveler’s Personal Lines
Division.

4. Shared Perspectives
 Some people see things that are and ask, Why? Some people dream of
things that never were and ask, Why not? Some people have to go to
work and don't have time for all that.
George Carlin
 The problem is never how to get new, innovative thoughts into your
mind, but how to get old ones out.
Dee Hock, Founder of Visa
 There is nothing so useless as doing efficiently that which should not be
done at all.
Peter Drucker
 That wasn’t flying. That was falling with style.
Woody, A Toy Story

5. 5 Things Your Claims System Should
Do For You
 What is a Good Claims System?
• What are the objectives? How measured?
• Designed to serve the customer? The company? Both?
• Designed for today? Tomorrow?
• How can better data, information and knowledge create value?
 Sharing Their Perspectives with us today:
• Bill Garvey, CEO – Eastern Shore Consulting, Inc.
• Bob Khosropur, SVP of Operations – Mariposa Insurance Services
• Gary Plotkin, Principal – KPMG Financial Services Advisory

6. Bill Garvey
Bill Garvey, CEO – Eastern Shore Consulting, Inc.
Bill Garvey, originally from Massachusetts, lives and works in Halifax,
Nova Scotia. Bill has held senior level management positions in Claims
and Information Technology. Bill brings a realistic approach to
developing strategies that link business goals to automation
solutions. He leads initiatives to search for and install industrial
strength software, and has helped insurers change the paradigm for
how they conduct software searches.
Bill provides more than software analysis. He has installed major
insurance systems, often as an early adopter. He understands
"buyer's remorse" and the complexities involved in acquiring
operational software. Bill has deep product knowledge of the
software vendors in the Property/Casualty and Life/Health space.

7. Before Your New Claim System Does
Anything For You…
 But first, the new system and vendor should…
• Help you analyze your operation for transformation
•Workflow analysis from FNOL to closure
•Organizational changes
•Claim management’s vision
 Know what and where you want to “be” before you replace
a Claims system

8. First – Accelerate the Claims Process
 Remove bottle necks
• Automatically assign the right people
• Escalate claims that aren’t getting proper attention
 Reduce cycle time
• Lower cost per claim
• Higher customer satisfaction
• Reduce loss leakage & LAE

9. Second – Improve Productivity
 Reduce the adjuster learning curve
 Create an intuitive work experience
 Place services and links at the adjuster’s fingertips
 Leverage Web services
 Leverage ancillary applications

10. Third – Manage the Claim Process
 Flexible workflow rules
• Respond to organizational changes
• Reassign/ escalate losses
 Real time productivity data
• Allocate field resources
• Define claim specialization
 Management reports

11. Fourth – Leverage Claims Data
 Transform useless notes into precious data
 Predictive analytics
• Claim severity
• Subrogation opportunities
• Fraud
 Management reports
• Injury type
• Settlement trends
• Venue issues

12. Fifth – Improve the Customer’s
Experience
 Online reporting and status
 Electronic submission of documents
 Multiple payment options
 Mobile access

13. Bob Khosropur
Bob Khosropur, SVP of Operations – Mariposa Insurance Services
Bob is a senior Insurance executive for personal property and casualty
insurance, recognized for the passion and skills to build out claims
system and processes from the ground up. Honored in 2011 by Claims
Magazine as ‘Claims Person of the Year’ for work in modernizing
claims systems. Bob has extensive experience in catastrophe
management, strategic sourcing, and specialty underwriting. Over a
24 year career he has developed and enhanced operations and
strategies through effectively communicating and deriving
collaboration among otherwise divergent groups. Bob holds a
bachelor’s degree in chemistry from Goddard College in Vermont.

14. Core Claims Systems
Customer-centric Claims Service Through
Innovative Technology

15. Customer-centric Claims Service Through
Innovative Technology
 Basic Facts of Life & Loss:
• Policyholders call to hear some good news only.
• More bad news after their boo-boo is not greeted well.
• Claim years are like dog years - the first five minutes of the claim are like
the first two years of life; and it sets the stage for all to come.
• Policyholders don’t know about or care about interfacing, software as a
service, outsourced solutions or anything else except the boo-boo.

16. Customer-centric Claims Service Through
Innovative Technology
 Basic Facts of Life & Loss:
• Loss should only have four simple parts for the policyholder:
1. You know who they are
2. You’re happy to help
3. Something good will happen soon
4. It’ll all be over before you know it

17. Customer-centric Claims Service Through
Innovative Technology
 The Slightly Less Simple Basic Facts of Life & Loss
Other Stuff

18. Customer-centric Claims Service Through
Innovative Technology
Great Expectations
 The policyholder is welcomed (by phone, web-site, hand-held app, etc.)
 The policy’s existence is verified
 Emergency action can be taken immediately
 General information and expectations can be given
 Follow-up is guarantee-able
 Field work is seamless – done once and for all
 No frustrated inquiries should ever come from the policyholder or agent
 Payment is predictable
 Recovery of deductible is never forgotten

19. Modernizing Claims Management
Processes & Systems
The Core Claims System
 Solution should be web-based
Provide company-wide access to claim records, financials, tasks, diaries, vendors,
contacts, theories of defense, images and documents
 Access from remote desktops/laptops/pads
 Easy to populate FNOL elements by staff or by third party call center
 Highly customizable by in-house administrative staff
 Add or remove granularity to reporting elements
 Alter roles and authority limits as required

20. Modernizing Claims Management
Processes & Systems
Claims System Feel and Touch
 Able to improve claims turnaround time
 Ease of use
 Screen flow logic
 Multi-tasking between screens and various claims
 Semi-transparent panels
 Reliable to the touch and feel – 24/7
 Rapid screen-to-screen transition
 Quickly train new users to reach a level of proficiency in its functionality
 Speedily develop lines of insurance and their respective coverages and perils

21. Modernizing Claims Management
Processes & Systems
Claims System Interfacing
Ability to interface with suppliers of service, e.g.
 Subrogation
 Estimating software
 Aerial imaging
 Independent adjusters
 Damage mitigation and repair vendors
 Legal services

22. Modernizing Claims Management
Processes & Systems
Enhanced Features – examples:
 Segmentation of Claims – Split assignments and Access
 Collision assigned and handled by physical damage specialist
 Bodily Injury handled by casualty specialist
 PIP handled by centralized units
 Subro investigated by in-house or outsourced specialist
 SIU handled in secrecy
 Claims Activities / Tasks
 Utilize a rules-driven task reminder system for scheduled activities
 Follow-up queues for management
 Compliance edits to assist with multiple state variations
 Forms and wording assistance
 Process consistency - treating all customers with the same quality of
response

23. Modernizing Claims Management
Processes & Systems
Don’t forget the Basics
 Logically record /retrieve the first notice of loss, and all subsequent
investigation and damages of parties involved
 Statistical reserving, and manual revision for loss and expense
 Create payments with simple transactional logs readily available for audit and
review
 The ability to create, use and store correspondence, reports, photographs,
sound files, emails, etc.
 Identify and monitor subrogation / salvage recovery potential
 Identify and monitor litigated files

24. Modernizing Claims Management
Processes & Systems
Can’t Manage Without
 Enforce authority limits based on company role to monitor reserving and
payment practices
 Enforce policy coverage limitations
 Basic financial reporting tool for daily inquiries
 Catastrophe coding and management
 SIU scorecard and flagging
 Vendor/Contact management capabilities (across claims)

25. Thank You

26. Gary Plotkin
Gary Plotkin, Principal – KPMG Financial Services Advisory
Gary Plotkin is a Principal at KPMG and a member of the IT
Advisory Services practice for Financial Services focusing on
Insurance clients. Gary has 22 years of Financial Services
experience specializing in Business and IT transformation work.
Gary has split his career between Advisory Services management
and the roles of CIO and CTO for large and small Insurance
Carriers. He has a strong background across the full life cycle of
strategy and project delivery with several $100M+ program
management experience including software development,
implementations and transformation initiatives. Gary’s past
clients include leading entities in the financial services industry.

27. Claims - the Customer’s Moment of Truth
Having a claim is the “Moment of Truth” for the Carrier
to build brand loyalty and customer retention
 Insurance is not a tangible or well understood product for Customers but a
claim is a REAL AND POTENTIALLY TRAUMATIC EVENT
 Claim professionals have the DIFFICULT TASK of balancing company policies
to reduce expenses and loss payments while maintaining a high-level of
customer satisfaction
 Satisfaction does not equal overpaying claims. It means SETTING AND
MEETING EXPECTATIONS

28. Customer Visibility and Support
Recent JD Powers Study* on Auto Claim Satisfaction
found the following:
 Focusing on keeping CLAIMANTS UPDATED and quickly communicating
what will be covered in the claim has a major IMPACT ON THEIR
PERCEPTIONS of how fairly they are treated
 Insurers continue to focus and improve on offering more OPTIONS to keep
customers informed on the progress of their claim with 64% of claimants
indicating they were offered options.
 Failing to adequately explain and update claimant may lead to their
QUESTIONING THE SETTLEMENT offer and potentially increasing the rate of
negotiations, which negatively impact overall satisfaction.
2012 JD Powers Auto Claims Satisfaction Study

29. Customer Visibility and Support
Best of Breed Companies:
 Truly ENGAGE CUSTOMERS to assist in the claims process by providing them
with easy to use interactive applications and mobile access
Ability to diagram accident scene, upload pictures, document home
contents
Support telematics data for claims assessment
 Providing customers with VISIBILITY into the claims process, while enabling
interactions and FEEDBACK to allow REAL-TIME customer satisfaction
Insurance carriers providing online updates via email or text on the status
of a customer claim
Ability for Online viewing of Auto Body repairs to a customer vehicle
Dedicated Portals for customers to share their claims stories and
encourage positive interaction

30. Is the Insured Satisfied?
How is Customer Satisfaction identified:
 Most companies evaluate customer satisfaction with claims POST
SETTLEMENT. This is TOO LATE in the process and does not provide the
company with an opportunity to ensure a positive customer interaction
 For those companies that have decided to conduct open claim customer
surveys‘, is there a FEEDBACK LOOP in place to provide the data back to
those interacting with the customer
 Is the customer satisfaction DATA AVAILABLE to claims operations REAL-
TIME to help address process improvement or is it only a function of
marketing

31. Building Customer Intimacy
A recent Gartner report* states that “just one-third of P&C
Carriers know their customer”
 Claims Systems Need to support Customer PREFERENCES
 Customer preferred means of communication (Email, Phone, Text, etc)
 Language preferences
 Customer Lifestyle - what do they want to know and how often
 DATA IS CRITICAL to support Customer Intimacy
 New product development
 Cross-sell opportunities and marketing to the right customers at the right time
 Retention programs and revised pricing (what is this customer worth?)
 Enterprise customer knowledge - Is the customer information shared (where
allowed) with other areas of the company and the Agent
Insurance and Technology Magazine, Feb 2013

32. Summary
Claims is the single most important interaction between the
customer and the Insurance carrier
Claims systems are no longer about addressing back-office
operational efficiencies but rather Customer Facing front-office
Brand-building capabilities
Investments in Claims needs to look beyond the traditional
return on investment and also address loss opportunity costs
Understanding the context of the claims systems within the
aspects of the larger application architecture is necessary given
the integration of the platform and the need to share data with
the overall Enterprise

33. Questions
 John Roblin
• jroblin@cover-all.com
 Bill Garvey
• billgarvey@easternshoreconsulting.ca
 Bob Khosropur
• bob.khosropur@mariposaltd.com
 Gary Plotkin
• gplotkin@kpmg.com

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