Draining the Swamp of Insurance Fraud
Too many agents compete unethically, offering illegal advice to clients. It's time to start reporting those who commit insurance fraud.
Too many agents compete unethically, offering illegal advice to clients. It's time to start reporting those who commit insurance fraud.
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William C. Wilson, Jr., CPCU, ARM, AIM, AAM is the founder of Insurance Commentary.com. He retired in December 2016 from the Independent Insurance Agents & Brokers of America, where he served as associate vice president of education and research.
Why one insurtech that is putting structure to critical claims and underwriting data is becoming part of the industry’s lexicon.
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Andrew Robinson is an insurance industry executive and thought leader. He is an executive in residence at Oak HC/FT, a premier venture growth equity fund investing in healthcare information and services and financial services technology.
Decision-making shortcuts can be useful but may lead to inaccurate judgments in complex business situations of high uncertainty.
Risk management competencies should become an important attribute when hiring personnel – HR teams should include risk management requirements in all relevant position descriptions when hiring new personnel for the organization. The level of detail will of course depend on the risks associated with each role. Any finance, accounting or investment individual should possess a basic understanding of risk.
Risk-based decision-making in induction training for new employees – New hires come from a variety of educational and experience backgrounds, and, most importantly, each new employee has her own perception of what is an acceptable risk. It is important for risk managers to cooperate with the HR team or any other business unit responsible for training, to jointly carry out training on the basics of risk-based decision-making for all new employees.
Risk awareness sessions for senior management and the board – Executives and board members play a vital role in driving the risk management agenda. Nowadays, many executives and board members have a basic understanding of risk management. Auditors, risk management professional associations and regulators have been quite influential in shaping the board’s perception of risk management. It is important that risk management training focuses less about risk assessments and more about risk-based decision-making, planning, budgeting and investment management. The paradox is that risk management training should not teach management how to manage risks; instead, it should show them how to carry out their responsibilities with risks in mind. Click here to order training for your company.
Advanced training for “risk-champions” – Additional risk management training may be needed for the risk management team and business units responsible for internal control, audit, finance, strategy and others. In-depth risk management training should include: risk psychology and risk perception basics, integrating risk management into culture, basic knowledge of ISO 31000, risk management and decision-making foundations, integration of risk management into core business processes and decisions. Click here to order risk management training for your risk/audit team.
Passive learning techniques – Make risk management information available to employees, contractors and visitors. Place the risk management policy on the intranet and the corporate website. Record and publish risk management training or awareness sessions videos on the dedicated risk management intranet page. Invite guest speakers (risk managers from other companies) to speak to the audit committee or risk management committee and give all employees the opportunity to participate. I have used this in the past, and it worked very well.
Risk management as part of everyone’s responsibilities – It helps to include risk management roles and responsibilities into existing job descriptions, policies, procedures and committee charters. The common approach of capturing risk management information in a single risk-management framework document does not work well.
Risk management integrated into day-to-day work – My experience shows that updating existing policies and procedures to include aspects of risk management works much better than creating separate risk procedures or methodology documents.
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Alex Sidorenko has more than 13 years of strategic, innovation, risk and performance management experience across Australia, Russia, Poland and Kazakhstan. In 2014, he was named the risk manager of the year by the Russian Risk Management Association.
Startups like Lemonade, Slice, Zhong An, Haven Life, Bought by Many and Neos are embarking on Digital Insurance 2.0 business models.
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Denise Garth is senior vice president, strategic marketing, responsible for leading marketing, industry relations and innovation in support of Majesco's client-centric strategy.
The elephant in the room is legacy: legacy thinking, legacy processes and, most definitely, legacy systems. The answer is "digital decoupling."
Digital decoupling for an intelligent enterprise
Insurers can look to new digital architectures to help address the issues of legacy. For example, cloud services, data lakes, microservices, open APIs and robotic process automation can not only reduce dependency on—and the cost of maintaining—legacy systems but also help them execute business strategy more quickly.
See also: Innovation Is Really Happening
Accenture calls this digital decoupling. Digital decoupling is a way to release an organization from its dependency on legacy systems. In many cases, we can rebuild the capabilities needed for the back office in the cloud, without the convolution of the legacy system. Robots and cognitive processes can help identify where the cloud-based system needs to plug into the legacy system. Digital decoupling can deliver savings to release capital for investments. It also contributes to the stable foundation required to underpin agility and support innovation. Let’s look at a few ways that digital decoupling can help insurers.
Case study 1: Buy a car…while you’re in the car
One global bank was mired in legacy systems but wanted to grow its car financing market. Accenture helped it launch the capability to have customers buy a car when they’re in the car. Think of it: You’re immersed in the new-car smell, fresh off a test drive. With the push of a button and a digital signature, you can buy the car, along with the financing, insurance and extended warranty. Talk about delivering a knockout customer experience at the moment of truth.
Accenture made it happen in just three quarters. We used cloud-based digital tools to rebuild the bank’s back office, enabling almost exclusively straight-through processing. Next, the cloud-based back office was integrated into essential enterprise systems, but otherwise bypassed the legacy system. The cloud-based office is 50% cheaper to run, creating an immediate cost advantage over the competition. And in this particular market, where the economy declined by 8% over the past two years, the bank’s car sales are up 30%.
Case study 2: Robots enable Sunday mortgages
This particular bank had a mortgage office with typical office hours: Monday through Friday, 9 am to 5 pm. But when do people buy houses—and, therefore, when do they need mortgages? The weekend. But in this region, weekend mortgages weren’t possible.
Accenture worked with this banking client to develop an AI-backed mortgage capability. Robots worked beside people to learn how to make mortgage decisions. When the people go home for the day, the robots keep working. Today, if you want a mortgage on a Sunday, you can get one—and, more important, you can buy your dream home.
Accenture tapped into new technologies to bypass this bank’s legacy systems to deliver the AI-backed mortgage capability in just 20 weeks.
What’s notable about these digital decoupling efforts is that they tend to be self-funded, especially when data lakes are leveraged. For example, using data lakes and other technologies, Accenture was able to create an entirely new bank in about six months—and eventually, as the business shifted to the data lake from the mainframe, the project became self-funding. Using data lakes, in particular, tends to result in a new architecture that is more efficient and cheaper to run than the legacy system.
See also: Linking Innovation With Strategy
With digital decoupling, insurers can innovate without being shackled by their legacy systems. Think of it as two-speed IT. You can move fast with innovation by decoupling the back end. Meanwhile, you have time to move slowly later as you start shutting down parts of the legacy system—a process that releases even more trapped value.
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Michael Costonis is Accenture’s global insurance lead. He manages the insurance practice across P&C and life, helping clients chart a course through digital disruption and capitalize on the opportunities of a rapidly changing marketplace.
Understanding where the gaps are, both in the current insurance market and in the customer experience, will be key.
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John Cusano is Accenture’s senior managing director of global insurance. He is responsible for setting the industry group's overall vision, strategy, investment priorities and client relationships. Cusano joined Accenture in 1988 and has held a number of leadership roles in Accenture’s insurance industry practice.
Agents need to go beyond knowing details and trends and be able to ask clients the right questions. AI and chatbots are poor substitutes.
A quick personal story
My first role overseas was working on a project team where we set up an insurance carrier in Poland. My role was to set up the target operating model of the agency force for our Polish business, which included everything from recruitment of agents to the sales process with customers.
I was nervous because, up until that time, I had only been a financial adviser and wholesaler and was not sure if I could deliver. I had the following conversation with my former boss a few weeks after joining the project (he was running the project and is a qualified actuary by trade):
Me: "I know nothing about back-office operations, actuarial/product pricing, how to set up a branch. How am I supposed to define the requirements of what the agents need when I have never actually worked in these areas?"
Boss (with a smile): "You have quoted and sold policies to customers, right? You’ve spoken to them about how the underwriting works and then worked with operations people to make sure the policy issued correctly, correct? You’ve walked a customer through a policy document, helped with a claim, dealt with multiple servicing issues and back office people on their behalf, right?"
Me: "Yes."
Boss: "Then you know a lot more than most of the people you are going to be working with on this project…as a lot of them have only seen one area of the business, whereas sales people have to interact with all areas of the business. I will always say, the sales person is one of the smartest people in the whole company and typically will make more money than most of the CEOs, too!"
In our next meeting, in which every workstream lead was present (product, operations, actuarial, etc), my boss stood up in front of everyone and said, "This business will only succeed if the agent is successful. The agent is the heart of this business and will drive our growth. As such, we need to put all of our efforts in place to support the agent in our business model, which also means giving Stephen the support he needs to be able to build the best operating model he can for our success in Poland."
(Thanks, ML, for giving me the confidence in those days. FJ, you, too.)
Some start-ups enabling rather than replacing the agent
There were many startups that presented at the Plug and Play event, some of which focused on enabling the agent/broker, including:
Wellthie – Wellthie is an insurance marketplace and sales optimization platform for brokers and carriers to help with the end-to-end sales process to small businesses. The platform offers live quoting from top medical and ancillary carriers nationwide, contribution modeling, customized proposals, an integrated CRM and more.
Hello ZUM - Hello ZUM is a startup out of Latin America that aims to "organize the world’s insurance information in one click." The management team is made up of veteran insurance industry professionals. Their solution is a SaaS platform that was born out of looking at two areas: 1) the different roles in the insurance industry and how they will evolve in a new digital environment and 2) how they interact with each other and exchange information. Hello ZUM helps to provide all the different stakeholders within the insurance ecosystem with consistent information, which helps make operations and distributors more efficient and ultimately provide a better customer experience, while generating significant cost reduction.
Client Desk – Client Desk is a Canada-based software startup focused on giving tools to brokers and carriers, focusing on engagement, self-servicing and claims management. They provide a white-labeled policyholder web portal and mobile app, as well as a management dashboard used internally by brokers and agents.
HazardHub – HazardHub has two goals: (1) to create the best geographic hazard data available and (2) make it free for every person in the U.S. to see the risks around their property. This can help individuals and their brokers to identify the specific risks that may be around their property. You can try it for free here and sign up for the API here, which will give you as many as 10 inquiries a day for free! For carriers and brokers that want to incorporate HazardHub data into their quoting and rating routines, HazardHub offers a novel pay-on-the-bind approach to pricing.
acuteIQ – acuteIQ is an AI platform that helps brokers and agents with customer acquisition and prospecting by searching a database of 21 million small/medium-sized businesses.
Summary
A few weeks ago, I wrote about my experience of buying health insurance this year. After doing all my research online, I also spent time talking to two different agents. I was amazed at the information that they shared with me that I couldn’t find online; which included information on the evolution of ACA and how it’s affected their business and their clients' experience with different carriers, as well as many other general tips on what I should be looking at for my own insurance needs as a repatriated entrepreneur.
I was reminded about how the role of the agent is much more than only selling and servicing, but about knowing continuing trends, regulations and being able to ask the right questions to individuals to determine what the most appropriate route is to go with the advice they want to provide.
Can AI and a chatbot provide for this? Possibly. But for people like me (and I know I’m not the only one), I prefer talking to a real, live person, who is paid for knowing all the complexities of the market and industry to guide me. As I used to say in my financial planning days to prospective clients, "Just because you can use WebMD to diagnose your problems doesn’t mean you will perform the surgery on yourself, right?"
See also: How to Augment Agent Channels
That’s not to say that agents don’t face a risk. Some of the simpler personal and commercial lines may be able to be sold direct (though, in my opinion, there will almost always need to be a live person to be a backup to answer questions for a customer who purchases online).
The more complex lines and individual circumstances, specifically when it comes to estate/legacy planning, tax sheltering and comprehensive solutions for businesses (both small and large), will need to be assisted by agents. Further, I can’t see super-high-net-worth customers using digital only as their means for buying insurance.
Agents need to start eating their spinach. They need to invest in educating themselves as well as in digital tools that can enhance the customer experience. In the digital age, customer experience is going to the key differentiator. I personally use an agent because I want to have the expertise of a live person to bounce ideas off. But, if the agent I am working with as well as the carrier he is representing both have tools to make my experience with them more engaging (and back office systems that also run smoothly), then I will be a happy policyholder.
In posts here and in conversations I have daily, I keep saying that insurtech startups need to have an insurance person on their team (either as an adviser or part of their management team). I’m going to take that a step further; they need someone who has done insurance sales. If they really want to learn the business, this is going to be the best way for them to do so.
You can find the original article published here.
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Stephen Goldstein is a global insurance executive with more than 10 years of experience in insurance and financial services across the U.S., European and Asian markets in various roles including distribution, operations, audit, market entry and corporate strategy.
There are some basic capabilities that customers expect from their insurers—and insurers generally fall flat.
See also: Digital Insurance 2.0: Benefits
Here are some of the basic capabilities that customers expect from their insurers—and where insurers generally fall flat.
The list above isn’t exhaustive, but it’s a good place to start. Yes, it’s long. Yes, it shines a light on some of the flaws that insurers have ignored for decades. Yes, fixing them will take work. But, rather than view it as a list of challenges, you should see it as a to-do list of digital opportunities—it’s a way to begin your core transformation efforts to deliver more value to your customers.
It’s easy to get distracted by shiny innovations when we talk about digital transformation. But as I’ve been emphasizing throughout this blog series, it’s irresponsible to look at how artificial intelligence (AI) or blockchain fits into the enterprise if your customers can’t easily see the status of their claims. What’s more, successful core transformation supports a strong foundation and releases investment capital—which, in turn, funds innovation and fosters the agility needed to effectively pilot and scale new projects.
See also: Global Trend Map No. 6: Digital Innovation
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Michael Costonis is Accenture’s global insurance lead. He manages the insurance practice across P&C and life, helping clients chart a course through digital disruption and capitalize on the opportunities of a rapidly changing marketplace.
In a time of industry transition, auto insurers should address more customer desires; breakdown services top the list.
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Mark Hodes is the founder and CEO of ForeverCar, a digital platform for powering vehicle repair plans. ForeverCar is helping insurance companies drive customer value and competitive advantage by offering flexible coverage options and top-rated support for vehicle repair plans.
Gen Z tops the list of groups ready to purchase Digital Insurance 2.0 offerings that include messenger apps and mobile quoting.
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Denise Garth is senior vice president, strategic marketing, responsible for leading marketing, industry relations and innovation in support of Majesco's client-centric strategy.