---

Claims represents the "delivery-of-value" point for insurance. Insurers and their services providers face the challenge of meeting customer satisfaction demands, driven by the consumer, competition and even regulation. On the other hand the cost side of the balance scales drives companies to look for new claims business models, to enhance the productivity of their staff, and to apply approaches -- including technology -- to improve both efficiency and effectiveness. Our speakers will address the trends in the use of technology in the Claims process.

Seminar Topics

8:00 – 8:30: Registration and Coffee

8:30	Welcome: Doug Grant Insurance-Canada.ca
	Re-evaluating the Claims Business Model Al Otton , Sr. Vice-President, Newlink Group Inc., and Pierre Gagné , Sr. Vice-President, NewLink Group Inc.
A number of organizations are now starting to plan for the implementation of new Claims business models supported by the appropriate technology. NewLink Group has worked with a number of insurance companies, assisting them during the process. They will share with you their knowledge and discuss the following points: What makes Claims so attractive? Where is the payoff? What are the business drivers? What are the trends regarding Claims automation? How do other insurance lines of business do it? Approaches and methodologies for Claims process design and automation Perspective on the potential technology solutions Imperatives for success There are a lot of technology solutions evolving that allow the implementation of new Claims business models. The major challenges will be on the organization and the cultural side of things.
	break
	The Future of Claims: Looking into the Crystal Ball John Anders, General Manager, Canadian Network Operations, NDCHealth
Process Re-engineering, Informatics, Underwriting, Fraud & Abuse, Benefit Management, Utilization Reviews... Common buzz words from the past and present. All require information, and in some instance very specific information to have an impact on your operations. Claims, and in particular the information contained in that packet, is the fuel for change and advancement. How is technology enabling easier claims submission and processing? What provider communities will soon be enabled to submit claims? How are claims standards evolving to enable this? This presentation will provide insight into how technologies and business practices are evolving over the next short while.
	Automating Claims Payments Processing for Worker's Compensation: A Case Study Jane Goguen, Director, Multi-benefit Solutions, BCE Emergis Inc. Rob Timlin, Director Claims, WSIB
In 2002, with business goals such as improved provider relations and increased operational efficiencies in mind, The Workplace Safety and Insurance Board of Ontario partnered with BCE Emergis to deliver an electronic and automated system for Bill Approval and Payment. What had been a process with a large manual component and a series of deficiencies including lengthy payment cycles, uncoordinated processes and cumbersome rules was, over a period of 12 to 18 months, transformed into an electronic process for provider bill capture, eligibility, automated rules-based adjudication and payment. This Case Study will describe the Health Claim Management (HCM) solution implemented as well as the efforts, challenges, lessons-learned and ultimately the benefits of deploying such a solution to the Injured Workers, the providers and the Board. From this basis BCE Emergis will be leveraging this solution for WSIB to any P&C Insurer facing similar challenges for AB/BI Claims, including newly introduced Treatment Plans.
	break
	Understanding, Addressing and Detecting Fraudulent Claims Michael Turney, Senior Program Manager, SAS
As people experience more financial pressures and the business environment becomes increasingly complex, the rate of attempted fraud and manipulation of claims increases. In a study perfromed by the Canadian Coalition Against Insurance Fraud, it was found that 40 per cent of all accident benefits claims contain elements of fraud! Statistics Canada reported in May 2003 that one national organization estimates that insurance fraud alone costs policyholders $1.3 billion annually. This presentation is designed to help organizations better understand consumer's attitudes and reasons behind various types of insurance fraud, as well as what insurance companies can do to help mitigate their exposure to fraudulent activities.
	Services Provider and Other Perspectives Doug Grant, Insurance-Canada.ca
Those organizations which provide the service to the ill or injured claimant are striving to make the best use of technology within their environments. Third parties between the claimant and insurers are looking to provide solutions to bridge the technology gap. This presentation will look at some of those initiatives.
12:15	Close

Seminar Sponsors:

	ci   Canadian Insurance Magazine

Speaker Information

John Anders, General Manager, Canadian Network Operations, NDCHealth

NDCHealth provides network connectivity to pharmacies and dentists across Canada for the submission of health benefit claims to private and public payers. Mr. Anders has been involved in the health care industry for over 25 years, and has been an integral part of the development of business requirements, claims standards, messaging standards, and the implementation of "community of interest" based EDI.

In addition, Mr. Anders has served on numerous Business Development initiatives associated with the Provincial and Municipal sectors.

Pierre Gagné, Sr. Vice-President, Newlink Group Inc.

During his career, Pierre has been assisting insurance companies in their quest for growth and profitability through the practical use of information techhnology. Pierre has worked with various industry sectors but most of his career has been dedicated to all facets of the insurance industry. He is known to be a practitioner who understands the business of insurance and who can judiciously apply technology to leverage organizations.

Pierre has 25 years experience in the management of the insurance business and the application of information technology. Within the insurance industry, he has worked with General, Life, Group and Government insurance organizations. His achievements have been based on sound business practices in strategic and tactical planning, business reengineering, project management and successful implementations of systems to support organizational strategies.

Jane Goguen, Director of Multi-benefit Solutions.

As part of eHealth Solutions of BCE Emergis, Jane Goguen is the Director of Multi-benefit Solutions in the Product and Services Management group. She is responsible for Drug, Dental and Other Health Claim Management including electronic invoice submission, adjudication and payment.

Jane has been with BCE Emergis for three years in the roles of Business Architect and Product Manager. Her background is 15 years in application development, delivery and customer support for the Health and P&C insurance markets as well as Operation Support software for the telecommunications industry.

Al Otton, Sr. Vice-President, Newlink Group Inc.

Al is primarily engaged in the achievement of corporate strategy through business engineering and the application of information processing. He has experience in all facets of the financial services industry, with an in-depth understanding of insurance industry requirements. He has a consistent record of innovation and implementation, and is regarded as a pragmatic and results oriented practitioner.

Al has over 30 years experience in strategic and organizational planning for business and information services. He has led many strategic initiatives and business reengineering projects which have achieved significant business advantage through the effective use of information technology. He has been engaged, often, to translate critical business requirements into system architectures which are aligned with the long term needs of the business.

Rob Timlin, Director Claims, WSIB

Rob Timlin is a Director in the Operations Division of the Workplace Safety and Insurance Board. Rob has held a variety of Sr Management positions at the Board including; Program Manager for the Eastern Ontario Region, Director, Labour Market Re-entry Program and most recently Director in the WSIB's Business Design and Implementation Unit where he worked with BCE Emergis to implement a new Payment and Case Management System for Health Care and Labour Market Re-entry providers.

Michael Turney, Senior Program Manager, SAS

Michael is a Senior Program Manager at SAS (Canada), a subsidiary of SAS Institute Inc., where he manages a portfolio of predictive intelligence solutions. In his role, he is responsible for developing and implementing strategic plans for SAS' suite of analytical solutions across a variety of industries including insurance, retail, telecommunications and manufacturing.

Before joining SAS, Michael was Product Marketing Manager, Integrated Solutions at Ironside Technologies Inc. Prior to that, Michael was Product Manager, Net.Commerce for IBM Canada Limited. Michael holds an Executive Master of Business Administration from The University of King's College, as well a Bachelor of Arts, Economics, from Concordia University.

Host and Moderator

Doug Grant MBA CIP, Consultant, Insurance-Canada.ca

As a keen analyst of computer and networking evolution for more than thirty years, and the opportunity and impact on the insurance industry, frequent industry speaker, columnist, and consultant. Doug is cognizant of the changes that are occurring in the Internet insurance world. As a principal in the Insurance- Canada.ca Web site, he brings a unique perspective to the session. For a more extensive biography.

Doug will be host of the seminar and will welcome and set the stage, build the linkages between topics, and then provide conclusions and points to ponder at the end of the session.

(Examples will be used throughout)

Questions? call Doug Grant 416-921-7756 or email at doug.grant@insurance-canada.ca

See a list of our Previous Seminars.

[ Announcement Flyer | Speakers and Topics | Online Registration | Registration Form ]