Posts tagged as:

Insurance

Fraud Detection with Oracle Data Mining

December 3, 2008

Charlie Berger and some others presented on using data mining for fraud detection. Fraud is a huge issue – for instance there is $31B annually in insurance claims fraud (10-15%) with 25% of all claims have some fraud and more than 1 in 3 bodily-injury claims from car crashes involving fraud. Other industries have similar [...]

Read the full article →

On the importance of holistic decision making

November 6, 2008

I was chatting with someone the other day who shared a story of a European health insurer.   Their decision-making in claims looked only at the validity of the claim and nothing else. This of course created a situation where good (and very profitable customers) could be treated correctly but ineffectively – such as one [...]

Read the full article →

Integrating Predictive Analytics and BRM to Improve Health Plan Member Experience

October 30, 2008

Two gentlemen from Deloitte presented Integrating Predictive Analytics and BRM to Improve Health Plan Member Experience. 80% of healthcare costs are incurred by 20% of members and traditionally the 20% get all the focus. Analytics and data mining get applied to claims, authorization, costs as a result. Segmentation focuses on the unprofitable and unhealthy. Increasingly [...]

Read the full article →

Rules and Process Management for Insurers

October 28, 2008

Chubb has been working with Blaze Advisor to automate a number of decisions. They began with specialty lines underwriting (automated renewals), claims severity calculation and work queue assignment. Current focus is on integrating predictive models and some legacy modernization.
The automated renewals project reduced the time to make renewal rule changes from 3-6 months of IT [...]

Read the full article →

Live from InterACT – Insurance in the 21st Century

April 28, 2008

After lunch I joined the Insurance track and listened to Don Light of Celent (who wrote this nice paper some time ago) and Mike Gordon of Fair Isaac. Mike started and his first slide was headlined “survival of the fittest” which seems like the right headline! There is clearly a lot on in insurance these [...]

Read the full article →

Live from IMPACT – Evening Activities

April 7, 2008

Evening of Monday night and its party time in the solutions area of IMPACT. Once again the wonderful string quartet were strutting their electric stuff and the food and drinks were good. I spent my time speaking to the few folks present who were really interested in decisioning (Chordiant, ILOG, select IBMers) and then went [...]

Read the full article →

Live from DAMA – Impact of Service Oriented Architecture on Data Modeling: A Case Study

March 20, 2008

First session today was some folks from Allstate Financial talking about the Impact of Service Oriented Architecture on Data Modeling: A Case Study. AllState Financial has the large number of data sources typical of a large corporation. Each line of business has its own administrative systems and mergers and acquisitions also create new data sources. [...]

Read the full article →

A post to replace a comment because Tibco can’t count…

March 4, 2008

At least it’s blog cannot. I saw this post by my old friend Paul Vincent – Business rule execution: stateless/transactional, stateful/monitoring, or both? and tried to comment on it. Sadly the Tibco blog can’t add 6 and 2 and so rejected my comment (the sum was spam protection). So here’s my comment:
I am not sure [...]

Read the full article →

Here’s how one company is using EDM to improve healthcare

March 4, 2008

Silverlink is an interesting company whose approach is to apply science to drive healthcare behaviors in a scalable manner. They made some announcements today at the Health 2.0 conference. I recently got a chance to speak with the CEO (Stan Nowak) and his team. Silverlink has 50 healthcare clients representing 150 million lives (including 9 [...]

Read the full article →

Live from DIALOG – Breakthrough in Claims Excellence Management

February 26, 2008

Last session of the day was from Rodolfo Viola of Swiss Medical Argentina on Breakthrough in Claims Excellence Management. Claims is, of course, a prime target for rules-based automation so I was excited to hear how an organization outside of North America/Europe was handling it.
Swiss Medical is a privately owned company founded as a clinic [...]

Read the full article →

Automating detection of insider trading, money laundering and fraud

January 29, 2008

One of the most interesting uses of enterprise decision management or EDM is in automating detection of various kinds of “bad” activity. Whether the concern du jour is insider trading, money laundering or just plain old fraud. There are a number of reasons why EDM is such a powerful approach.

Automation is fundamentally the best approach [...]

Read the full article →

Live from Business Rules Forum – Reaping the Benefits of Rules through SOA and Business Rule Management at Travelers

October 24, 2007

Alan Weiss of Travelers and Brian Stucky of InScope presented on Reaping the Benefits of Rules through SOA and Business Rule Management at Travelers. Travelers is a Fortune 100 insurance carrier and Alan is part of a group focused on moving control over processing into the business. The key purpose of business rules in this [...]

Read the full article →

Live from Business Rules Forum – True Adventures in Business Rules.

October 24, 2007

Paul Armborst, someone I have known for a long time, was up after lunch talking on True Adventures in Business Rules. Paul is from Westfield Group, a top 50 insurance company based in Ohio. Back in the 1990s needed to transform their business – from a mainframe/back office company to one where agents could serve [...]

Read the full article →

Live from Business Rules Forum – Insurance 2020: Innovating Beyond Old Models

October 23, 2007

Jamie Bisker was up after lunch talking about Insurance 2020: Innovating Beyond Old Models. Jamie used to be a Tower Group analyst and now works for IBM in their Institute for Business Value (I blogged about his reports before). Studied future customers and their needs, how automation is flattening the competitive environment, what fundamental trends [...]

Read the full article →

Book Review – Competing on Analytics

February 26, 2007

Competing on Analytics: The New Science of Winning by Tom Davenport and Jeanne Harris
Tom and Jeanne have written a new book (building on a paper they wrote some time ago) about what they call “analytic competitors”, that is to say companies that use their analytic prowess not just to enhance their operations but as their [...]

Read the full article →

Next Entries →