Claims Reporting Overview - PowerPoint Presentation

Claims Reporting Overview

Agenda Methodology Reporting PyramidTechnology and ArchitectureKey Performance IndicatorsClaim KPI DefinitionsKey Reporting MetricsClaims RatiosClaims MeasuresClaims MetricsDashboardsOverviewClaims Financial FocusClaims Metric FocusClaims Historical Focus Claims Graphical ReportsOverviewClaim MetricsClaim TimelinessIncurred LossesEstimated Loss TrendPaid vs. DeniedPaid vs. RecoveredLoss HistoryTimelinessClaims Register ReportsOverviewReport Definitions

Methodology - Reporting Pyramid The Business Intelligence reporting structure offer by Oceanwide is built in three distinct layers, with each layer increasing the granularity of detail exposed in the reports: Level 1 – DashboardThe dashboard reports are intended to give at a glance snapshots of Key Performance Indicators and summary trends. Level 2 – Graphical Reports The graphical reports are available within dashboards and from drill downs or links in dashboards, they are intended to give a breakdown of high level trends across lines of business, geographical areas etc.Level 3 – Register ReportsThe register reports are intended to give granular detail level reporting, typically the reports will offer advanced filtering and distribution options to allow for reporting of specific areas of interest in detail (e.g. Claim Payment Details).

Methodology - Technology and Architecture The Oceanwide Business Intelligence platform is built on SQL Server databases and IBM Cognos .IBM Cognos allows for the creation of static reports, ad-hoc reporting, scheduling and distribution of reports in various formats and methods (i.e. HTML/PDF/EXCEL formats, email/file system distribution). The diagram below outlines the database and ETL architecture of the platform:

Agenda Methodology Reporting PyramidTechnology and ArchitectureKey Performance IndicatorsClaim KPI DefinitionsKey Reporting MetricsClaims RatiosClaims MeasuresClaims MetricsDashboardsOverviewClaims Financial FocusClaims Metric FocusClaims Historical Focus Claims Graphical ReportsOverviewClaim MetricsClaim TimelinessIncurred LossesEstimated Loss TrendPaid vs. DeniedPaid vs. RecoveredLoss HistoryTimelinessClaims Register ReportsOverviewReport Definitions

Key Performance Indicators – Claims KPI Definitions The following KPIs are available to be included in Claims Dashboards:NameDefinitionNoI CountThe number of Claims currently in Notice of Intent statusFNoL CountThe number of Claims currently in First Notice of Loss statusHVC CountThe number of Claims with a Reported Loss Amount equal or greater to the configured High Value Claim amount of the ProductIncidentsThe number of Incidents which have claims in Notice of Intent or Open statusCatastrophesThe number of Catastrophes which have claims in Notice of Intent or Open status

Agenda Methodology Reporting PyramidTechnology and ArchitectureKey Performance IndicatorsClaim KPI DefinitionsKey Reporting MetricsClaims RatiosClaims MeasuresClaims MetricsDashboardsOverviewClaims Financial FocusClaims Metric FocusClaims Historical Focus Claims Graphical ReportsOverviewClaim MetricsClaim TimelinessIncurred LossesEstimated Loss TrendPaid vs. DeniedPaid vs. RecoveredLoss HistoryTimelinessClaims Register ReportsOverviewReport Definitions

Key Reporting Metrics – Claims ratios The following Claims Ratios are available to be included in Claims reports:NameDefinitionLoss Adjustment Expense RatioThe sum of Loss Adjustment Costs divided by the sum of Earned Premium, where the Loss Adjustment Cost is the sum of the Actual and Reserved Loss Expenses Loss Incurred RatioThe sum of Claim Payment amounts and changes in Reserve amounts divided by the sum of Earned Premium

Key Reporting Metrics – Claims Measures The following Claims Measures are available to be included in Claims reports:NameDefinitionClaimRequest for payment based on terms of policyReserve Amount reserved to pay unsettled claimCostExpenses of adjusting Claim Case (i.e. surveyor costs, legal fees)PaidAmount paid to claimants and other claim partiesIncurredAmount paid and open Reserve amountsNet IncurredAmount paid and open Reserve amounts less Reinsurance amountsSeveritySeverity level of claimSubrogationAmount recovered to offset loss amountLitigationIndication that the claim is in legal dispute Suspended Claim is awaiting non adjuster activity or evidence

Key Reporting Metrics – Claims Metrics The following Claims Metrics are available to be included in Claims reports:NameDefinitionAgingNumber of days the claim case has been openReporting Time Number of days from loss occurrence to notice of intent recordedSettlement TimeNumber of days for claim payment from notice of intent recordedCycle TimeNumber of days for claim case to be closed from notice of intent recordedFrequencyNumber of claims divided by number of exposures (coverages)

Agenda Methodology Reporting PyramidTechnology and ArchitectureKey Performance IndicatorsClaim KPI DefinitionsKey Reporting MetricsClaims RatiosClaims MeasuresClaims MetricsDashboardsOverviewClaims Financial FocusClaims Metric FocusClaims Historical Focus Claims Graphical ReportsOverviewClaim MetricsClaim TimelinessIncurred LossesEstimated Loss TrendPaid vs. DeniedPaid vs. RecoveredLoss HistoryTimelinessClaims Register ReportsOverviewReport Definitions

Dashboards - Overview The dashboards offered are focused on distinct areas of interest: FinancialsIntended for users focused on the financial performance of products over time and current liabilitiesMetricsIntended for users focused on the volume of claims and processing times of claim casesHistoricalIntended for users focused on the historical performance of products and the loss levels experiencedEach dashboard is laid out to provide KPIs at a glance, a main graphical report and two secondary graphical reports.

Dashboards – Claims Financial Focus The diagram below illustrates a financially focused claim dashboard:

Dashboards – Claims Metrics Focus The diagram below illustrates a metrics focused claim dashboard:

Dashboards – Claims Historical Focus The diagram below illustrates a historically focused claim dashboard:

Agenda Methodology Reporting PyramidTechnology and ArchitectureKey Performance IndicatorsClaim KPI DefinitionsKey Reporting MetricsClaims RatiosClaims MeasuresClaims MetricsDashboardsOverviewClaims Financial FocusClaims Metric FocusClaims Historical Focus Claims Graphical ReportsOverviewClaim MetricsClaim TimelinessIncurred LossesEstimated Loss TrendPaid vs. DeniedPaid vs. RecoveredLoss HistoryTimelinessClaims Register ReportsOverviewReport Definitions

Claims Graphical Reports - Overview The graphical reports are designed to provide a summary roll up of key claims reporting areas at a glance, the reports allow for filtering : Report NameInsurerDistributorAdjusterProductUnderwriting YearAssuredClaim Metrics YYYYYYIncurred LossesYYYYYYEstimated Loss TrendsYPaid VersusYYYYY Loss History Y Y

Claims Graphical Reports – Claim Metrics Live metrics report, providing the number of claims in each statusStacked column chartReporting by Adjuster, by Product

Claims Graphical Reports – Claim Timeliness Illustrating the claim case processing performance in days to closed Stacked column chart Reporting by Product, by Adjuster

Claims Graphical Reports – Incurred Losses Reports the break down of total losses by type and distribution over products Stacked bar chartReporting by Product, by Loss Type. Additional filtering for Losses Report by Date

Claims Graphical Reports – Estimated Loss Trend Reports total estimated losses historically against the target set for the product Stacked line chartReporting by month, quarter, year

Claims Graphical Reports – Paid Versus Illustrating the ratio of payments to denials and recoveries 100% stacked bar chart Reporting Paid vs. Denied, Paid vs. Recovered, by Product, by Underwriting Year

Claims Graphical Reports – Loss History Reports the historical loss including payments, reserves and incurred amounts Stacked line chartReporting by month, quarter, year

Agenda Methodology Reporting PyramidTechnology and ArchitectureKey Performance IndicatorsClaim KPI DefinitionsKey Reporting MetricsClaims RatiosClaims MeasuresClaims MetricsDashboardsOverviewClaims Financial FocusClaims Metric FocusClaims Historical Focus Claims Graphical ReportsOverviewClaim MetricsClaim TimelinessIncurred LossesEstimated Loss TrendPaid vs. DeniedPaid vs. RecoveredLoss HistoryTimelinessClaims Register ReportsOverviewReport Definitions

Claims Register Reports - Overview The register reports are designed to provide in depth detailed reporting, providing filtering options for targeted granular reporting, the standard filtering options are:Policy DetailsProductUnderwriting YearCoveragesClaim DetailsInsurerDistributorAssuredAdjuster

Claims Register Reports – Report Definitions The following register reports are offered: Claims Summary Summary details of claims, including claim participants, reported loss amounts, loss types, reserve amount and payment amount roll upsClaims Detail Expanded details of claims, including coverage individual reserve amountsClaims Ageing Detailed report of claims ageing allowing granular filtering to provide claim processing performance by product, adjuster, assured, insurer, distributorClaims Lag Analysis Detailed report of claims processing performance tracked between key claim statuses, e.g. FNol to In Progress.

Claims Register Reports - Report Definitions Claims Metrics Detailed report of number of claims in each statusClaims Payment summary Detailed report of all claim payments provided in descending chronological orderRecovery Summary Summary of all recovery payments for claimsSalvage Summary Summary of all salvage payments for claimsBordereaux Summary Summary of claims included in a bordereaux

Claims Register Reports - Report Definitions Catastrophe SummarySummary of claims included in a catastropheIncident SummarySummary of claims included in an incident