StoneRiver: Claims Processing Made Simple

Thomas Burke, Executive Chairman, StoneRiverThomas Burke, Executive Chairman In 2013, Boston-based Plymouth Rock Group of Companies (PRC), which was making more than $1 billion from its annual automobile and homeowners’ insurance premiums, was experiencing claims processing challenges. The cause was clear—PRC’s heavy dependence on legacy systems that were installed in 2002. Not surprisingly, it was becoming difficult to cost justify the investments to further enhance the legacy system. The company was looking to deploy an advanced platform that could be aligned with its strategic platform, and enhance their business opportunities. The pursuit concluded with the adoption of Stream® Claims, the powerful insurance claims system from StoneRiver, which helped PRC to streamline the end-to-end claims processes and adapt new business requirements with the underlying platform. Stream Claims is part of the Stream Suite™ core system suite, including policy administration, billing, claims, customer, and distribution components. The Stream Claims platform enables carriers to develop multiple functions on smart devices—from filing claims, to getting estimates of payments and checking the status of claims to even scheduling appointments. The success story of PRC is one of the many achievements that add credence to StoneRiver’s ability to deliver agile, service-oriented solutions in response to the transformations occurring in the insurance sector.

"Stream Claims allows carriers to evaluate claim conditions to identify proactive alerts within a specific period to avoid penalty"

The key challenge in the insurance sector today revolves around the inability to adapt to the ongoing, rapid technology changes. “Though data and analytics are changing the course of insurance companies, they are still lagging behind their counterparts from other sectors,” explains Thomas Burke, the new Executive Chairman of StoneRiver. The dramatic shift due to Internet of Things (IoT) and big data has helped companies react faster and utilize real-time information to analyze the characteristics and behavior of customers in a better way. “The insurance domain has rapidly been adopting the digital trend by shifting information and disseminating it on devices. And there’s been a fundamental shift in claims processing—from restoring value for damaged property, to preventing claims from happening at all, thereby reducing the amount of loss,” adds Boyd Fittes, VP-Product Management at StoneRiver. Finally, it is the changing dynamics of the workforce where insurers demand infrastructure that empowers customers to integrate with the massive data influx. “StoneRiver’s solutions are customer-centric with a microservices-oriented architecture, so carriers can quickly adapt to changes, including new technology and high volume of data,” Fittes asserts.

Revamping Legacy Operations

Built on the service-oriented architecture, Insurance Integration Platform (IIP®), the Stream Suite can be installed as an enterprise suite or standalone technology, providing flexibility to perform quick version upgrades. The platform enables easy integration with other systems with a futuristic vision. “The StoneRiver patent embodies advanced architectural concepts implemented with the IIP, featuring an advanced enterprise bus and composite functional services. The result is a suite that addresses insurers’ needs today, while preparing them for the future,” elaborates Burke.

An important development in the insurance sector is the transition from payment transaction-oriented claims to customer service-oriented operations. “The challenge in claims technology is to be fully aware and adaptive of all the vendor/service relationships. Carriers often have a unique inventory service process as a part of their workflows,” explains Burke. Stream Claims, a part of Stream Suite, allows customers to integrate the systems to automate the nature of the workflows. Its configurable rules engine assists companies in building workflow rules to effectively manage claims. When integrated with ISO ClaimSearch, the platform helps identify suspicious claimants by evaluating the claim conditions—eventually reducing the chances of fraud.

Burke touches upon a scenario to highlight Stream Claim’s efficiency. “Carriers are proactive in identifying the problematic claims. The claim system helps them answer questions such as ‘who should get this claim to adjust?’ and ‘how can we mitigate long-term cost?’ Carriers can rely on the rules driven approach to determine effective claim assignment—based on severity, complexity, or other criteria—to route claims to the appropriate adjuster,” he adds. In this situation, Stream Claims allows carriers to evaluate claim conditions to identify proactive alerts within a specific period to avoid penalty. Carriers can use Stream Claims alone or with other Stream Suite components for policy, billing, customer and distribution. Each can be purchased and deployed as a standalone component or as part of an integrated suite of core processing systems.

StoneRiver’s solutions are customer-centric with a microservices-oriented architecture, so a carrier can quickly adapt to technological changes

StoneRiver’s team has a keen eye on customer service to help understand their future behavior. “For example, without an integrated system like Stream Suite, carriers might get the personal details of a person or organization, but updating those details to the policy and billing systems becomes a problem,” Burke notes. To trounce the hurdle, Stream Customer allows the insurer to capture and store information on people and vendors for policy, billing, and claims.
Boyd Fittes, VP-Product Management, StoneRiverBoyd Fittes, VP-Product Management
Consolidating the behavior information into a single report provides a 360-degree view of their relationships and information on how people and organizations are involved throughout the carrier.

Partnerships and Innovations

A walk into StoneRiver’s innovation lab gives us a firm image of the company’s ability to transform the major market challenges into robust solutions. The team constantly gathers information on consumer and technology trends from industry experts to build solutions that meet the market requirements.

For instance, taking advantage of the cloud computing revolution, StoneRiver recently partnered with Microsoft Azure to enable agility, flexibility, and lower the total cost of ownership to their clients, versus traditionally provisioned insurance systems. Elaborating on the same, Burke says, “Microsoft is clearly the leader in cloud technology, and that strength, combined with StoneRiver’s breadth in insurance technology, makes the partnership highly valuable. In bringing our broad insurance system offerings to the cloud, we extend our footprint and provide better solutions to customers choosing to move to the cloud.”

The Future is in the Cloud

Undoubtedly, insurance businesses are forming new networks to provide a more customized product to clients. In addition, with the new level of hyper-connectivity and data harvesting being facilitated by the IoT, StoneRiver is ready to meet the changes that digital transformation is driving. The firm will soon launch new capabilities that will help Life and Property/Casualty insurers deliver service with greater efficiency. “Our systems are moving to the cloud and carriers will have StoneRiver portals that will make it easier for the insured as well as the agents to work with the carrier any way they want to,” says Fittes, pointing out the system’s flexibility and the team’s in-depth expertise.

Moving forward, Burke is also confident that the shift to a SaaS-based model will also provide greater flexibility and speedy go-to-market strategy. “The SaaS migration, which we are focusing on right now, will redefine the process for its quicker and cheaper integration process—new products and services can be launched in a much more timely manner,” he concludes. With all these changes disrupting the industry, remaining nimble and connected makes all the difference, which StoneRiver is doing the right way!

- Ambili Sasidharan
    November 03, 2016