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Industry Insights

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Eight Months into Coronavirus – What Have We Learned, Where Are We Going?

By: Mark Lawrence December 4, 2020
I went home from my office at 501 Penn Avenue in Pittsburgh, PA, around noon on March 18, 2020, after making sure one of our new employees had the computer equipment she needed to work from home. During my commute, I listened to a President Trump news conference on CNBC radio discussing the Coronavirus. At the time, I thought we would be home for six to eight weeks, and then we would be back in the office and things would return to normal. Well, a lot has happened since then.
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Predicting the Unpredictable

By: Justin DeCroo September 29, 2020
The element of surprise. Facing the unknown. Making predictions. That’s what comes to mind when students interested in the actuarial profession ask me why I have enjoyed this career for the past 22 years. There are always problems to solve, but on any given day, I can never fully predict exactly what will come my way. Every morning, I start with my short list, but something unanticipated is usually on the horizon, case in point, the Coronavirus.
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Innovating for Next-Level Stop Loss Claims Processing

By: Kristen Baker September 9, 2020
You can probably imagine that working with more than 100 third party administrators (TPAs) means that HM Insurance Group (HM) receives tens of thousands of claim detail files every year. It’s a lot of data to manage. Files come into a secure, designated Stop Loss claims email box or via an FTP site. They are then saved to a corporate drive so our Claims team can format the TPAs’ Excel files into a format acceptable for loading into our claims system. The entire process takes a lot of manual work.  
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Coronavirus Considerations – Underwriting in a Changing Self-Funded Risk Landscape

By: Mark Lawrence May 12, 2020

I have a confession to make. As I watched the Coronavirus pandemic spread throughout the world and into the United States in late January and February, I was openly derisive about the potential impacts. I was convinced this would just be another flu (don’t we have one of those already), and this would not likely be a significant concern, both from a risk/loss perspective and from a societal impact standpoint. It’s a good thing I learned an important lesson a long time ago: be humble in defeat. 

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Do Your Part to Recognize and Report Health Care Fraud

By: Cathy Safran March 24, 2020

Health care claims are more expensive than ever (many exceeding $1 million). In this industry, we frequently see the impact catastrophic claims could have, and it’s our job to help protect our clients’ financial stability should they face them. To make matters worse, some statistics I have heard in training seminars show that up to 10 cents of every dollar spent on health care goes toward paying for fraudulent health care claims.

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