Jahangiri: How is innovation playing a role in supporting nib Health Funds (nib)’s strategy to attract and retain the Gen-Y customer base?


Kneale: Relevant innovation is critical.  At nib we are focused on innovation that:

• Makes our communication with customers more relevant and effective. We have achieved this through the introduction of online video streaming; email; online access, services and information; and mobile communications through SMS, mobile sites and services.
• Saves our customers time, makes it easy to do business with us and delivers real value from their product they have with us. Eliminating the need for paper submission, online claiming, tele-claiming and interactive self-service technology at key locations have been key to delivering these benefits.
• Supports our customers as they go through a health episode. We have technology available to customers that allows them to access details regarding health service providers and also health information relevant to their condition.

However, technology is not the sole focus of our innovation.  We need to have a clear understanding of our customers’ requirements and ensure that any innovation continues to meet these daily needs.  Product and cost innovations are central to this understanding.  A change in technology is not enough if your product is not competitively priced or suitable for a customer’s particular life stage.


Jahangiri: What advice can you give IT executives on how to protect against the risk of reputational damage with the advent of social media supported products and services? 


Kneale: Being such a new medium, this is a key question that many of us are facing and still working through. The social media space is still evolving, as is our understanding of the role it will play in communicating with our customers.  I am convinced it has had some impact, which is only going to grow.  What is apparent is the ability for customer feedback to now be spread faster and far wider than ever before.  A piece of negative customer feedback on Twitter or Facebook is now potentially all pervasive. How to turn that negative into a potential positive will be the key. The first step is having the capacity to monitoring the sites and responding as quickly as possible.
In terms of company reputation and customer privacy, we are carefully educating our staff on the ramifications for communicating confidential or personal information on public domains such as Facebook.  This will become an increasing challenge as the popularity of these social media sites increases.


Jahangiri: How close is the insurance industry to automating end-to-end healthcare claims processing online?

 
Kneale: Private health insurance is well advanced in terms of our claims processing automation, with electronic systems now available for both ancillary and hospital claiming.  More than 70 per cent of out-of-hospital ancillary claims are processed electronically at the point of service.  This allows customers to receive their health insurance benefit straight away, while the health fund receives accurate claims data instantly.  A similar point of service system used through hospitals was launched by the Federal Government in July 2008. This has resulted in a significant increase in electronic processing for hospital and specialist claims.


As a company nib is well advanced in this area, and has taken the further step of outsourcing the automation of the residual paper-based claims and in-bound documentation using not just imaging but OCR.  This, coupled with our increasing rule base in the system, is gradually increasing our STP rate.


nib was one of the first health funds to offer online claiming and we are constantly evolving this capability for those claims we cannot automatically process at the point of service.  We recently added the ability to upload receipts and have a number of other innovations that will be launched in the coming months.


Jahangiri: How do you ensure your systems are kept abreast of sophisticated techniques used in fraudulent claims and identity theft?


Kneale: Monitoring fraudulent claiming trends is a key focus of our business as we aim to minimise our claims expenses. We cooperate as an industry and with the appropriate professional bodies to ensure we remain at the forefront of fraud detection. 


Our broader position regarding fraud is to practice overt vigilance. Our experience has shown that this is more effective in changing behaviour as opposed to prosecution of a few minor cases.  If people know we are watching they tend to self regulate.  In addition, we conduct audits on online claims, however the level of potential or actual fraud is very low.


The majority of our large claims are paid directly to hospitals; the likelihood of fraud or identity theft by a customer around these transactions is minimal.  Other claims are relatively small by nature when compared with those associated with the banking and life insurance industries. As a result, the fraud risks are also relatively low.
Maintaining tight controls around our privacy and security systems and processes ensures we provide our customers with the highest level of identity protection. We are constantly monitoring changes in this technology to ensure this remains the case.


Jahangiri: What are your key technology projects for the year ahead?


Kneale: While this is a challenge for most business, we aim to place our core application development on a more flexible and responsive footing to enable quicker response times to the business.


More specifically, our current technology projects include:

• improving our tools that support proactive and reactive communication with customers;
• introducing new customer self-service capabilities, some of which will be firsts for our industry;
• further accelerating automation and STP of inbound and outbound correspondence; and
• finalising our server virtualisation to drive the business benefits

Jahangiri: What emerging IT trends are changing the face of the health insurance sector?


Kneale: Claims automation continues to be one of the biggest challenges in the industry, as all health funds aim to drive greater efficiencies within their business. Due to recent technology changes, approximately 60 per cent of all nib claims are now received electronically, with the aim of increasing this to between 80 per cent and 90 per cent in the next two to three years.


The introduction of electronic channels has dramatically changed the way we interact with customers over the past five to 10 years and this will only continue in the future. Technology changes will help us to improve proactive customer interactions. As mentioned previously, social media is set to play a role in customer communication, but to what level remains to be seen.


Virtualisation, outsourcing and the use of cloud computing are other changes in technology that are set to shape our business and the industry.


Jahangiri: How do you see the customer channel evolving in health insurance within the next  five years? 


Kneale: Channel integration and channel choice will continue to be an issue not only for ours but all service industries.  The challenge is to provide customers with multiple options to choose from for different interactions.  However, making it simple and easy to understand is the key.  There are a number of exciting emerging technologies that we can now leverage in this space that will allow us to more efficiently and effectively service customers.


Jahangiri: What has been your proudest achievement since you started at nib?


Kneale: My team.  I am part of a fantastic team of open minded individuals who are always looking for a better way to do things.  I can’t take credit for that but it does make me very proud.


The broader nib team has achieved some great industry firsts through technology and service enhancements that our competitors have quickly emulated.  This is a source of pride for all of us.


Jahangiri: Every IT leader has a legacy they wish to be remembered for. What is yours?


Kneale: That I made a noticeable difference and that I was fair, honest, and insightful, particularly in terms of my interaction with people and my team as we deliver business results.  I think the ‘way’ we do things is equally, if not more important, than ‘what’ we do.  This is the hardest thing to master, but I would like to be perceived as having aimed for it and as always working as part of a team and being willing to learn.


From a specific IT point of view, I would like to feel that we have achieved the right level of responsiveness, flexibility, and pragmatism to meet the needs of the business.  If I can leave with the business thinking that IT is not a ‘handbrake’ but an enabler of change I will be happy.