Beyond the Claim

This week features host Marc Cunningham’s conversation with Paul King (Chief Client Officer at myMatrixx), which took place at this year’s RIMS RISKWORLD2024 conference. Paul covers all things Pharmacy Benefit Management (PBM)—from implementation to challenges to benefits.

Join us as we discuss:

• How clinical edits fit into the PBM process
• The concept of benefit neutrality and treating whole-person health
• Using virtual healthcare platforms in managing conditions like COPD, asthma, and obesity

If you’re a reporting entity, there’s a good chance you have October 11, 2024 circled on your calendars, as it’s when Medicare’s Section 111 becomes applicable following the effective date of December 2023. Naturally, questions remain for many regarding what effective compliance looks like—and when companies need to fully comply by. Given the hefty penalties that come along with the guidelines, most companies truly can’t afford to be left in the dark.

This week, we’re joined by Suzanne Jordan, Compliance Manager at Broadspire, who helps break down Section 111 and demystifies the various dates, forms, processes, and acronyms companies that all manner of companies need to know. 

Join us as we discuss:

• The process for registering and recertifying with Medicare as a responsible reporting entity (RRE)
• The various challenges for meeting Medicare reporting standards
• The claim review process and the relevant deadlines for reporting entities

Just how valuable is the human touch? And how necessary is it? More and more, it seems like the winning recipe for success in the Risk & Claims Management industry involves harnessing cutting-edge trends and technology without making your clients or team members feel like they’re dealing with an organization run by analytics and machines. It’s a challenge—but also an opportunity.

On today’s episode, we’re joined by Crystal Sanderson, National Director of Strategic Partnerships and Placement at McGriff Insurance. Crystal harnesses more than two decades in the insurance industry—as well as experiences in many different areas—to continuously redefine and sharpen what effective internal collaboration and client support looks like.

Join us as we discuss:

• The role of market dynamics and internal company culture in shaping strategic vision.
• How unifying cultures and expanding into new industry verticals can excite and rejuvenate an organization.
• The value of non-linear career growth and exploration.

The importance of partnerships and collaboration isn’t limited to product-driven spaces. In fact, they hold just as much weight in the program space. Making sure you work with top-of-the-line partners in mutually beneficial agreements can help build a strong brand across the high-competition program marketplace. But how are partnerships and M&As decided in the modern MGA environment?

We’re joined by Brad Isaacson, Senior Vice President, Program Development at Amynta Group, who shares all things program — from new trends, best practices and success stories, Brad’s insights and experiences can help you shape a top-tier program with the right partners and cutting-edge strategies.

Join us as we discuss:

• The MGA space and business segments at Amynta
• The impact of hardening in the program industry
• Current state and emerging trends across the program industry

With countless moving pieces, businesses function like extremely complex machines. But this doesn’t make one function more important than any other. So how do you address risk management while simultaneously fostering internal growth? And what metrics and systems can be put in place to accurately judge success and while also highlighting areas of weakness?

Today we speak with Brian Riley, Associate Vice President at Compass Group Canada, a food facility service provider that serves countless industries including healthcare, sports, leisure, education and beyond. Brian dives into exactly how his team works to balance business and ensure each function of the machine works in unison with proper care and attention.

Join us as we discuss:

• Key indicators to implement in risk management systems
• How to deliberately impact team members’ success
• Open communication as the key to teamwide growth and success

The use of captives in industries such as the sharing and gig economies, as well as in unique risk areas such as cannabis and crypto, has become more prevalent due to the challenges faced by the commercial market in pricing and structuring insurance programs for these risks.

Richard Cutcher, Founder at Captive Intelligence & Host of the Global Captive Podcast, says that in particular, captive owners in the gig economy require claims support, and Crawford plays an important role in this area. The popularity of cell captives is growing, with some large structures seeing members paying up to $20m in premiums per year. Some even suggest that well-capitalized captives could take on significant business from the parent and start setting prices for premiums.

Join us as we discuss:

• What the benefits of using AI in supply chain management are
• How AI can be integrated into supply chain management processes
• When the best time to implement AI in supply chain management is

We’ve entered the era of the accommodating workplace.
From telecommuting to ergonomics, recent changes in the status quo have made the workforce more welcoming to more people than ever before. And that’s good news for everyone.

Today, we’re speaking with Matthew McCord, Senior Consultant at Job Accommodation Network, and Nesha Courtney, National Product Manager Advocacy, Biopsychosocial, Disability, and Return to Work Services at Broadspire, about what’s fueling the trend.

Join us as we discuss:

• Why companies are investing in ergonomic modifications
• The COVID effect on accommodation in the workplace
• How legislation is impacting accommodation

Offering products and services across Latin America is no small task. The region is massive and its languages and traditions just as varied. What works in one country may not work in another and even exact translations may be problematic because of cultural nuances. It’s an opportunity that Roberto McQuattie, President, Latin America at Crawford & Company, has learned to manage with finesse. 
A reluctant chip off the old block, Roberto followed in his father’s footsteps to insurance, but certainly did it his way and in ways his father likely could not have imagined. 
Join us as we discuss:
How to navigate the challenges associated with different customs, languages, and traditions
What Crawford’s Latin American strategy looks like
Where to offer various products and services in a varied region

Are you innovating? We all think we are, but is your company really committed to driving impact for clients, colleagues, and industry culture in the midst of a changing world? Is your company committed enough to hire somebody precisely to do that job?

That’s exactly what Rachel Perry, Chief Innovation Officer, Commercial Risk North America at Aon, is here to do. The way Rachel sees it, you can’t have innovation if you’re not driving growth for the company, solving client problems, and growing right as a firm.

Join us as we discuss:
What a Chief Innovation Officer does to be successful
Why diversity, equity, and inclusion is important for innovation
How to not just hire a good team, but retain them too

As a broker, you place a mind-boggling breadth of coverage in a lot of different industries. It’s a vast universe perfectly suited to a lifelong learner who wants to shape the future of brokerage.

Hear our conversation with Donna MacConnell, SVP, Managing Director, Claims at IMA Financial Group, Inc.:
Donna’s nonlinear career trajectory from psychology to SVP
The emerging theme of specialization in insurance
Respect for expertise and a call for DEI in the field

More information about Donna and today’s topics:
LinkedIn Profile: https://www.linkedin.com/in/donna-macconnell-bab9967/
Company Website: https://imacorp.com/

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