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Johnny C. Taylor, Jr. Offers Great Reset Survival Tips at RISKWORLD 2023

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ATLANTA—RISKWORLD 2023 kicked off on Monday with a high-energy keynote delivered by Johnny C. Taylor, Jr., president and CEO of the Society for Human Resource Management (SHRM). Taylor looked back on the last three years as a time characterized by major shifts in the way work and operations are performed, suggesting that it was an opportunity for the risk profession to lean in to change.

Taylor transported the audience back to March 13, 2020, when after nearly a month of rising public health fears, Proclamation 9994 was announced by the White House, declaring a national emergency concerning the COVID-19 pandemic.

RISKWORLD 2023 kicked off on Monday with a high-energy keynote delivered by Johnny C. Taylor, Jr., president and CEO of the Society for Human Resource Management (SHRM). Taylor looked back on the last three years as a time characterized by major shifts in the way work and operations are performed, suggesting that it was an opportunity for the risk profession to lean in to change.

“The way we work changed on that day,” Taylor said. He also noted the correlation of the change in the thesis for his book—from The Great Pause to The Great Reset—to reflect the reality of the time more accurately. He said the data compiled changed, and became more qualitative. “The data we collected told the story about employees saw the world.

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”

Based on data and interviews, along with anecdotes from his own experience leading SHRM, Taylor offered “survival tips” for the audience to use in an effort to navigate patterns in employment and productivity.

One tip was to flip the script on recent employment trends, such as how the “Great Resignation” of 2020 and 2021 has evolved into what he referred to as “The Great Regret” of 2023.

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He referenced the 9.9 million currently open jobs as a negative, but one that risk professionals can help correct through methods that may have seemed counterintuitive just five years ago, such as likening career and hiring patterns to a boomerang for the employee and employer. Taylor leans into this notion by contacting recently departed employees at 30-, 60- and 90-day intervals, to gauge if their new endeavors are gaining traction and whether their return would be suitable.

“The best companies are doing this more and more,” he said. “We know regret is real and employees who felt the grass is greener realize it might not always be the case.

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If someone was a great performer and left on the right terms, you should consider [reaching back to them].”

He also encouraged attendees to look within improve their hiring and employment practices. “You must not only hire for someone’s technical competencies and ability to do the job, but they must be culturally aligned,” he said. “News alert: They can’t be culturally aligned if you don’t have clarity around what your culture is. Do that, and you’ll solve for 90% of the problems in the Great Reset.”

Charting Risk Management’s Future at RISKWORLD 2023

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ATLANTA — As RISKWORLD 2023 kicked off on Monday, RIMS 2023 President Jennifer Santiago took the main stage of the Thomas B. Murphy Ballroom in Atlanta’s Georgia World Congrees Center to welcome attendees and help them prepare for three days of risk management education, insight and networking.


“You will leave here ready—ready to lead, to take action, ready for the next step in your career, and ready to help make the world a more sustainable and resilient place,” Santiago said.  

Santiago introduced RIMS CEO Gary LaBranche, who made his RISKWORLD debut after having joined the Society in June 2022. LaBranche quickly established a presence as the new face of RIMS, having appeared at RIMS global, regional and chapter events regularly as well as those hosted by other organizations in the past year. He unveiled a video detailing RIMS’ new 10-year strategic plan and mission statement, which he said, “makes the case that risk management professionals play an indispensable role in making organizations more resilient, in driving strategy and decision-making and generating better outcomes.”

“For this plan to work, it’s going to require contributions from everyone in the risk management community,” LaBranche said. “From C-Suite executives and senior risk leaders to rising risk professionals and those in adjacent fields like HR and IT. Just as important, it will require the perspective and contributions from professionals from all walks of life and from different cultures.”

Santiago and LaBranche also had major news regarding the future of the RIMS-CRMP (Certified Risk Management Professional), announcing a strategic partnership with the Pan-Asia Risk and Insurance Management Association (PARIMA). The goal of the collaboration is to establish a global standard of knowledge and professionalism for risk professionals. Central to this endeavor, PARIMA will market, promote and deliver the RIMS-CRMP Exam Prep Workshop to Pan-Asia’s risk community while RIMS will deliver course materials, case studies, instructors, and manage administrative and certification duties.The expansion, they said, is “critical to the profession’s future.”

Santiago and LaBranche were joined onstage by Franck Baron, a co-founder and chairman of PARIMA and RIMS-CRMP Commission Chair Ward Ching to officially sign a memorandum of understanding and commemorate the historic collaboration.

“Setting a global baseline for risk management skills and knowledge is a critical first step to advancing the profession,” LaBranche said.

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“As a unified force, RIMS and PARIMA are ready to deliver greater opportunities for risk professionals in the Pan-Asia region to earn the RIMS-CRMP, strengthen risk programs, drive organizational resiliency and advance professionally.”

LaBranche closed the general session by beaming up a clip from the original “Star Trek” television series, in which Captain Kirk realizes that he and his crew were in the business of risk. He noted the similarities between the Starship Enterprise and RIMS.

“RIMS has been that vessel for exploration and discovery for the risk management community for 73 years,” he said. “For generations, RIMS has been a source of guidance, education, connections and opportunity. But times change, new challenges emerge, and new journeys call us forth. Soon after I started my voyage with RIMS, the Board of Directors and the management team engaged in a comprehensive analysis and assessment process to plan for the future of RIMS. The result is a new strategic plan that charts a course for where RIMS aims to go in the future. There’s no better place to share that vision than here at RISKWORLD.”

left to right: Gary LaBranche, Franck Baron, Ward Ching and Jennifer Santiago

New NAAIA Report Focuses on Next Steps for DEI in the Insurance Industry

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As Black History Month kicks off, February presents a great opportunity to not only celebrate the history and accomplishments of African Americans, but also to meaningfully assess and advance diversity, equity and inclusion measures with the goal of ensuring lasting change rather than lip service. To that end, the National African American Insurance Association (NAAIA) recently updated its research on its members’ experiences and challenges in the insurance industry, releasing the new study The Next Steps on the Journey: Has Anything Changed? The new research updates NAAIA’s 2018 report The Journey of African American Insurance Professionals, evaluating what progress has or has not been made over the past five years, particularly given the increasing focus on DEI programs and, specifically, many companies’ discussions of DEI efforts after the murder of George Floyd brought the Black Lives Matter movement to the fore.

“On one hand, there is a prevailing sense from Blacks/African Americans in the sector that companies are seeking to find credible and practical ways to solve longstanding inequities,” said Omari Jahi Aarons, executive director and chief operating officer at NAAIA. “However, the report highlights that many of these actions are falling short because they are not addressing inequities at the foundational level.”

For example, most survey respondents agreed that their organizations were committed to diversity (60%) and inclusion (61%), and nearly half felt that their organizations were committed to advancing equity (43%) and equality (48%). Nevertheless, 84% of respondents said they continue to encounter obstacles in their career progress compared to other under-represented groups because of either conscious or unconscious racial bias.

Respondents shared several key changes that risk and insurance organizations can make to “more fully achieve and prioritize diversity, equity and inclusion,” such as enhancing recruitment and talent identification initiatives and placing greater focus on recruiting from HBCUs and institutions with substantially diverse student populations, promoting African Americans to officer-level roles, increasing board diversity across racial and gender identities, addressing compensation and pay inequities, increasing pay transparency, offering more mentorship opportunities and extending support through executive coaches.

To support the advancement, networking and development of African American risk practitioners, the report offers a number of recommendations “to catalyze conversation and action” for risk and insurance professionals, including:

Recommendations for Black/African-American risk and insurance professionals:

  • Demonstrate success: Attracting talent to the risk and insurance industry will depend upon the full engagement of Black/African-American insurance professionals who can illuminate under-informed or unaware communities and constituencies about the opportunities in the industry.
  • Seek and offer mentoring: Throughout the research, mentoring was mentioned as a critical factor for career success and satisfaction. Individual professionals can articulate their respective needs for mentoring and can provide mentoring to, and with, each other.
  • Get and provide exposure: Getting exposure and gathering knowledge about the industry can be a powerful, effective remedy to longstanding barriers for underrepresented groups. Individuals can consider their own social networks to foster partnerships to strengthen industry exposure, increase validity of career opportunities and encourage young people to view risk and insurance as a viable and rewarding career path.
  • Advocate for self and for others: Individual professionals must find ways to take charge of their careers, connect and exchange ideas with other professionals. The research revealed that most participants did not belong to any industry-related associations, which could hinder career progress and success. Expanding networks and deepening ties to the industry should be a top priority for every individual, and membership costs should be viewed as an investment in personal professional development. Facilitated introductions for employers and NAAIA to Black/African-American organizations can also foster engagement and collaboration.

While many organizations have introduced DEI programs and proclaimed support for African American employees since the Black Lives Matter movement took root, the survey found many of these moves lacking in actual impact thus far. “Respondents identified the tragic murder of George Floyd and many other Blacks/African Americans and People of Color as the catalyst for centering conversations on race and the risk and insurance industry has responded with a host of new initiatives to address disparities,” NAAIA noted. “Respondents reported increased exposure from initiatives specifically DEI-related training (57%), support for employee resource groups (35%) and mentorship programs (21%). However, these initiatives have not translated to career advancement.”

To help employers improve their DEI efforts, the report also offered the following recommendations:

Recommendations for employers:

  • Avoid performative actions: DEI-driven activities and training notably emerged in response to the events of the last few years. However, many organizations are “checking the box” by undertaking noticeable, but not meaningful, initiatives. A thoughtful and careful review of DEI initiatives is an important first step to ensuring that they are not merely performative, requiring courageous conversations by several stakeholders about the purpose and intent of each activity or program.
  • Turn barriers into gateways: With intention, employers should ensure that there are measurable DEI goals and outcomes visible at all levels of the organization. Measurements can include internal or third-party pay equity and workload balance analyses or tying compensation to the successful implementation of DEI initiatives, especially at middle managerial levels.
  • Use leverage: More employers could leverage the vast networks of employees and employee resource group participants for recruitment and to influence internal mobility, as well as to increase levels of employee engagement. Often, employers underestimate the power of personal connections and references within minority communities, foregoing opportunities to build awareness and enhance their brands both internally within their organizations and externally.
  • Provide meaningful, substantial support: Supporting NAAIA local chapters through sponsorship, mentoring and partnerships and cultivating multiyear partnerships with Black/African-American community professional, civic and youth organizations can lift a company’s profile. More importantly, these types of partnerships also allow for employers to create greater access to internal subject matter experts to communities that are underserved on relevant macro business and professional development topics (e.g., financial literacy, wealth creation or cybersecurity).
  • Connect human resources, senior executives and ERG leaders: Several respondents noted that beyond nominally sponsoring an ERG, many executives were not directly involved in planning or activities. Most of the ERGs are organized and driven by employee volunteers, which often renders them less effective because of time and work constraints. If human resources, senior executives and ERG leaders can convene to discuss mission, alignment with company goals and resource allocations, there is a greater likelihood of continuous progress.

For more of the report’s findings and recommendations, click here to read NAAIA’s The Next Steps of the Journey: Has Anything Changed?

Identifying and Preventing Provider Fraud in Workers Comp Cases

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Claimant fraud and premium fraud are two of the most well-known types of workers compensation fraud. In these cases, a worker may intentionally fake an injury (claimant fraud) or a business owner may misrepresent their employee headcount or incorrectly classify employees to obtain lower insurance premiums. Now, a lesser-known type is occurring with greater frequency: provider fraud.

Provider fraud occurs when a professional other than the injured worker or employer accepts a bribe or illegal kick-back in exchange for patient or client referrals. The circle of potential culprits includes lawyers, translators, doctors, chiropractors, nurses, and telehealth professionals. Opportunity, incentive and rationalization—the “fraud triangle”—are key factors that go into a person’s decision to commit insurance fraud. These factors have been exacerbated in recent years, due in large part to the pressures presented by the global pandemic and the growing reliance upon remote services.

Most schemes involve knowingly billing for medical goods and medical and legal services that are unnecessary or not provided at all. A chiropractor, for example, conducted illegal medical evaluations and billed these evaluations, claiming that he was approved as a medical legal evaluator. In another example, an attorney named his daughter as the owner of a translation services company, while in reality he maintained ownership of the business. Each time the attorney was hired, the translation business was also engaged and billed its services. Provider fraud is increasingly prevalent in California and Florida due to each state’s workers comp rules. For instance, in California, a provider can file their own lien with the Workers’ Compensation Appeals Board, even if the bill was denied. California is the only state that allows providers to file their own adjudication. At a higher rate than in other states, healthcare providers in California and Florida are sometimes found billing for services that were never rendered, billing for more expensive services than were actually provided, ordering unnecessary tests or procedures, and providing kickbacks to referring physicians.

So, how can we pin down provider fraud?

  • Review Provider Invoices and Reports: Risk professionals can spot potential fraud cases and fraud trends by closely reviewing provider invoices and reports and scrutinizing those invoices that are close to, but not at the top of, typical billing charges. In the workers compensation system, there are typically five levels of a doctor evaluation: Level 1 is the cheapest while Level 5 is the most expensive. Fraud often occurs in Level 4 billings since Level 5 would be too obvious. Providers who consistently bill at Level 4 could be a red flag for fraud.
  • Shine a Spotlight on Supplementary Services: Insurers sometimes overlook that provider fraud can occur with supplementary services such as translation and transportation companies, copy services, medical equipment suppliers and pharmacies. It is not uncommon for insurers to discover that these schemes may involve a criminal enterprise (possibly a referral network) orchestrated by individuals who are not medical or legal professionals. While claimants can be complicit, often they are unwittingly involved and potentially subject to treatment that is unnecessary or even harmful. 
  • Consider Emerging Tech to Pinpoint Provider Fraud: Artificial intelligence and machine learning are game-changers for fraud investigations. Through the analysis of historical claims data and insurance adjuster notes, some technologies can help professionals discover fraudulent claims faster. For instance, AI can be particularly effective at the entity level when a doctor or hospital that is identified as fraudulent can be added to a “bad actors” list for review in future claims. If you do not have a fraud feedback loop, start gathering information now. As risk and insurance professionals, we rely on business rules and claims adjusters to catch all the details of a claim and then form a cohesive narrative to investigate. While business rules work, the fraud feedback loop is necessary to effectively train machine learning models to detect patterns and flag anomalies.

Workers compensation insurance provider fraud has become a multi-billion-dollar industry that is bad for business. It is costly for insurance companies to identify and prosecute, it inflates costs for goods and services that honest business owners rely on, and it stokes consumer apathy and distrust in the insurance system. Risk and insurance professionals need to be aware of the warning signs so they can work diligently to detect and prevent it.