Pacific Claims Management is a licensed Third Party Administrator (TPA) and provides claims administration and management services to both public and private sector self-insured employers in the state of California. With a mission to understand an employer’s pain points and drive operational excellence, PCM helps its clients save money, streamline processes, and efficiently serve injured employees.
According to the California Department of Industrial Relations, private and public sector employers in California reported over 466,000 nonfatal workplace injuries and illnesses. Occupational injuries occur, regardless of industry, company size, or location. Luckily, workers' compensation insurance provides employees with critical coverage and protection when they suffer from an occupational injury or illness. But the task of administering workers' compensation claims is complicated for employers, particularly self-insured employers who are responsible for administering the claims themselves. Delays or errors made while administering a claim can negatively impact a worker’s recovery as well as the employer’s bottom line. This increases frustration and dissatisfaction for all parties involved.
As a Third Party Administrator (TPA), Pacific Claims Management (PCM) removes the complexity of claims administration for both public and private sector self-insured employers. With decades of experience in workers’ compensation, Jerry Laval, President of PCM, launched the company in 2011 to respond to a need for a more detailed and service-oriented TPA to service self-insured employers in the California market. “Many TPAs draw the line at claim administration,” explains Laval. “Our mission is to go beyond providing administration services and understand exactly how to help employers make a difference for their employees, save money, and streamline operational processes.” PCM invests a great deal of time into each client relationship and leads with a ‘targeted client base and superior client support’ mentality. “We look at our clients like partners,” says Randy Bugg, VP of Claims at PCM. “We review their needs before we initially meet to understand the impacts we can make and what’s in their best interests in the short- and long-term.”
To establish PCM as a different kind of TPA, the team needed a flexible, secure, and customizable software solution to address the unique and evolving needs of its clients.
PCM’s initial goal was to host a claims software solution on-premises. “When we started, we focused on running our server. We believed that would provide the tangible control we needed,” says Bugg. PCM evaluated a few providers and software options before deciding to run Insurity ClaimsXPress in a self-hosted environment.
“We wanted to talk to a company we knew had been successful in our industry. We approached Insurity about its ClaimsXPress solution because we felt it would be the best software to grow our business,” says Laval. “Because the ClaimsXPress software is designed by workers’ compensation experts with experience in the industry, they're able to understand any challenges we have or questions we raise quickly, and efficiently make changes for us within our guidelines. And by working within a platform that’s tailored to our industry, we’ve been able to evolve a number of our internal processes,” explains Bugg.
However, with great software comes great responsibility, and the PCM internal team weren’t experts in running and managing claims software on their hardware. The team quickly found that self-hosting and managing the claims software themselves took more time and was less cost-effective than they’d envisioned. “There are continuous updates and changes needed for the software to stay current,” says Laval. “Updating a claims system is cumbersome given the number of schedules, regulations, and additional information that must be regularly updated and changed, potentially in every state in which you write. We didn't want to, nor could we afford to be stagnant with our technology, and we ended up incurring large consulting fees to run the software on our hardware effectively."
The team wanted a hosted solution that enabled them to focus less on software updates and management and spend more time driving effective client solutions. The company again turned to Insurity, this time interested in the ClaimsXPress software as a service (SaaS) solution, Insurity’s SaaS version of ClaimsXPress running on AWS.
Insurity has a mission simple in message, yet disruptive in practice: to make technology simplify insurance. The company has several software products for enterprise insurance clients along with service delivery offerings to help customers drive business value out of their software. “Historically, Insurity has developed deep expertise in the ISO lines of insurance that are filed within each state,” explains Jonathan Victor, CIO at Insurity.
In recent years, Insurity’s focus has transitioned from a deployed software model to a cloud-first SaaS model. “Given the strict security requirements inherent in our space, there is a fair bit of scrutiny that comes with every deployment,” explains Victor. “The best way to couple both our insurance and technology expertise is through SaaS. We concentrate our efforts to approach the SaaS business with an enterprise perspective. Our goal is to ensure our software is built and continuously evolves to stay at the forefront of the commercial insurance software as a service market.”
For PCM, the choice came down to running ClaimsXPress on AWS themselves or moving to the ClaimsXPress SaaS offering managed by Insurity. “When we started looking at hosting alternatives, a recommendation from our trusted IT resource was to use AWS,” explains Laval. “We ended up with the best of both worlds - we run on AWS and are hosted by the experts at Insurity. It made sense to put everything with one company and turn to a hosted solution. And I will tell you…making that choice has taken away a lot of our day-to-day concerns,” says Laval. The team transitioned from a self-hosted solution to ClaimsXPress in the cloud efficiently with Insurity’s help every step of the way.
Each ClaimsXPress client production environment which runs on AWS is architected for scalability, security, and reliability. PCM’s architecture is an instance of ClaimsXPress running in a multi-tenant environment on AWS within an isolated Insurity Virtual Private Cloud (VPC). Data is encrypted at rest using Amazon Elastic Block Store (EBS) block-level encryption, in flight within the VPC using the VNS3 Encryption platform, and in transit to the desktop using 256-bit SSL-based encryption. All data is replicated to a disaster recovery instance, and for increased redundancy PCM’s production environment is deployed across two AWS Availability Zones (AZs). Insurity uses Amazon Elastic Compute Cloud (EC2), Amazon CloudWatch, and Amazon Simple Storage Service (S3) as critical components within its ClaimsXPress offering.
ClaimsXPress – Architected for Redundancy and Availability on AWS
Additionally, Insurity uses AWS Partner Network (APN) Technology tools and applications to run ClaimsXPress, including:
- Alert Logic for advanced threat detection, intrusion detection/prevention, and active monitoring of the production environment,
- App Dynamics for application performance and end-user monitoring,
- Cloudberry for file system backups and encryption of data in real-time before the data is written to S3 buckets,
- CloudCheckr for validation of security configurations on all public-facing endpoints in the AWS environment such as Amazon Elastic Compute Cloud (EC2) instances, ELB, and Amazon Simple Storage Service (S3) buckets,
- Metricly for system management, alerts, and AI-based trend analysis for system performance and stability,
- VictorOps for alert consolidation and escalation, and
- Sumo Logic for log collection and storage.
The PCM team needed assurance that once in production on ClaimsXPress they’d still be able to access their data and rapidly make changes to their environment. To address this concern, Insurity provides the PCM team with a test instance of their ClaimsXPress environment. “Within our test environment, we’re able to model what we need to do with our data and provide Insurity with our requested changes, which are then published to our production instance quickly and seamlessly,” says Bugg.
Since moving to ClaimsXPress, PCM has been able to focus on what’s important: building customer relationships and helping clients improve their approach to claims management. It’s also given PCM the flexibility it needs to respond rapidly to changes in the workers' compensation industry in California. “The costs we were incurring, having consultants make updates and customizations to our self-hosted environment, are no longer an issue,” says Laval. “We’re able to maintain the flexibility that has kept us on the cutting edge in the Workers' Compensation Insurance industry, and our uptime on ClaimsXPress has been tremendous.”
For the Insurity team, the decision to go SaaS-first is traced back to the company’s ultimate desire to use technology to simplify insurance: SaaS helps customers drive insurance solutions. “We’ve historically had a much greater span of control over the success of ClaimsXPress implementations when they run in our cloud vs. being deployed by clients,” says Victor. The success comes down to Insurity taking ownership of and responsibility for all ClaimsXPress troubleshooting, updates, and maintenance. “Hosting a SaaS solution brings vendors and clients closer together. As a vendor hosting the solution, troubleshooting and resolving software issues is inherently on us, and we know our environment intimately. We focus on the challenge at hand and resolve it quickly,” explains Mack.
From the PCM team’s perspective, relative vendor invisibility is a crucial indicator of how well the vendor’s solution is working for them. “Good software and cloud providers are invisible to people like us. If their solutions are consistently performing as we need them to be then they won’t be in our line of sight on a day-to-day basis,” explains Bugg. “It's that stability and continuity that we rely on. Using ClaimsXPress on AWS is simply easy for us, and that’s been critical.”
Insurity, Inc. helps property and casualty insurers to modernize their enterprise and achieve their business goals. Insurity’s property & causality processing, data integration and analytics solutions are backed by deep insurance industry experience and SaaS expertise. Insurity is an AWS Partner Network (APN) Technology Partner and runs ClaimsXPress on AWS to provide clients consistent, uninterrupted access to the latest version of ClaimsXPress, without having to make a large upfront IT investment.