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Essay on How Insurance Works

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In August of 2003 I took a position with AdminOne Corporation located in Bentonville, Arkansas as a Financial Services/Systems assistant. AdminOne is a privately owned and operated Third Party Administration that provides all of its clients virtually all their benefit needs. We work directly with employers representing a wide variety of industries to provide a comprehensive assortment of services with hassle-free Customer Service.

For organizations determining that the high cost of health care requires alternate methods of funding, plan design, and plan management, AdminOne can provide many different functions. Some of these functions include: preparing all communication material, assisting in the implementation of the plan, recommending cost containment procedures and plan document changes, analyzing existing plan benefits and funding methods. Additionally, AdminOne also provides a wide variety of other products and services at the client’s demand, such as life insurance, long term disability, short-term disability, 401K plans, etc.

As like many organizations, AdminOne feels that our customers deserve the highest quality of service and administration of their benefit plans. In keeping this our main focus, we have acquired the highest quality, technologically advanced claims adjudication system available on the market.

AdminOne use the RIMS (Resource Information Management System, Inc.) system. RIMS began their business in 1981 and are still the dominant leader in claims adjudication systems. There are over 400 insurance companies across the United States that use the RIMS system, however, they haven’t seen the advantage of AdminOne.

We believe we have an advantage over other insurance companies because we have built in the technology and automation functions to provide the maximum opportunity to pay claims accurately, timely, and in the most cost efficient manner for our clients.

Our system is way more advanced than other insurance companies in many ways. First of all, it has the ability to link multiple fee schedules to single providers. Second, unlimited note screens can be used to aid in the documentation of every inquiry. Third, every customer who comes through us can doesn’t have to worry about fraud or abuse to their benefit plans. This is because we have installed a security system that will detect any hacking or abuse to any benefit programs. We believe this added on feature should keep clients knocking on our door for service.
A new addition to our RIMS system is our customized client access website. This website is actually connected with our RIMS software so that clients can actually view their current claims. This is another advantage for us in that it keeps the phones from ringing all of the time. For example, if Allen Canning Co. wanted to access their current claims and make an adjustment because of termination of one of its employees, they could easily visit our website and make the adjustments themselves. This keeps our clients from having to call in and requiring us to make the manual adjustment.

Moreover, to keep our system up to date and working efficiently, it was imperative that AdminOne recruit a systems team. There were five positions that needed to be filled and I was one of the recruits for the position.

My primary responsibility, as a systems assistant, is to help my supervisor, Angie Baker, with client billing functions, implementation procedures for new clients and new computer systems and training on new systems. I actually talk to clients, such as Allen Canning Co, and help them decide how they want their claims invoices to look like. This usually takes thirty minutes to an hour to complete.

Following the interview, I take their claims information and input the data in to RIMS. However, the process of inputting the data can be very extensive because every piece of information about each customer of the organization must be inputted. Then I go through a huge amount of modules and processes to produce the desired result, the invoice. Each invoice has its own number and group name associated with it. For instance, if I see AC802 in the top right corner of the plan document, I know that am working on Allen Canning Company’s invoice.

Another responsibility of mine is to train clients on our custom designed client access website. I travel at least once a week to the surrounding cities and train our clients on how to use our website. Most of the time I meet with managers and other users of the system to insure they know how to input the data correctly. Most of the users have a general idea on how to use the system, but there are a few that don’t and I have to start from scratch. Furthermore, after the managers and current users understand how our website works, I give them user names and passwords which RIMS already assigns to their group name. After all this, they are now ready to view their claims and make any adjustments where they are needed. However, the clients only have limited access to our website. For instance, they cannot go into our system to change billing rates or selecting a different plan. That is something that only AdminOne has access to and there cannot be any debate.

The client access website is one part of our system that I tend to a lot of the time. At the end of every day, I log in to the RIMS website and download any changes that went on in the system. For instance, if A.G. Russell Knives hired some new employees and added them to their plan, then I would extract that data and save it to our main server, which contains all of our client information. However, we do back up the server weekly to prevent loss of information in case of a fire or something along those lines.

Moreover, I deal a lot with marketing materials, presentations, and proposals when necessary. For instance, whenever AdminOne has the opportunity to acquire a new client, our company will have meeting with that client in person or via videoconferencing. Sometimes I will join my team and participate in these meetings. The topics usually discussed in these meetings range from new ideas on administrative software to potential clients that we could obtain in the future. The meetings are normally 30 minutes to an hour and are very beneficial to our company.

In addition to working for AdminOne as a systems assistant, I also do a number of job duties for the financial side. My primary responsibility is to update our RIMS system whenever we receive payment from our clients or when we have to cut checks to our re-insurance carriers. This is the more complicated area of my job and requires a lot more number crunching. I actually assist our accountant in keeping AdminOne’s books balanced and make sure that the money we receive goes in the correct account.

My favorite part of the financial services assistant is the monthly billing, which we generate through our RIMS software. The process for calculating invoices and printing them from our server can actually be quite tedious. For example, whenever we get a new client, it is my duty to input their plan information into our system as soon as possible. I do this by creating a new table in RIMS that is specifically for our new client. Then I give them a group number, which is generated by RIMS, so that we can distinguish them from other clients. After all this is completed, RIMS will calculate their invoice based on what I input. However, since AdminOne is a third party insurance provider, we do not get all of the money that comes from paying the invoice. We have to pay other PPO carriers and re-insurance carriers based on a percentage that I enter. This is where the hard stuff comes into play because every client we have has a completely different plan. Some companies prefer to use a broker and some clients prefer to use re-insurance carriers. Whatever the client’s decision may be; the point is that we actually enter the disbursement of payment into RIMS and it calculates the fees for us. That is the awesome attribute about RIMS because everything is automated.

In addition to using the RIMS software, I also use many other software applications to complete my duties as a financial services assistant. Microsoft Excel and Quick Books are the main two that I use quite often. These applications are used to record payments whenever we receive them and aid in the accounts payable process. For instance, after I receive payment from Allen Canning Co, I open Allen Canning’s folder in Excel and update their information. This information includes the current number of people that is on their plan, which PPO carriers they used, and if they used a broker. Next I print out all of their sheets on Excel and match them to the printouts that RIMS generated. If all is correct then we are ready to cut the checks to the appropriate providers.

Following the update of Excel, I then turn my attention to Quick Books. First, I prepare all of the paperwork, which was generated by RIMS and Excel, to enter the exact dollar amount. This part is very crucial because if I make one mistake it will throw off our balance sheet and income statement. Then we could possibly cut too much money or not enough. Second, I take the dollar amounts that I just entered and create a balance sheet that is generated by Quick Books. These balance sheets are then matched with our projected balance sheets that we generate earlier in the month. Sometimes the balance sheets don’t match up, but that doesn’t mean that there was an error entering the dollar amounts. It could mean that their head count had changed for their plan, such as firing someone or hiring someone. Next, after we have matched up the balance sheets, and everything looks good, we then cut the checks to the other providers. These checks are actually produced through Quick Books and contain the dollar amounts for which I entered earlier in the process. Finally, after all the checks have been cut I immediately take them to our mailbox so that they can be mailed to the providers.

One additional thing I did learn from my co-op experience was the act of confidentiality. This doesn’t play a big role in all organizations, but it is huge at AdminOne. It is imperative at insurance firms to keep all customers’ information kept suppressed. For instance, if I accidentally sent Allen Canning’s invoice to the wrong company, that firm could view their rates and what they are billed. This could pose a huge problem because the other firm may view their rates as being higher than Allen Canning’s and get very frustrated and we could possibly lose their business. Because everybody knows that insurance rates and premiums are based on whether the client is more risky or less risky. If they are more risky, then they will have to pay a higher premium and if they are less risky, they will pay a lower premium. Another example of keeping information suppressed is our internal network, or intranet. AdminOne has their own private network within the company that holds only accounting information and billing information. These records are to be kept suppressed at all times and AdminOne employees make sure that it does. That is why we install firewalls and blockers to keep outsiders from hacking into our system. There has been never been an occasion where anyone has tried to hack in, but there is always a first time for everything. So I guess you could see how keeping information suppressed is a must in an insurance organization.

Upon joining AdminOne in early August, I really didn’t know what to expect since this was my first job in a real work environment. So I decided to come up with three objectives, or goals, that I could try to achieve throughout my co-op experience. The first goal that I set for myself was to obtain a better understanding of how internal business procedures actually work. Because I learn about them all of the time from the classes that I take and I really want to see if that is how it actually is in a real environment. The second objective that I came up with was to learn how to implement new systems in a real work setting. I believe that this is important for all ISYS majors for the simple fact that computer systems are always changing. New hardware and software hits the market all of the time and it is important as an ISYS major to become familiar with as much as you can. My third and final objective was to learn how to prioritize my duties so that I could be more efficient. Since this was my first real job, I thought that this would be a good objective because it would definitely look good to my employer if I got a lot of work done in a short amount of time. I believe that it makes a person look good and motivated if they can prioritize and get more things done in a small amount of time.

In conclusion, I would like to say that this co-op experience has really helped me in many ways. I am very fortunate I received a job that had something to do with my major and it has encouraged me to keep pursuing a career in this field of study. Since I have been working for AdminOne, I have learned so much more about my job than I ever could from a textbook. Not saying that the classes I have taken haven’t helped me, but I actually got some hands on experience while working there. For example, I have learned how to use many more software programs than I ever had while taking my ISYS classes. However, there are a few classes that really helped me out and can now see what they were talking about all this time. My Organizational Behavior class is one of the main classes where I developed a strong foundation. In that class we learned about the roles and norms of certain organizations and how they all differ depending on the organization in which you work. And on the first day of my job I could see with my own eyes what they were talking about. I saw how all of my co-workers conducted themselves in the work environment and outside the work environment. I also leaned about our dress code while working at AdminOne, which is norm itself. In addition, my Business Statistics class was another key factor. I believe if I hadn’t taken that class, I wouldn’t be where I am because the job that I have right now requires a lot of number crunching. That is basically all we learned in Business statistics.

Overall I am very pleased with my co-op experience and believe it will be very beneficial for my future. I enjoyed telling you about my organization and I hope you now have a better understanding of what we do.


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