Entreprise Risk Management

Client Situation How We Helped Outcome
client

Client

Major healthcare insurance carrier

situation

Situation

Following continued NOLs, decreasing premium revenues, and the onset of ORSA reporting, board and executive leadership reached out after a lengthy RFP, for RGP to mature the insurer’s ERM program to one that would stem-out losses, provide insights on how to successfully compete, and comply with ORSA.

howwehelped

How We Helped

  • RGP conducted an in-depth assessment by reviewing our client’s governance, risk, and compliance effectiveness, processes, approach, and capabilities. During this assessment, we sought to identify control weaknesses that may impact financial and operational performance. Furthermore, we developed and implemented a sustainable and highly effective ERM program. The project is described by the following two
    phases:
  • Assessment Phase. RGP utilized a cultural survey to help assess the organization’s readiness to implement a more robust risk managementfunction, and we employed a risk-based approach to evaluate the following
    • Internal audit program for effectiveness and process quality.
    • Compliance program for scalability and effectiveness in monitoring potential key risks mapped to Office of Inspector General’s (OIG)
      Seven Elements of an Effective Compliance Program.
    • Complaint management process and capabilities within HR, Internal Audit, and Legal.
  • ERM Design Phase. RGP recommended and assisted with the development of an ORSA-based ERM program to serve a two-fold purpose: as the platform for managing the client’s enterprise-wide risks; and as an ERM framework to meet NAIC ORSA regulatory compliance.
  • Furthermore, RGP also helped form and implement a Risk Committee and risk management tools for the client’s management and monitoring
    of enterprise-wide risks.
outcome

Outcome

RGP’s Project Team contributions:                

  • RGP’s initial assessment and recommendations were adopted by the client’s executive management and board of directors.
  • The ORSA-based ERM program that RGP designed for our client helped them manage and monitor their enterprise-wide risks and meet NAIC’s ORSA Model Act requirements for insurers. (this means filing an annual ORSA Summary Report to show evidence of the description of the
    insurer’s risk management framework, insurer’s assessment of risk exposures, and group risk capital and prospective solvency assessment).
  • A couple of years after implementation, client begun experiencing significant growth in premium revenues with same underwriting guidelines,
    reduced overall losses, and increased risk-based capital.