From the claims desk to the product plan

Mandate

Make Lacmorin's products and member journeys work for plan members at the moment of need, in both official languages.

Outcomes

• Added a case manager's call to every online short-term disability claim; median decision time fell from 21 to 13 days
• Introduced co-drafted French and English wordings, starting with a small-employer plan
• Rebuilt evidence-of-insurability questions; clarification holds fell from 38% to 15%
• Raised registered app and portal users from 171,000 to 268,000

Decisions in context

As chief product officer I own what members and plan administrators use: plan designs, wordings, the app and portal, administrator tools and the research behind them. I do not set prices, assess risk or decide claims, and much of my work consists of persuading the colleagues who do. The three cases on this site show the pattern. I brought members' evidence to the claims, sales and underwriting leaders, proposed a change that cost something, and accepted a compromise where their objection was sound. I present the product plan to the board each year and report product risks, including complaint trends by province and language, to the risk committee. I hold no Lacmorin directorship. The role has taught me to separate a decision I can make from one I can only recommend, and to say which is which.

Reason for the move

Current role; seeking one compatible independent board seat with Lacmorin's consent.

Mandate

Modernise disability products and give members a digital route to claims and information.

Outcomes

• Launched online short-term disability claiming in late 2020
• Rewrote long-term disability letters to a plain-language standard in both languages
• Built the first member research panel, with 1,900 volunteers
• Led the member portal's transition to a mobile app

Decisions in context

Disability products changed how I understood service. A claimant may be unwell, worried about rent and dealing with an employer and a physician at the same moment as they deal with us. I rewrote our long-term disability letters, starting with the ones that explained a decline, and built a research panel of 1,900 members who agreed to test drafts. I also led the launch of online short-term disability claiming in late 2020. It served confident users well and left too many claimants with incomplete files, which I corrected as chief product officer. I worked closely with the disability claims leadership, who retained every adjudication decision. Those four years gave me the habit of asking what a product requires of a person on their worst day, and whether we have made that requirement visible before they need it.

Reason for the move

Appointed chief product officer when product responsibilities across group lines were combined.

Mandate

Simplify the health and dental range offered through advisers to small and mid-sized employers.

Outcomes

• Reduced 140 health and dental plan variants to 46 standard designs
• Introduced a plan comparison that sponsors could share with employees
• Cut adviser quotation turnaround from nine business days to four

Decisions in context

Group benefits introduced me to a second customer. The plan sponsor chooses and administers the plan, but members use it, and the two often want different things. I inherited 140 health and dental variants, many created for a single adviser's clients, which made wordings hard to maintain and impossible for members to compare. With the chief actuary and the sales team, I reduced them to 46 standard designs. Some advisers lost bespoke plans they valued, and we kept nine legacy designs open for two years to ease the transition. I also introduced a one-page comparison that an employer could hand to staff during enrolment. The work taught me that simplification is a negotiation with distribution, and that it succeeds only when the people giving something up can see why their clients benefit.

Reason for the move

Promoted to lead disability and member products.

Mandate

Improve plans sold to people leaving employer coverage and bring French and English documents into line.

Outcomes

• Redesigned the conversion plan for people leaving group coverage; take-up rose from 11% to 17%
• Produced the company's first glossary of benefit terms in both languages
• Reduced critical illness wording queries from advisers by about a third

Decisions in context

Brisemont brought me to Quebec City and made French my daily working language. Most of my buyers had just left an employer plan through retirement, self-employment or redundancy and had a short period in which to convert their cover without new health questions. The existing conversion offer was explained in a dense letter that few read in time. I redesigned the offer into three clear choices and a single deadline, and take-up rose from 11% to 17%. I also started the company's first two-language glossary of benefit terms after finding that the French and English critical illness wordings used different expressions for the same condition. My team was small, and every wording change needed the actuarial, legal and compliance teams' agreement. I learnt how slowly an insurer can change a promise once thousands of contracts rely on it.

Reason for the move

Recruited by Lacmorin to lead group health and dental products in Ottawa.

Mandate

Reduce disputed claims arising from misunderstood medical questions for older travellers.

Outcomes

• Rewrote the over-sixty medical questionnaire after testing with 120 retirees
• Disputed pre-existing condition declines fell by about 40% over two winters
• Introduced a free pre-departure call to check medical answers

Decisions in context

After more than four years of reading declined claims, I asked to work on the questions that produced them. My first project was the medical questionnaire for travellers over sixty. With the underwriting team, I tested each question with retirees in Mississauga and Laval and found that the stability questions mixed new medicines, changed doses and new symptoms into one sentence. We separated them, added examples and introduced a free call before departure in which a nurse could help a traveller check an answer. Underwriting kept full authority over what was covered. Over the next two winters, disputed pre-existing condition declines fell by about 40%. I became product manager in 2005 with three analysts and studied plain-language communication part time. The role taught me that a precise question is not the same as an answerable one.

Reason for the move

Recruited to manage individual health products at a Quebec mutual insurer.

Mandate

Adjudicate emergency medical claims, including those from French-speaking travellers and foreign hospitals.

Outcomes

• Handled about 1,400 claims a year across French and English files
• Prepared the first French-language claim checklist for Quebec travellers
• Recorded recurring misunderstandings of medical questions for the product team

Decisions in context

I joined straight from university because the company needed examiners who could read French hospital records and speak with Quebec travellers and their families. I adjudicated emergency medical claims within a delegated limit, worked with assistance coordinators on hospital bills from the United States and Mexico, and explained decisions by telephone. Many declines involved pre-existing condition clauses. Most were correct under the policy, and some were the result of travellers answering a question they had understood differently. I began keeping a simple log of those misunderstandings and sharing it with the product team, which eventually led to my move. I also wrote a French claim checklist so that families did not have to translate requests in a crisis. The role gave me a lasting respect for claims colleagues, who have to apply a wording exactly as it was written.

Reason for the move

Moved into product to work on the questions that caused disputed declines.