Profile of a chief executive:

Rafael Moliterno Neto (Seguros Unimed, Brazil)

This article by Andrew Bibby, in a slightly different form, was first published by ICMIF (International Cooperative & Mutual Insurance Federation) in Voice magazine, 2013

Most people would be content with just one of the two jobs which Rafael Moliterno Neto undertakes each week. As CEO of Seguros Unimed, he has presided over a period of phenomenal growth for his insurance company, which is owned by more than 360 independent doctors' cooperatives. Seguros Unimed has seen premium income grow during the last five years by an average of well over 20% each year. Its health insurance business has grown even faster and the company is just about to enter the general insurance market as well. When asked how business is going, Rafael Moliterno is happy to offer the simple response ‘good'.

But Rafael did not begin his career as an insurance professional. He trained as a doctor at the Faculty of Medical Sciences in the Brazilian city of Santos , about eighty kilometres from São Paolo, becoming a specialist in the field of otorhinolaryngology – or, put another way, he is an ear, nose and throat consultant. After graduating from medical school, he became actively involved in his own local Unimed medical cooperative in the nearby town of Americana (the town's name records its history as a destination for emigrants leaving the United States after the Civil War). He also took on responsibilities for the federation of Unimed cooperatives in the whole São Paulo region, the country's most populous state. And from there the next step was, logically enough, a board position in the Brazil-wide Unimed federation, a position he occupied for four years in the late 1990s.

It was thanks to this experience that he was strongly encouraged by his medical colleagues to put his name forward for one of the directorships at Unimed's insurance operation, Seguros Unimed. He has been a director of the insurer since 2001 and the elected CEO since 2011, a role he had taken over on a transitional basis a year earlier.

Make no mistake, this is no sinecure. Seguros Unimed's CEO is very much a day-to-day executive, running a business which has about six million policyholders and income (2012) of BRL 1.2 bn (USD 500m). He works closely with his fellow executive directors, also professional doctors who like Rafael combine life as senior managers in insurance with their original day jobs.

Rafael Moliterno's home is still in Americana, where he lives with his wife and one of his three adult daughters and where he sees his patients and holds weekly surgeries. But every week there is a two-hour drive to São Paulo , where Seguros Unimed has its head office and where, conveniently, his other two daughters live. It means he can stay with family during the week when he lodges in São Paulo as well.

Which of his two careers gives him most pleasure? He laughs, and replies that he likes both very much. Clinical work, he says, is necessarily very operational. By contrast, the work at Seguros Unimed is very strategic in nature. “I like the challenges of both. And there's certainly no monotony,” he says.

Medical cooperatives

The story of Seguros Unimed is bound up with the larger history of Brazil 's Unimed medical cooperatives, which can now be found in almost all the parts of Brazil 's great land mass. The Unimed network has grown since the first small Unimed cooperative was begun back in 1967, at a time when the health service in Brazil was going through great changes. The 360 Unimed coops now operate in 83% of Brazil 's municipal authority areas, and between them have about 110,000 doctors and health workers as members. The Unimed network runs its own hospitals and clinics (it currently has about 110 hospitals and 180 accident and emergency units), and also has a string of laboratories and diagnostic centres. Between them, Unimed coops have nineteen million customers, representing 40% of the 44 million Brazilians who choose to use the private health sector (the public health service provides health care for the remaining 160 million or so inhabitants).

Unimed started what was to become its insurance offshoot in the late 1980s, initially as a pension scheme provider for Unimed's doctors. Various legal changes have been necessary since then to accommodate Brazilian insurance and company law, but Seguros Unimed today is a set of three companies which use the single Seguros Unimed brand. Not surprisingly, health care is the most important part of the business, contributing premium income of BRL 788m (USD 340m) in 2012, a 24% growth over comparable 2011 figures. This makes Seguros Unimed the third largest health insurer in the country. Life and pension products broadly comprise the other third of premium income. Five million people are covered through products on the life side, 80% of them coming from the Unimed cooperative network's client base and 20% from the general market.

Professional liability

Seguros Unimed is also expanding into new areas of insurance. In 2012 it launched a new dental health plan which has quickly grown to have about 200,000 clients. More radically, Seguros Unimed is also creating a new legal entity to offer general insurance. The first priority is to provide professional liability insurance for Unimed's doctors and health workers, an area of business which Rafael Moliterno says is potentially huge. From there, the next step will be to other non-life insurance products, particularly property insurance. The Unimed cooperatives themselves have their hospitals, clinics and ambulances, all needing cover.

Brazil is a country with enormous potential for insurance, and the overall market has been growing strongly in recent years. Recent figures suggest plenty of scope for further growth, however: per capital expenditure on insurance is just over USD 300 per annum, compared with figures up to twenty times greater in some developed economies. For Seguros Unimed, there is particular scope to extend its business through the Unimed cooperative network, both to cooperative members (the doctors themselves) and to the broader public who use Unimed health services.

Rafael Moliterno gives one example, commenting that only 30,000 of Unimed's 110,000 doctors are in the pension scheme. “We're now training staff to talk to doctors and explain to them the importance of having a pension. We're trying to raise awareness and educate them,” he says.

The Unimed cooperative network is central to the distribution channel used by Seguros Unimed to market its products. “Because the Unimed network reaches most municipalities in Brazil , we have a distribution network that is just as good as any bank's, if not better. We also have very good brand recognition. Unimed is known as a cooperative and not just a money-making business,” Rafael Moliterno says. The insurance company pays commission to the individual cooperatives for products sold, at below that normally offered to brokers and agents by other insurers but, as Rafael explains, this is acceptable to the cooperatives because they also benefit from the profits made by Seguros Unimed. The recent run of strong trading years has seen the insurer return the equivalent of 110% of its capital base to Unimed cooperatives since 2008.

Notwithstanding the many years' medical training he undertook, Rafael Moliterno has also made sure that he has the professional expertise to perform his role as an insurance CEO, having completed two separate Masters in Business Administration, one in marketing and business administration and one specifically focused on insurance. The courses involved classes at night and on Saturdays and he has admitted that sometimes the work was hard-going, although he adds that he also found the studying enriching. But he also argues that his skills as a doctor directly help him in his role in leading a major insurer. Doctors know, he points out, that a course of medical treatment can solve one problem but create another. He tries to be aware of any unexpected side-effects, too, when he and his colleagues take strategic decisions at Seguros Unimed.

Rafael Moliterno has now taken on the additional responsibility as Chair of ICMIF/Americas, and he is already playing a much appreciated role in the life of the wider cooperative and mutual insurance world. He is also turning over the possibility of Seguros Unimed partnering with other cooperative insurers in other countries. There is time for home life, though. He says that he enjoys walking, not least for the time it gives him to think (“walking is much better than talking to a psychoanalyst,” he jokes). Tennis is another passion, as is going to the cinema. But his family is central to his life: there are some benefits to that weekly commute to São Paulo after all.

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