6 Core Building Blocks of a Group Benefits Underwriting Application

Transcription

1 6 Core Building Blocks of a Group Benefits Underwriting Application POWERING PROFITABLE GROWTH WITH AN INTEGRATED SOLUTION

2 Roger Soppe, CLU Director Industry Principal, Insurance PEGASYSTEMS Non-linear underwriting procedures, complex business rules, rigorous underwriting discipline, regulatory compliance, disparate systems, and judgment-based decision-making for risks makes group underwriting one of the most challenging operations to automate. In this e-book, Pegasystems Roger Soppe reviews the six technology building blocks needed for a next-generation group underwriting solution that will provide the power and flexibility to streamline underwriting and pricing, offer exceptional customer experiences, increase sales and deliver the agility needed to capitalize on new market opportunities. JOIN THE CONVERSATION

3 The Need for Human Judgment Requires Flexible and Powerful Technology Group Insurance has traditionally been a fragmented and underserved market requiring major group insurers to be dependent upon manual processes and outdated technology. This has lead to alignment gaps between their ability to growth and actual underwriting capacity. The Distribution Channel wants to sell all products to any size market. This approach can overwhelm underwriting capacity of group carriers as they seek new markets and products. High cost structures and lack of automated underwriting process confine a carriers ability to remain cost competitive. A far better approach is an integrated solution that provides common underwriting functions out-of-the-box, yet delivers the flexibility to configure the solution to suit the group carrier s specific policies and procedures. There are six building blocks that large group carriers need to transform their underwriting operations. By understanding the function of these building blocks, group carriers can successfully support the needs of the underwriter with a flexible, customer-centric, process-driven and fully integrated underwriting solution. Any Risk GAP Right Risks Channel Sales Growth & Production Any Benefit GAP Optimal Benefits Underwriting Capacity & Performance GAP Cost Competitive Best Price & Margin Inflexible systems create execution gaps in underwriting operations that limit business agility and growth. 3 6 Core Building Blocks of a Group Benefits Underwriting Application

4 1 The Customer File Know Everything about the Account Effective selling requires access to comprehensive information about the group or customer. Carriers have lots of customer data, but the ability to execute on this information is compromised by isolated systems, spreadsheets and inconsistent processes. A 360-degree view of the customer is necessary, including a profile of the business, contacts, relationships, interaction sales history, billing and claims information. Of equal importance is the ability to understand the customer s intent. When you can take intent into account, cookie-cutter sales strategies can be replaced with personalized and relevant retention and cross-sell/upsell strategies. Improving sales strategies requires the ability to see relevant customer data across all sources and systems; to act on this data with a real-time understanding of the work being done for the customer; and then to interact with customers and brokers across multiple channels. This requires an advanced front-office solution that provides a seamless multi-channel experience and is a holistic part of the underwriting process. Execution Gap BUSINESS PROCESS ANALYTICS DECISIONING CASE INTEGRATION MOBILE SOCIAL CLOUD SYSTEMS OF legacy Effective selling requires a complete view of the customer, an understanding of the customer s intent and the ability to engage seamlessly across all channels. 4 6 Core Building Blocks of a Group Benefits Underwriting Application

5 2 The Underwriting Case Manage Everything around the Opportunity For years physical folders and spreadsheets were used to consolidate and manage all of the information needed for underwriting and risk evaluation. This practice can be applied with far greater efficiency and agility using electronic case management. A case can be defined as an organized unit of work that carries all the information, tasks, content, correspondence and outcomes associated with a business objective, such as a new group submission, renewal or change request. In group benefits underwriting, risks are unique and often require real-time adjustments to standard procedures. In scenarios where some sub-processes are already handled by other applications, a federated case management approach is needed to connect the dots. It is vital to look for a case management solution that can dynamically respond and manage all types of information and activities within the single case process as well as interact seamlessly with other systems. Telephony Mobile Machine Messaging Multi-Channel Cases & Folders Priority Skill Based Routing Open Database ENGAGE ORGANIZE Automated Transactions Productivity & Quality Alerts RESOLVE CUSTOMERS ANALYZE Model & Simulate System-Driven Processing RESPOND OPTIMIZE Guided Processing Next-Best-Action Tailored Interactions Adaptive Analytics Anticipatory Retrieval A group benefits underwriting case include components which can be structured, unstructured and dynamically driven. Case management must provide the flexibility to manage all of the different types of information and activities that can occur within the context of the single case. 5 6 Core Building Blocks of a Group Benefits Underwriting Application

6 3 Guided Business Processes Drive Consistency and Efficiency Group benefits underwriting processes are non-linear, with teams adjusting tasks to the available information and going back and forth until due diligence is completed. However, there is always structure to the stages through which an underwriting case travels from intake/submission to pricing to proposal. Underwriting is a process with a network of relevant business rules that become active depending on the situation, context and demands. Carriers need to be able to support process consistency and efficiency, while having the flexibility to respond to change. Agile, process centric underwriting solutions can deliver these capabilities. These solutions use rules to dynamically initiate process steps and tasks based on available case data and stage in the process. They can integrate seamlessly with the other building blocks to deliver a holistic, flexible underwriting environment. Underwriting functionality can be easily configured to the carrier s unique requirements enabling rapid deployment with a far more flexible and business-friendly approach compared to that of rigid packaged offerings. 1. Applicant Identification 2. Benefit Selection 3. Rating 4. Proposal 5. Complete Set Channel Data Benefit Selection Rate Benefits Generate Proposal Complete GP Submission Initialize Submission Duplicate Opportunity Chec Present to Producer Customer Identification Plan Design Questions Producer Review Get Customer Profile CensusDataEntry Customer Review SIC Determination Collect loss History DNQ Determination In Good Order Determinatic Collect Agent Agency Details Reject Submission DNQ Submission Lost Submission Decline Proposal Do Not Quote Lost Plan Agile BPM technology supports every stage in an underwriting process with the ability to guide the user and adjust the process to account for new information and changing requirements. 6 6 Core Building Blocks of a Group Benefits Underwriting Application

7 4 Underwriting Tools The Core Business Logic Group carriers use desktop tools and spreadsheets to assess risk and support decision making throughout the process. However, these tools can get unwieldy, and the intelligence within them is difficult to share as they become islands of automation, isolated to a particular user. Successful group benefits underwriting requires the ability to model complex business logic to drive data validations, guide process steps, manage authority levels, flag alerts, calculate values and even make context-driven recommendations at various points in the process. Such capabilities cannot be delivered solely using simple if-then-else constructs. Thus, capturing and managing business rules as part of the business process is essential, and the best way to do this is by using underwriting solutions with an integrated rules engine. These engines provide forward and backward chaining to handle non-linear process scenarios and keep case data current and accurate. These solutions can also unify process and rule definitions using familiar office tools, enabling business users to quickly react to changing market conditions and rapidly roll out changes. Rules and processes need to be integrated in order to support the complex underwriting activities of large commercial carriers. 7 6 Core Building Blocks of a Group Benefits Underwriting Application

8 5 Real-time Systems Integration Seamless Information Exchange Integration plays a major role in an underwriting solution. Building real-time interfaces with channels, back-end systems and third-party services is essential to achieving operational efficiency and data accuracy. Service-oriented architecture (SOA) has become the de facto standard to solve complex integration challenges. A BPM strategy is not complete without a complementary SOA strategy because it is these capabilities that deliver information to the business process. One without the other will result in a sub-optimal solution that will complicate the technology environment and impact process design and execution. A good group benefits underwriting solution will begin with integration to sales automation systems and continue with integration to back-end billing and administration systems, along with third-party services, rating, document management systems and knowledge repositories. A solution that includes prebuilt connectors and standards-based integration methods is the best solution for simplifying the integration process and ensuring the level of integration required to optimize underwriting. Vision ESB, WSM Strategy Planning The Future of SOA STRATEGY TECHNOLOGY ARCHITECTURE BPM, BAM, BEM EAI, EII, BI Data Services Interface Design Registry, Repository WSDL, XSD, XML, SOAP Taxonomy, Ontology METADATA EDUCATION CERTIFICATION Executive Education SOA Certification XML Certification BPM solutions that provide standards-based integration capabilities simplify and streamline the process of connecting to existing technology. Carriers can continue to gain value from these core assets while reaping the benefits of flexible, automated underwriting processes. 8 6 Core Building Blocks of a Group Benefits Underwriting Application

9 6 Real-time Analytics Put Business Intelligence to Work The use of historical business intelligence data during risk evaluation is not often possible as it is only available in static reports. And while executing statistical models for loss-cost modeling, underwriting intensity determination, competitive pricing, etc. can provide strategic advantage, these capabilities are usually disconnected from the business process. Predictive analytics does not have to be confined to a data warehouse department or back-office reporting team: It can impact in-flight underwriting with real-time predictions, propensity analysis, and suggested actions and offers. An underwriting solution that takes advantage of invoking analytical models in real time and within the context of the business process brings statistical rigor to decision-making. Real-time analytics also support retention and cross-sell/up-sell models at the time of risk assessment and quoting. The most sophisticated analytics solutions offer adaptive learning, which allows predictive models to learn and automatically adjust the operational intelligence used to determine the next step to take or offer to make. CHANNELS CUSTOMER NEEDS BUSINESS OBJECTIVES CONTEXTUAL GROWTH TIMELY RELEVANT CUSTOMER NEEDS SERVICE BUSINESS OBJECTIVES RETENTION CONSISTENT RISK Real-time predictive and adaptive analytics can take into account the customer, current situation, customer s intent and business objectives to recommend personalized and relevant actions and offers during the course of an interaction. 9 6 Core Building Blocks of a Group Benefits Underwriting Application

10 Business Outcome-Driven Delivery is Essential One of the biggest benefits of using a building block approach is the opportunity to slice and dice the complexity of transforming your underwriting operations. With a phased, iterative approach, you can implement capabilities based on a sound benefit realization model. A solution which includes incremental development of the customer file and the underwriting file; selective automation of the most impactful business processes; elimination of duplicate data entry and tactical solutions is the most cost-effective approach to delivering the next-generation group benefits underwriting solution. Using an outcome-based model that aligns with the business goals will help drive the evolution of the solution, providing a mechanism to easily map and manage capabilities being built throughout the project lifecycle. Group carriers can also build in exit points within the strategy to be able to change the pace, pause and resume the journey based on market conditions and business priorities. Such situations are quite normal in a highly competitive group insurance market, and a building-block approach is the most optimal way to embrace it. REDUCE EXECUTION RISK IMPROVE PRICING ACCURACY INCREASE OPERATIONAL EFFICIENCY GROW IN TARGET AREAS By tying the development cycle to business goals in iterative phases, you can realize benefits over time, leveraging the success in previous phases to drive further transformation of the underwriting process Core Building Blocks of a Group Benefits Underwriting Application

11 About Pegasystems Pegasystems, the leader in business process management and software for customer centricity, helps organizations enhance customer loyalty, generate new business, and improve productivity. Our patented Build for Change technology speeds the delivery of critical business solutions by directly capturing business objectives and eliminating manual programming. Pegasystems enables clients to quickly adapt to changing business conditions in order to outperform the competition. For more information, please visit us at Copyright 2015 Pegasystems Inc. All rights reserved. All trademarks are the property of their respective owners.