Success Factors - Policy Administration Insurance Software
The critical success factors in the policy administration insurance software space, for health and benefits, include processes where there is ease of client customization & integration and valuation calculations for claims. Best practices where big data analytics determine accurately the cost of covering a customer base and effective communication through data sharing are additional success factors.
Client Customization & Integration Ease
- The ability to support multiple libraries where the base code and custom code could be placed in separate libraries so as not to interfere with each other is one such success factor.
- Utilizing client relationship management functionality and support file structures to tie both the group and individual lines of business together has allowed for ease of client customization and integration.
- Another feature includes enabling users to streamline data collection workflow for a quicker sales process by leveraging a data prefilled system that auto-verifies prospects' information, ensuring accurate quotes while reducing time and expense spent manually managing these processes.
- If the company deals with several small private practices — which still handle paper documents — the import is streamlined by image recognition algorithms that digitize the documents.
- The various support features of a successful system such as the Flexible Insurance Marketing, Management, and Administration System (FIMMAS) software and Applied Systems, has immensely contributed to the management of contracts and certifications of clients.
Valuation Calculations for Claims
- Claim management software can automate information exchange between insurance and healthcare provider systems.
- Special rating adjustments are controlled by the system that can be applied for substantial insureds and for other scenarios in which the calculated premium is based on a multiplier times the basic premium rate per unit.
- Reserve factors can be uploaded into the system to support various types of valuation calculations for statutory, tax and GAAP reserves.
- Each benefit can be configured to control which types of valuation calculations should be done, and how the respective amounts should be calculated.
- The system can calculate coverage and payment for each claim according to set policies.
Big Data Analytics
- To determine accurately the cost of covering a customer base is the single greatest determiner of an insurer’s success or failure.
- Calculating a potential client’s risk of illness, injury, accident, or death has been refined to a science. Big data coupled with analytics translates to insurers developing risk indicators targeting individuals, rather than demographics.
- A case study by Insurance CIO Outlook stated that big data analytics was the reason behind saving well over $210 million in fraudulent health claims.
- Using Human API, customers can electronically share their health data with companies such as Guardian using digital health records to streamline underwriting, improve customer satisfaction, and differentiate themselves in the insurance space.
- Elaine Costigan, director underwriting for individual disability insurance for Guardian noted that 77% of applicants indicated that their healthcare providers were found in the Human API network.
- According to the case study, applicants who required an Attending Physician Statement (APS), approximately 30% successfully connected their patient portal accounts and shared their Electronic Health Records (EHRs).
Our search for critical success factors in the policy administration insurance software space for health and benefits found that there were no precompiled reports or analyses. We determined that the success factors relate directly to the project management process and have highlighted findings that correlate directly with policy administration software for health and benefits also referred to as insurance administration systems. Additional examples of such a system were also highlighted e.g Allied Systems.