Client Overview

A leading insurance business house in North America with a significant retail insurance business and a high volume of claims processing

Business challenges

The client, an insurance services provider functioned with an old business model that lacked the agility to meet current demands of the new business environment, involving new business models. The insurance industry itself functioned in an unpredictable and ever changing business landscape.  Constant regulatory changes, mergers and acquisitions, strong competition from peer companies and emergence of new competition from non-traditional players contributed to the woes of the client.

• Lack of long term portfolio management
• Manual and rigid process contributing to the long cycle time for application processing
• Complex process involving several variables depending on the line of business, type of loss and severity of claim
• Loss leakage and poor benefit disbursement
• Large number of critical parties
• Lack of single customer view
• Region specific regulations
• Escalating concerns regarding deception

GSS America solution

The GSS Information Architecture for Insurance involves Re-architecturing and prioritizing processes as per enterprise dynamics. The GSS solution is reflective of the attributes captured across people, process and technology. GSS assessed the efficiency of processes involved and their change frequency. The effects of process on operation environments were studied to identify the gaps.

Methodology

The customer pain points were identified and addressed through enhanced system utility and collaboration of call center with policy holders. The claims management, policy administration, deception management and external data systems were revalidated according to newly implemented work flow tasks.  A Business Process Orchestration was established which enabled interaction with various systems while simulating workflows. The Business Process Orchestration interfaced with the Claims Management System, Deception Verification System and a process portal, set up for claims reporting by the policy holder. The program management processes implemented, covered defect tracking, risk management and Change Management Process. Consolidated status report generation was also facilitated based on reporting across several teams.

Tools used

ACORD XML, IBM Process server, Oracle, ESB, Aqualogic Service Bus, Mule, Open ESB, Rule Standard JSR - 94

Benefits

Strategic

• Better positioned for future integration with partners
• Enabled reusability of business services

Tactical

• Increased reuse rate for a set of common services

Operational

• Reduced cycle time for claim process
• Facilitated real time interaction
• Lowered cost through lower incidence of errors
• Reduced cycle time for claim process