Solution
Insurance Solution
Claim Process
Pre-Approval (Fax-Claim)
Pre-authorization is a necessary step before patients receive medical treatment or services to ensure that these treatments or services will be covered by insurance. This process typically involves submitting pre-authorization documents via fax to the insurance company. These documents usually include details of the required treatment, the physicians diagnosis, and patient information.
Direct Billing
The process where hospitals or healthcare facilities bill the insurance company directly instead of requiring patients to pay upfront. The insurance company then pays the healthcare facility directly according to the agreed terms and conditions.
Reimbursement
Reimbursement is the process where patients pay upfront for medical treatment or services and then request a refund from the insurance company according to the policy terms. This process requires patients to submit proof of payment and relevant documents to the insurance company for review and approval of the reimbursement.
Underwriting
Simply design for Doctor
The process of assessing a patient's risk before approving insurance coverage and determining premium rates should be straightforward and user-friendly in a system designed for physicians. This ensures that doctors can quickly and accurately input information and evaluate risk.
Key Features
- Design a form for physicians to easily fill in patient information, such as medical history and health details.
- Use graphics and illustrations to display patient health information and risk factors.
- Implement a system that can automatically verify information and calculate risk.
- Physicians can quickly access relevant information, such as previous medical history.
Communication channel between Underwriter and Accessor
Communication between Underwriters and Assessors is crucial for risk assessment and insurance approval decisions. Effective communication channels ensure that information is exchanged quickly and accurately, reducing misunderstandings and delays in processing requests.
Key Features
- There is an internal messaging system that allows direct communication between Underwriters and Assessors.
- A notification system for important communications and tracking the status of requests.
- Record conversations and data exchanges for future auditing purposes.
- Utilize online meeting tools for real-time conferences when necessary.
Submit Application
Complete Customer Info
Completing customer information is the first step in submitting an insurance or financial service request. This information is necessary for the company to accurately and promptly evaluate and approve the request.
Key Features
- Personal Information: First Name, Last Name, Date of Birth, ID Card Number or Passport Number.
- Contact Information: Address, Phone Number, Email.
- Financial Information: Income, Source of Income, Bank Account Details.
- Health Information (if necessary): Medical History, Current Health Conditions.
Multiple Dependent (Spouse, Child)
If the applicant has dependents, such as a spouse or children, providing their information is necessary for the company to consider appropriate coverage and benefits.
Key Features
- Spouse Information: First Name, Last Name, Date of Birth, Contact Information.
- Children Information: First Name, Last Name, Date of Birth, Educational Information (if applicable).
- Health Information of Dependents: Medical History, Current Health Conditions (if necessary).
- Separate Forms for Each Dependent: To ensure clarity and completeness of information.
Follow by Application Form
After completing customer and dependent information, tracking the application process using the Application Form is necessary to ensure that the request is submitted to the company and processed accordingly.
Key Features
- Verification of Completeness: Ensure that all filled information is accurate and complete.
- Signature and Confirmation: Electronic signature or print signature to confirm the submission of the request.
- Attachment of Supporting Documents: Attach relevant documents such as a copy of the ID card, income statements, and medical documents.
- Submission of Application: Submit the application form to the company through specified channels (online or mail).
- Status Tracking: Have a notification system in place to track and update the status of the application.
Auto Premium Calculation
Premium Broken Down by Member
Individual Premium Calculation: The process of calculating insurance premiums separately for each family member or group member to provide a clear breakdown of each individual's premium.
Key Features
- Separate Premium Calculation for Each Member: Each individuals premium is calculated separately based on personal risk factors and details, such as age, health conditions, and medical history.
- Total Premium Aggregation: The premiums of all members in the group are combined to show the total premium amount due.
- Detail Presentation: The premium details for each individual are displayed in the premium statement or online system.
Multi-Level Discount
Tiered Discounts in Premium Calculation: Applying various discounts during the premium calculation process to reduce costs for policyholders. Discounts can come from brokers or insurers.
Key Features By Broker
- Special Discounts from Brokers: Brokers can offer special discounts to clients based on promotions or specific conditions.
- Calculation and Display: Broker discounts are calculated and shown in the quote and premium statement.
Key Features By Insurer
- Insurer Discounts: Insurers can offer discounts to clients based on their policies and defined conditions.
- Calculation and Display: Insurer discounts are calculated and displayed in the quote and premium statement.
Multiple Formula by Product
Premium Calculation Using Multiple Formulas: Employing various formulas for different products to ensure accurate and appropriate premium calculations based on the specific risks and characteristics of each insurance product.
Key Features
- Product-Specific Formulas: Each product has a distinct premium calculation formula tailored to its unique risks and features.
- Adjustable Calculation Formulas: Insurers can customize calculation formulas to adapt to changing market conditions and risks.
- Calculation and Display: The premiums calculated using the appropriate formulas are displayed in quotes and premium statements.
Application Status
View Application by Status
Tracking the Status of Insurance Applications or Services: Monitoring and evaluating the process efficiently by displaying requests according to their status, providing a clear overview of the process and actions taken at each stage.
Key Features
- Status-Based Grouping: The system categorizes requests based on their status, such as in progress, approved, pending additional documents, or denied.
- Filtering and Searching: Users can easily filter and search requests based on the desired status.
- Real-Time Status Updates: Application statuses are updated in real-time to ensure information is current.
View Pending Day of Each Status
Monitoring the Duration of Each Status: Tracking the number of days a request remains in each status helps identify areas for improvement and enhance process efficiency.
Key Features
- Displaying Duration in Each Status: Show the number of days a request has spent in various statuses, such as 5 days in pending additional documents or 2 days in progress.
- Delay Notifications: The system can alert users when a request takes too long in any given status.
- Performance Reporting: Generate reports displaying data on the number of days in each status for analysis and process improvement.
Easy to Prioritize
Prioritizing Requests: Prioritizing requests is essential for managing and processing the most critical ones first. Having tools that facilitate easy prioritization helps improve workflow efficiency.
Key Features
- Priority Settings: Users can set the priority level of each request, such as high, medium, or low.
- Filtering by Priority: The system can filter requests based on their priority levels, allowing focus on the most important requests.
- Using Colors or Symbols: Utilize colors or symbols to clearly indicate the priority level of each request.
- Important Request Alerts: The system can notify users when there are high-priority requests that need urgent attention.
Other Solutions
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