Policy Owner Services
BizFlow provides BPM-based case management frameworks for automating New Business, Underwriting, and Policy Maintenance processes. With it users initiate, manage, review, and track work. They manage absences, create notifications, forward, escalate, and pend work. Managers decide roles and responsibilities, dictate workflow distribution logic, monitor assigned cases, review vacation requests, create metrics, and run reports. The resulting insight, automation and adaptability lead to better use experiences, improved productivity, and deeper customer relationships.
- Sales prepares the proposal, send to underwriting for review and approval, and prepare documents for sign-off
- Underwriting supports proposal review, pricing, search, approval, second approval, reinsurance review, and submission to sales, update, counteroffer, and accept/decline/reassign actions to sales admin for further updates
- New Business enables system setup, preparation of policy contracts, enrollment, medical underwriting, printing of cards and life certificates, billing, posting of binding premiums, and dispatch of policy kits
- Policy Maintenance enbles direct correspondence with policyholders, agents and distributors to enroll, terminate, endorse, initiate claims, and execute change requests
- Billing, Collections, and Commissions supports check handling, bank reviews, premium postings, and commissions (reconciliation, commission payout)
Claims and Customer Service
BizFlow provides BPM-based case management frameworks for automating Customer Service and Claims processes. Customer Service frameworks enable users to initiate and track correspondence as well access and edit documents. Managers can assign roles and responsibilities, determine workloads, and monitor assigned cases. Whether cash, credit, life, personal accident, PPO, or pre-approved claims, BizFlow claims frameworks enable all steps of intake, distribution, adjudication, approval, and payment. Users get complete visibility into process activities, correspondence, and documentations. Managers see workload and potential bottlenecks. Everyone gets access to data to measure and improve productivity.
- Triage validates data and documentation to trigger change request or claim
- Intake reviews, validate, and categorizes requests based on policyholder, channel, region, request type, etc for streamlined routing
- Distribution creates propertise to automatically route and process requests
- Posting and Payment Issuance enables dispatch, resubmission and reprocessing, pending follow-up, reinstatement, status updates, quality assurance
Appeals and Grievances
BizFlow provides Compliance A&G, a BPM-based case management framework that streamlines Appeals and Grievance (A&G's) processes. By law members of Health Insurance providers have the right to appeal any decision made by the provider. Members may also submit grievances expressing dissatisfaction with any aspect of the operations, activities or behavior of a Medicare health plan, or its providers, regardless of whether remedial action is requested. Providers who do not strictly follow the laws involving Appeals and Grievances are subject to regulatory fines. Annual costs of managing such programs for a mid-sized medical insurance can quickly exceed $500,000, for large HMO's more than $1M/year. Compliant A&G automates appeals and grievances operations from intake, distribution, assessment, and issuance. Training is made easy as case managers only have one solution to learn.
- Skill-Based Routing of Cases automatically routes work to the most skilled individual based on client, request type, region, amount, and other criteria
- Track and manage aging cases with reports and dashboards to improve CAG quality metrics and SLAs
- Aging Alerts occur at various times in the workflow, depending upon deadlines that may be set at the time of the initial entry, or as deadlines change based upon a variety of factors, such as CMS Turnaround Deadlines, Expedite Requests, and Turn-around to IRE, CMS and other 3rd parties.
- Form Letter Creation, Generation, and Attachment can auto-generate forms, emails, and attachments at various points in the workflow
- Correspondence allows for review, rewrite approval and tracking (generated, ready for approval, approved, printed, mailed)
- Triage uses work load distribution management to identify simple to complex items to most effectively handle to completion