Since the mid- to late 2010s, with the surge of the Insurtech space, we saw that creating a user- friendly, adaptable Policy Administration (PA) system leads to winning and retaining customers. Carriers snapped up or invested in Insurtechs and their own home-grown technology, helping to make the long, and even sometimes still handwritten, process efficient and sleek.
As technology adaptation and advancement grew internally and externally, employees, consumers and agencies began to expect the fast, capable processes. Companies also correlated business growth and retention specifically using advanced PA systems.
While there are a lot of companies focused on bringing these systems to market, each with their own sizzle, they likely all have similar learnings to share from development to launch to partner. From my own experience, I hope the following helps to identify and invoke some thought as you consider, adjust, build, buy, etc. any system you use or wish to use in the future.
1) Failure to have key people with insurance knowledge at the table in the initial development stages.
The insurance industry is complex (which may be an understatement). In the United States we may be selling the same product, using the same name of a product but, because of the insurance industry being regulated by the states individually, we may have slight product variations to take into consider from state to state.
Variation in the insurance industry could span from product to claims to regulation. Additionally, different products may have different features that may require additional PA systems capabilities. This is why having the right people aiding in the selection of or development of a PA system is key.
A short list of these key people should include:
1) Insurance product owner and/or Underwriter – they know what the coverage terms are, benefits provided and any variations that may exist. They will know what makes a customer eligible for coverage and what restrictions need to be put in place pre- and post- inception date. They also will be able to help create those much-needed email templates for notices that any modern PA system is going to have automated.
2) Claims expert – they will be able to provide details on what kind of information is needed to properly adjudicate claims. They too will have their own set of state restrictions and needs and understand what kind of documentation / notations their handlers will be required to keep. Additionally, they will know what kind of restrictions and authority levels need to be put in place for the handlers of the claims as well as any escalation processes should be easily automated.
3) Customer Service Representative / Expert – This person is going to know the standard procedures they have in place and what questions they are going to need to answer fast. They also know where current systems are maybe deficient and what the customers are asking for in terms of their experience with your company. They are your eyes and ears and they ultimately, just like the claims reps, are your ultimate users. They are going to be the ones who lead and assist customers and make sure everything is done correctly and efficiently to save the customer and the company time and potentially money.
3) Compliance – In the insurance industry, we need to live and die by compliance and as you probably gathered from the last few sections, it is an incredibly tricky compliance arena due to having 50 states + DC each having their own set of rules and regulations to follow. They will know which states require mailing of cancellation notices to what types of data protection needs to be in place to comply with the latest regulations to new developments in the regulatory environment due to recent regulation adoptions.
Each of the three people may be internal or external – consultants and/or carrier experts and may be a combination of many different sources.
Unfortunately, many systems focus on just one end user/ one product at a single point in time and fail to consider expansion into new products and/or changes in regulation. Does it have capabilities to restrict or allow sales/cancellations/changes in certain states, by agent or by product? Can it take payments Venmo or Zelle or Paypal in addition to ACH and Credit Card payments? Does it allow for variable policy terms? Can it quickly comply with a moratorium issued by a state due to storms?
If your PA system cannot adapt to changes in tech, regulation and or consumer desires This means considerable loss of time or even turn off of product sales in order for the systems development time needed to address the changes. For this reason, there is a key importance of having the system be adaptable and duplicative (in the instance of adding additional products).
With the introduction of AI and the capabilities of OCR, your PA systems can help mitigate human need and error where things really have become standardized. These new tools can read claims invoices and medical records and identify coverage types and claims costs, aiding in setting up claims for your reps. They can detect fraud and duplication of submissions by seeing where documents have been submitted elsewhere or even edited prior to being submitted. They also can answer those basic questions of “Where can I find this?” or “What is the waiting period on my policy?” By including these tools we give our reps and our customers more time back to do other things, we can get to the adjudication process faster, we can dig deeper in to the more complex, and we demonstrate we know our customers wants and needs while also showing we know our product.
We can’t talk about PA systems without mentioning that they need to have key data collection capabilities. Whether its how many customers made a claim after asking a question or visiting their member portal to what changes customers call in most often for to what coverages are getting denied the most? Each of these and many other data points lead to additional opportunities to delight your customers (internal and external) and expand your product set. You can’t get better or more efficient without knowing where you are starting from.
Summary
Building and/or buying a policy administration system is very complex, especially in the US. Having the right players at the table to ensure that core capabilities and data insights are available will set the company up for long-term success, both in taking care of their current customers and expanding in the future. Having key process automated leads to deeper dives into tougher matters and potentially additional protections against the bottom line from fraud. Finally, a customizable PA system will enable you to deliver the secret sauce that sets your company apart from the rest.
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