US Insurance Company Automation: Switching from 3 Third-Party Systems to an Internal One

Quick Video About the Project

Collaborating with HQSoftware, the customer developed a system that automates the core business processes of the insurance industry: agent certification/onboarding, commission billing, enrollment, claims payment, sales/marketing campaigns, etc.

With the delivered platform, the customer was able to replace three different business-specific solutions — each addressing a certain pool of tasks — from different vendors. Thus, the customer eliminated extra expenses on customizing those solutions and monthly vendor fees.

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Customer

The customer is a health insurance company with over 1000 employees, operating in the United States.

Challenges

In the course of the development, the team at HQSoftware had to face the following challenges:

• As long as the solution was to facilitate all the business processes, it needed to have a scrupulously designed business logic that would ensure smooth interoperation of the core modules.
• To enable accurate accounting, the module responsible for commission billing needed to distinguish between multiple factors—e.g., was it the first sale or a change of an insurance plan—and comply with the business rules provided by the customer.

Solution

The delivered system comprises a number of modules that automate the core processes of health insurance.

Onboarding

Starting with onboarding the agents, the solution allows for educating and certifying the specialists. Thus, developers at HQSoftware made it possible for the agents to watch tutorials online and take a test.

In case of satisfying results, an agent was offered to upload his/her license, so that the system could check his background. Engineers at HQSoftware integrated the developed solution with the NIPR service that verifies the validity of the agent’s license.

Our experts also delivered functionality that enables top managers to get real-time reports on how many agents were hired, who passed the test, whose license is valid, etc.

Commissions

To ensure the accuracy of accounting, the team at HQSoftware developed an algorithm that calculated the commission to be paid to in-house agents and external brokers. While the in-house agent’s commission was KPI-based, the one of an external broker depended on multiple parameters.

For instance, the algorithm had to take into account such criteria as the state the sale took place, which insurance plan a client was using before the sale, etc. Furthermore, the hierarchy of the insurance system implies that some brokers may get a percent of a deal made by another broker. This percentage differs greatly in accordance with the broker’s place in the hierarchy, so the delivered solution allowed for configuring the rate.

Sales

The developed sales module stores information about all the agents and leads. For instance, an agent profile provides access to the licenses, the states an agent can operate in, onboarding information for the current year, as well as for all the previous ones, etc. The module allows for automatically changing the status of a lead once it gets into the system and goes through all the stages of processing / verifying. Furthermore, it is possible to track the history of a status change at any point in time. The system also features an advanced search by numerous options, including the one by tags.

Marketing

Developers at HQSoftware then delivered a marketing module that automates the process of allocating the leads between the agents. The module also allows for running marketing campaigns: on creating a campaign, a telephone channel is assigned to it. The lead call is automatically transferred to such a channel and the agent responsible. To track the efficiency of the campaigns, engineers at HQSoftware made it possible to analyze data gathered and generate reports.

Third-party service integration

Our developers provided integration with another third-party service, which allows for checking the credibility of an insurance holder as some plans were available for particular groups of people only.

Providers

Experts at HQSoftware designed a module that maintains the cooperation with healthcare institutions and doctors, as well as with the agency responsible for claims’ payments.

Reports

To furnish decision-makers with a tool that enables efficient supervision, our team also designed a module that generates highly interactive reports with clickable values, advanced full-text search, etc.

As long as the system covers all the key business processes, the customer is planning to whitelabel the developed SaaS solution to get an additional revenue channel.

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