ICICI Prudential Life Insurance : SOAl Curry for Life

ICICI Prudential, one of the largest

insurance companies in the private sector, has been relying heavily on

technology for all its needs. Right since its inception, about nine years ago,

as a part of the mammoth ICICI Group, IT was adopted in full scale. And there

were very few hurdles to IT adoption, as the group company was already ahead of

the curve in adopting some the best IT infrastructure and applications in the

industry.

Under the aegis of Anita Pai, EVP, ICICI Prudential Life

Insurance, the company has adopted IT as an essential part of its operations and

customer service. Not only robust CRM tools, ICICI Prudential has also invested

in a very nimble HRMS system that has automated almost 99% of the employee

processes on the platform. Apart from that ICICI Prudential has also recently

deployed a Sybase data warehousing application and a claims processing system

using the ACORD models.

Based on the BizRules engine, the internal IT team has also

built a customised underwriting system. The fact that the company has set up a

project management office comprising senior officials from all departments of

the company, to ensure that all projects are completed in time has enabled

faster adoption of technology. Now, the company plans to focus on delivering

services on the mobile and as part of its customer self service models.

One IT project that has provided maximum benefits to the

company has been the Health Claims Management System (CAPS). "The project was

conceived to build a robust, scalable web based integrated system that will

serve as a single application to be used by all third parties.

The system would be accessed by the entire ecosystem of

health insurance domain nation wide comprising payers (insurance companies),

providers (hospitals and clinics), TPA and branch offices.

The project was innovative in many respects. it was a pure

SOA based health claims solution; it was the first successful usage of ACORD

(international insurance data model standard) for health insurance claim system

in india. It provided pure acord XML driven integration with third party system

which facilitated real-time hospital access to provided claims decision within

hours instead of days. it also featured a flexible claim benefit calculation

engine built primarily on actuate engine.

The project has been implemented with best of breed design

patterns by using spring and hibernate framework. The solution is compliant with

international health insurance standards such as HIPAA and ACORD. It also has

inbuilt fraud rules for alerting blacklisted customers and hospitals. The system

is completed integrated at the back end. The claims solution is integrated in

real-time with sms, e-mail and document management engine for customer and

hospital communication at various stages of claims processing.

The project has reduced the turnaround time for cashless

claims decisions from 8 hours to 3 hours. providing anywhere and everywhere

access, it allows real time information for analytics that reduces the

fraudulent claims. it also allows the executives to track per customer wise

claims that helps in up-selling the portfolio of products.

The claims management system also features hospital

credential ratings to help take right cost decisions and communicates with the

customer at all stages of the claims lifecycle as all processes are integrated

at the back end and made available through e-mail and SMS. The system has also

improved employee productivity as it auto allocates the claims cases to

respective assessors.

According to Pai the healthcare claims management system is

the first of its kind of system to integrate with heterogeneous third parties

such as, hospitals, clinics TPA and brokers and has capability to exchange

message in pure XML standards.

Priya Kekre



priyak@cybermedia.co.in