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
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.
claims management system is the first of its kind to integrate with
heterogeneous third parties such as hospitals, clinics TPA, and brokers
Anita Pai, executive VP,
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
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.