I. Customer Relationship Management
- This process would enhance the relationship between Management, Staff, Agents / Brokers / TPA’s, Beneficiaries, Groups, Clients, Vendors.
- The concerned departments of Carrier would be responsible for maintenance and updating of Information pertaining to CRM activities.
- This process [CRM] includes Call / Request Registration, Call / Request Tracking and Call / Request Closure.
- Control Reports will be generated for Pending, Open and Closed Calls / Request.
J. Accounting and Audit
- The amount received as Premium will be validated against the expected and exception report will be generated for each client and plan.
- The amount paid against Commission and brokerage will be based on type of payment and periodicity.
- The amount due to Individual beneficiary will be based on Service charges to the Client and the rebate from the Carrier.
- Carriers will carry out audit on percentage of approved and rejected Claims manually at random and an audit report will be made.
- The payment dues towards service charges and rebate will be credited to Corporate Accounting.
- The Commission and Brokerage will be calculated for payments to Agents and brokers.
- The Premium Payments to Vendors will be calculated and payments made/ adjusted.
- Receipts and Acknowledgements will be sent through appropriate media.
- Summary and Individual Reports will be generated as needed by the Management
Insurance and Benefits Management Business Processes:
a) Publicity and Promotion of Products.
b) Product Evaluation.
c) Enrollment of Beneficiaries for the Plans.
d) Receipts and Accounting of Premiums.
e) Processing and Settlement of Claims.
f) Payments Processing and Settlement of Accounts with Vendors.
g) Payments Processing and Settlement of accounts with Agents/ Brokers.
h) Routine and Exception Reporting for Management Control.
i) Customer Relations Management with Beneficiaries and Vendors.
j) Accounting and Audit.
 System Administration.
Case Studies:
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