F. Payments Processing and Settlement of Accounts with Vendors

1. The records should be updated and prefer a claim on the Vendor. Based on the business relationship with the Vendor, reimbursement of the Claims passed will be by book adjustment against Vendor Payment or Imprest Account.
   
   
2. Then generate Payment advice, Payment Orders and Control Reports as per the needs of the management as well as Vendors.
   
   
3. Similarly when Premium Payments are received from Individuals, Groups and Corporate Clients by Carriers, the Processing Staff will calculate the amount payable to Vendors for their plans and credit the amount to the Vendor. They will also generate required reports for the information of Vendors.

1. The Agents / Brokers / TPA's canvass for enrollment into Insurance and Benefit Products. The commission amount to Agents / Brokers / TPA's will be paid as per business rules and agreements. This may be fixed or based on a percentage of Premium amount. The periodicity of payment may be either onetime or periodic.
   
   
2. The Brokers can make use of a custom developed software to promote both Software & Insurance / Benefit Providers for soliciting their Products. The software would calculate the amount due to Agents/ Brokers / TPA's to cater for all types of payments. It will also Generate Pay orders, update Accounts and print needed control and information reports.

1. Reports are required to have control on the activities outlined in each of the above processes. These reports will help the management for decision-making.
   
   
2. Ready reckoned for calculating Premium amount, commission and brokerage for different plans will be made.
   
   
3. There will also be a list of FAQ's for use by Management, Agents / Brokers / TPA's, Individual beneficiary, Clients and Staff.

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:

• Cook Children's Health Care System, U.S.A.
• Claim Management Services Inc., U.S.A.
• Memorial Hermann Health Network Providers., U.S.A.