KPI Implementation-A simplified

guide book
 Eco system

•
The Operation is categorised into •
Claims
the following: •
Parent Suit and Non Suit Hubs at
•
Business Office(MO/Br.DO) RO centre
•
Key Business Office(To attract •
Child Suit and Non Suit Hubs at
Key Clients) Various Places other than RO
Centre(To provide localised
•
Regional Office
service)
•
Head Office •
Accounts
•
Corporate Business Office(LCBO •
Single Window Payment system
at par with a RO)
at RO(Better Finance
•
Auto Tieup Office(Nodal) Management)
 New Words and Meanings

•
Workflow-The CWISS driven •
Webservice-A real time
process of systematic control communication between two
over the movement of offices of NIA used for referring a
Proposal/Claim. Non SIP proposal.
•
Work List-The list of approvals •
SIP: Standard Insurance product
awaiting response. where the rates are decided
•
FSO based approvals-Financial •
Non SIP: All products other than
Standing Order Based claim SIP.
approval. (For Eg: if a Claim is
within Scale 2 Financial
authority, the claim can be
approved by Scale 2 Officer or
 Steps in Underwriting

Underwriting: •
4.If the Proposal is under Non-
SIP category, the proposal goes
1. Proposal entries can be made
to Underwriting Dept., RO/HO
through CWISS/CWISS Lite(for
for approval.
selected products)/Agent
Portal/Other Portals. •
5. Once approved, the proposal s
returned to Business Office
2. Supporting documents if any
through webservice visible
can also be uploaded.
through the worklist.
3. If the said proposal is under •
6. The Policy can be issued by
SIP category Policy, the Quote
BO.
gets generated, approvable at
Business Office and Policy can
 Steps in Claims(Non suit other than
Health)
•
1. Intimation: Claims can be •
Role of Centralised Accounts
intimated in any office/online Unit: The Centralised RO
through agent portal/call centre. Accounts Unit will pay the claim
amount based on data uploaded
•
2.Processing of Claim: Non OEM
by Child Hubs on daily basis.
Tie-up claims would be handled
by Child Hubs and Parent Hub in •
Role of Parent Hub: The Parent
Regional Centre. Hub at Regional Centre would be
monitoring the performance of
•
Role of Chid Hubs: The claims
Child Hubs apart from
would be processed and
Coordinating at RO level.
approved.
•
More details in following slides.
SIP-NON SIP Workflow
 SIP & NON-SIP Insurance Products

•
SIP (Standard Insurance Product) can be issued by operating offices
without seeking any approval from RO/HO
•
NON-SIP (Insurance Product requiring underwriting evaluation) can be
issued only after getting approval from RO/HO
•
Bifurcation of SIP/NON-SIP depends on factors such as Sum Insured,
ICR, Discount etc.
 SIP issuance Life Cycle

SIP policy issuance will not have any impact. It will continue as per the existing practice.

NON-SIP issuance Life Cycle

SIP policy issuance will not have any impact. It will continue as per the existing practice.
SIP-NON SIP bifurcation in CORE

•
SIP-NON SIP classification
can be seen under policy
attributes (view) after a
quote is approved/sent to
workflow for approval
Workflow approval process for NON-
SIP quotes
•
On clicking “Approve proposal” button, If a quote becomes NON-SIP, it’s
status will be “waiting for workflow approval”
•
Follow up tab of quote will show, where it is pending for approval
•
For e.g. below quote can be approved by anyone from RO from scale 1
to scale 5 or ROIC
Status

Workflow pending
with
 NON-SIP quote approval at RO
•
When a quote flows to RO for
approval, it will be visible to
RO underwriter in their
worklist

•
Worklist will be directly
visible on login to CORE
•
It can also be accessed under
tab My Preferences > My
Work Items
•
Upon clicking the Sr. No. of
any quote, user will be taken
to quote approval page
NON-SIP quote approval at RO

•
From this page, RO user can either
•
Upon Approval, the status of quote will be “Workflow
approve the workflow or send it back to Approve”
•
If Ro user clicks on Send Back, the quote will become
operating office for clarification
a draft quote again and sent back to Operating office
Issuance of NON-SIP quote after
workflow approval
•
Once the quote is in “Workflow
Approve” status, it will behave
like a SIP draft quote
•
On clicking approve proposal
now, quote will be approved.
•
Collecting and policy issuance
will happen as usual
CLAIMS - FSO
Claims hierarchy in CORE

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There will be one ROCL (Regional Claims Hub-Parent Hub) under every RO
•
There will be several child claims hubs under every RO
•
Some Child hubs will be attached to an OO if they are in different state than
their RO (to avoid GST related issues)
Claims FSO in CORE
•
Claims will be processed as usual in CORE.
•
Payment creation will happen in ROCL/Child Hub
•
Payments will flow to respective scale officer at ROCL/RO/HO for
approval depending on their allowed limits
•
Transfer to AP will be done at respective claims hub where claim is
processed
•
Vouchers will be generated either from RO or OO where the claims
hub is tagged under hierarchy. GST impact would be considered.
•
Once a payment is initiated, the home screen of •
Any user logging from RO/ROCL will see the
claim will show where the payment has flown for pending claims in their work list (left)
approval. For e.g. this claim has 2 payments (Rs.
30000 and Rs. 40000), both have flown to 130001
•
Upon clicking the Sl. No. of any claim, user will be
taken to payment approval page of the claim
•
These payments can be approved by anyone from
Scale 1 to Scale 4 or an officer with CHC Role
•
Once payment is approved, Transfer to AP can be
done from CHO where claim was initiated
•
As highlighted in Blue, these payments were
approved by the officer with CHC role (Right)
 •
OOs to facilitate premium collection, all other account related activities to be taken up at
Principles
regional accounts offices

Office Level OO Level RO Level HO Level

Petty Cash Claims pay-outs

Payments
Bills created &
Admin or Business Salary,
approved at OO Admin. expenses
expense Re-insurance, IT infra
(paid by RO)
Commissions and others
Broker Invoice
approved at OO Co insurance
(paid by RO)
Reconciliation & State level
Premium: and RO level
Collection Commission closing of accounts
reconciliation
calculation

Audit Internal Audits (if required) Internal, Statutory & CAG Audits Internal, Statutory & CAG Audits
 Things to do in a Capsule

•
Before Roll out of New System:
•
1. Clear maximum unpaid invoices and Claims if handled at DO level.
•
2. HO will send you the list of Outstanding claims for easy reference.
•
3. Clear Scroll entries. HO will send you pending Scroll.
•
4. Keep the Reports generated in Soft copy mode for future use.
•
5. Take the Trial Balance soft copy for comparison.
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On Roll out of New System:
•
1. Take a print of Trial Balance and compare with the trial balance
taken before roll out.