Paper on Business Process Management in Insurance - www.conzulting.in

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APRIA conference
June 2003
BUSINESS PROCESS
MANAGEMENT IN INSURANCE
RAMA WARRIER & PREETI CHANDRASHEKHAR
INTRODUCTION
All enterprises of the modern era
operate in an environment of high risk
exposures. One of the critical areas of
exposure is the vulnerability of the
processes. Most of the conventional
manufacturing and service industries
are built on process intensive
operations models. Insurance industry
is no different. The stability of an
insurance company depends heavily
on the strength, consistency, reliability
and integrity of its processes. This
paper is aimed at ways of analyzing
the process risk exposures of an
insurance company and the ways of
efficiently managing it. A general
definition of business processes
(Hammer&Champy, 1994, Kueng &
Kawalek, 1997), defines a business
process as a set of partially ordered
activities aimed at reaching a well-
defined goal. Examples of goals in
insurance could be:
 Closing a sale i.e. converting a
proposal into an insurance
contract.
 Paying the promised amount on
the happening of the contingent
event.
Some business process types
(activities) that aim at reaching these
goals are:
 New Business process
 Claims process
Business processes would have clear
start or trigger events and have a pre-
defined sequence of tasks and
decisions to be performed by
nominated actors in a pre-determined
order. The standardization of
processes in a company is usually a
good measure of the quality and
efficiency of its operations.
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Business Process Management –
a key to business agility
Business process management does
not mean aligning technology to the
business objectives. Outdated or
moribund processes not only restrict
the manoeuvrability of business
processes, but also render any
technology applications in that
direction redundant. Granted, that an
effective IT strategy provides the
leading edge to a company in a highly
competitive market. But the key issue
is the ability to identify, understand
and communicate the changes in
business processes that this technology
assists. “Major systems investments
yield little return unless they are
accompanied by equally major
business change.”2
A top-down approach towards
processes and operations gives a more
holistic view and helps in managing
activities to increase productivity and
profitability. Listed below are some of
the advantages of an effective business
process management. “Claims
processing” has been chosen for the
purpose of illustration, since claims
costs can account for anywhere up to
80% of the insurer’s costs depending
upon how efficient the process is.
 Reduced Costs: Since claim costs
contribute to high management
costs and hence affect the margins,
an efficient Claims Management
process would enable the
company to leverage its resources
(both technology and human
resources) more effectively.
 Operational efficiency:
Impediments to an effective
Claims management involve
among others paper-based
workflow processes, collation of
disparate or poorly aggregated
data, disparate data standards.
Effective claims management
involves reduction in cycle time.
This reduction can be achieved
through various means -in the
form of using imaging technology
to reduce paper work or the ability
to automate complex transactions.
Studies have shown that an
effective BPM reduces the cycle
time for processing Claims in the
range of 50 to 75 percent.
 Improve quality: A well managed
business process helps in deriving
meaningful results from
quantitative data that is reliable.
This helps in the iterative process
of continuously improvising and
improving the business process.
Reports on benchmarks, key
performance indicators, and other
criteria provide insights on how
well the units are performing, in
their own work and as part of a
larger process.
 Increase customer satisfaction:
Persistency in business is the
hallmark of any insurance
companies’ ability to retain
customers. An efficient business
process, particularly in the area of
Policy Owner Servicing and
Claims Management increases
customer satisfaction, repeat
business and hence the margins
for profit.
 Increased agility: A rigid business
process reduces the companies’
ability and ease to respond to
market conditions. An efficient
business process adapts quickly to
changing needs at moderate costs.
 Collaboration: Standardization of
business processes within and
beyond the enterprise furthers

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interaction and improves
relationship management with
both business partners and
customers. Business Process
Management removes boundaries,
thus enabling inter-departmental,
intra-enterprise and inter-
enterprise workflow which
seamlessly moves through-out the
process. Such workflows improve
efficiency and control. It facilitates
uninterrupted movement of data
and information between different
business software applications and
data sources.
Business Process Analysis
The pressure of competition and
falling costs is steering companies
towards increased automation and
integration or re-engineering of
various business processes. Given
these kinds of changes in the system,
the biggest challenge that senior
managers face is ensuring that they
have effective and efficient controls
over the key business processes. A
systematic approach to understand
and analyze process is the first step
towards effective process risk
management. Business Process
Analysis provides a flexible and
systematic approach to assessing the
adequacy of controls on the business
process in a constantly changing
environment. One possible method is
analysis of the risks associated with
the business process. An effective
analysis of the process based on the
process risks helps the management in
taking informed decisions.
The various steps involved in the
analysis are :
 Business Process Identification
 Business Process modelling
 Business Process Risk
Management
Business Process Identification
The logical point to start is by
comprehensively identifying all the
processes which constitute the
business model of the company. At a
broader level, the business processes
can be classified as
 Operational and

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 Financial
A top-down approach is usually very
effective in the identification phase.
The operations of the company could
be split broadly into functional areas
and each one of them could further be
drilled down to processes.
A rule of thumb would be to map the
business processes at three levels:
Level 1 would be the highest level –
the total number of business processes
at this level being around 8-10. For an
insurance company, the business
processes at this level are:
 New Business
 Channel Management
 Compensation Management
 Policy Owner Services
 Claims Processing
 Corporate Accounting
 Reinsurance
 Client Relationship Management
 Actuarial Processes
 Product Development
Level 2 would breakdown the Level 1
processes into more granular details.
Again, taking the example of Claims
Processing, the various sub-processes
would be:
 Claim Initiation
 Claim Verification
 Claim authentication
 Claim authorization
 Claim payment
Level 3 would involve getting down to
the atomic level of each of these sub-
processes represented by activities.
These activities in turn, could be
activities that could be automated of
have to be manual.
After having identified the various
activities that logically make up the
business process, the next step
involves depicting the business
process in the form of a model.
Business Process Modelling
Business Process Modelling involves
analyzing the internal activities of an
existing business process to improve it,
usually by eliminating non value-
adding activities.
Some obvious benefits of business
process modelling are:
 Process Documentation
 Process improvement
 Process Risk Management
 Knowledge management
 Workflow management
 Activity Based Costing
 Technological improvisation
The various steps involved in Business
Process Modelling are:
 Business process mapping
 Process Risk identification
 Process Risk Measurement
Business Process Mapping
One of the preliminary steps for
business process analysis is to map the
processes.
Some methods of business process
mapping are:
 ER diagrams
 Data flow diagrams
 Flow charts
 Workflow models
 Event driven process chains
 Rapid Application Development
 Object Role Modelling
If one were to try to map the claims
process for an insurance company, the
process would require to be broken
into small sub-processes and then into

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activities/ tasks .Each step of the
process would be modelled on three
parameters:
• Actor – The person / department/
system which performs the
activity
• Activity – The business content of
the step
• Pre & Post conditions
A typical property claims process
could be mapped as shown below:
Process Risk Management
Process Risk identification
After classifying and modelling of the
processes, the risks associated with the
processes need to be identified.
Identification of risks is a very critical
and important activity which often
does not get as much priority as it
deserves. Identification is an activity
which would require a good
combination of process knowledge,
past risk experience and ability to
pinpoint trouble spots. This involves
collecting and analyzing the data to
assess the inherent risks to aid in
informed decisions. Process Risk
Identification and modelling help in
analyzing the process from a strategic,
operational and tactical perspective. A
few of the operational process risks in
the claims process mapped above
could be the following areas:
• Inaccurate prima facie liability
determination leading to legal
issues
• Lack of clarity in identification of
claims for investigation
• Over or under provisioning for
claims leading to accounting /
regulatory issues
Each of these risks can be identified as
ranked according to the numerical
value (or probability) associated with
them.
Some typical high risks associated
with ‘Operational Processes’, which
are general in nature, are:
• Product service failure
• Business interruption
• Performance gap.
Some low risks are:
• Obsolescence
• Service cycle time
• Redundancy
Using a numerical value for a process
risk is both preferable and desirable
for ranking the risks. This would be in
the form of “impact” or “magnitude of
loss” or “potential opportunity cost”
associated with the process. The
impact would either be measured in
financial terms or qualitatively using a
subjective measurement scale.
Process Risk Measurement
The crux of modelling a process to
measure the risks lies in the ability to
match the business process model to
correspond to what is going on in the
real world. There are various ways in
which business processes and the
associated risks can be modelled. The
method chosen will depend upon:
• Existing documented information
about the business process.
• Intended use of the model –
whether the model intends to
o Increase the level of
process maturity
o Create a basis for process
analysis and
reengineering.

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o Create a basis for
building computer
support systems.
The most used models in the insurance
industry (depending upon the nature
of the process and the associated risks)
are:
Individual risk models where the
total claims on a portfolio of insurance
contracts is the random variable of
interest.
Collective risk models which are used
when we need to model several claim
occurrences together. In this model, an
insurance portfolio is viewed as a
process that produces claims over
time. The variables that can be
modelled in both the above
approaches are
• Frequency of claims
• Severity of claims: A rather
simplistic way of representing the
aggregate loss is in the following
form:
C = X1 + X2 + X3 + … XN
Where N is the frequency
distribution
And X is the severity
distribution
And C is the aggregate loss
distribution
Diffusion models / stochastic
processes
These kinds of models are used while
assessing how the risk has evolved
over time. The models may be in
continuous time or discrete time.
They are typically used in financial
processes while assessing the
strategies in investment options and
the risks associated with them.
Some other models are:
• Multi-state models
• Cash flow models
Some Aids for BPM
Process Risk Management activities
include the analysis of various options
available. Some important aids in this
analysis are:
• Balanced score card – Some
elements which aid in business
process risk management are:
o Processing time
o Waiting time
o Process frequencies
o Process costs
o Time to market
• Benchmarking - Helps in
delivering quantitative results
rather than qualitative
comparisons.
• Six Sigma quality - This would
primarily aid when the aim is to
increase the level of process
maturity. It aids in focusing
quality control audits on those
processes that have the maximum
impact on the bottom line.
Role of IT
Technology plays a very important
role in process risk analysis and
management. The role of technology
would be mainly in the following
areas :
• Standardization of processes
System implementation
automatically standardizes the
processes and the exceptions.
Existence of a comprehensive IT
application would help to
standardize processes across the
organization and across
geographical units.
Standardization is one of the best

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ways to considerably control the
risk exposure. The fact that
standard processes deliver results
within expected range helps to
minimize the risk. There are many
areas in insurance operations
where process standardization
could bring dramatic effects. For
example, claims is an area where
companies want to give a lot of
flexibility for exceptions. This
could degenerate into lose
processes exposing the claims
process to higher risks.
• Ensuring compliance by building
in system checks and balances:
Even the most standardized
process requires good checks and
balances as human mind can
always find the easier route which
may not always be the best route.
A well designed software
application would have regular
check points to keep tab of the
process as well as to ensure that
the risk points identified from
experience are covered. For
example, if claims provision is a
risk aspect identified, checks
could be built into the system to
match the pattern of the current
claim to similar claims in the past
and verify the provision given. In
case the variation is high, the
system could alert the user or
even block further processing
without specific approval from an
appropriate authority. • Develop
effective alert mechanisms Alert
mechanisms could be a measure
to invite the attention of the user
to the risk at the appropriate time.
Alert mechanisms could be built
into more effective decision
support tools by providing facility
to assist the user to make the right
decision when alerted.
• Maintain metrics of process risk
exposure measurements
• Provide support/tools for process
risk analysis and modelling
• Improve audit trails for risk
monitoring
• Capture information once and at
the source.
Translating the business requirements
into appropriate IT application is more
difficult than it appears. It is the
problems with this step that renders
many innovative BPM ideas useless.
Requirements Gathering has been
identified as the biggest challenge for
any Information Technology initiative.
The need to get it right the first time is
often in conflict with the pressure to
start programming “now”. A typical
response to this issue is to “just
automate what we do now”. This leads
to systems which just pave over the cow
path.
Conclusion
Business Process Management is a
concept which gained clarity with the
advent of automation of processes,
though the concepts are equally
applicable to organizations with
different levels of automation. BPM
aims at defining, designing, managing
and automating processes to ensure
smooth workflow between various
business entities participating in the
execution of a process. Technology is
the key aid for achieving this objective.
Insurance industry of this millennium
is faced with two very critical
pressures – cost and service efficiency.
Both these are direct functions of the
status of the processes in the company.
Hence, time is ripe of insurers to focus

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on managing their processes in the
most and cost efficient way by suitably
re-engineering the processes and
leveraging the options provided by
technology.
References:
1. “Modelling in the Australian
Practice - Preliminary Results
from an ACS Survey” -Michael
Rosemann, Queensland University of
Technology, Centre for Information
Technology Innovation Auckland, 20
February 2003
2. Michael Hammer, “How to Sell
Change,” Optimize Magazine,
December 2001
3. “Risk Measurement in Insurers”,
Presentation at Fields Institute,
Toronto Stuart Wason, FCIA March 27,
2002
4. “Business Process Management and
its Value to the Enterprise”, An
executive overview, HandySoft Corp.
Authors could be reached at warrier@conzulting.in
or Preeti.Chandrashekhar@towerswatson.com

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Appendix