Bpm in insurance industry

Chicago-based Celtic Insurance Company is a leading national individual health insurance provider. For over 30 years, they have had a combined a track record of product innovation and financial stability in providing health insurance products for individuals of all ages. Celtic is known in the industry for high-quality products, an emphasis on customer service and technological expertise. Recognizing that insurance needs are constantly changing, Celtic seeks to make insurance coverage available to a broad range of consumers.

The insurance industry as a whole requires a tremendous amount of data collection and the management of compliance requirements with extensive security guidelines for that data. Celtic turned to Business Process management (BPM) to facilitate their data collection, reduce redundant data entry, ensure procedures were followed correctly from beginning to end, and to create a “true” paperless office. Celtic selected Ultimus to replace its existing document-based workflow system because it was unreliable and had grown to be unsupported.

The company also recognized that with more than 30 employees processing more than 100 insurance applications each day in an unreliable environment, circumventing the existing workflow system to get the job done had become commonplace. This activity avoided key security and HIPAA requirements, which put the company at regulatory risk.

Celtic planned to demonstrate BPM success in insurance application processing by laying the foundation for extending online underwriting capabilities. This success would allow expansion into insurance claims processing, customer relationship management, links to medical records, procurement companies, and many other business areas.

After a functional evaluation of 150 vendors based on current and future needs, Celtic selected Ultimus based on its significant financial stability and market share, extensive market experience, and solid business leadership. These traits were instrumental in bolstering Celtic’s confidence in a long-term relationship with Ultimus.

The most difficult part of any BPM solution is determining the full extent of the process and the numerous steps and exceptions that are required. This Discovery Process is a critical step in ensuring that automated processes accurately reflect the work methodology and policies of the organization. The first six weeks of the initial project included requirements gathering, which resulted in a 47 page document. This provided the information needed to implement a production plan.

Following the initial requirements documentation, the Ultimus discovery team fully documented expected use cases and scenarios. Using this information, the Ultimus team, in conjunction with Celtic, finalized the business process flow, mapped the process and created the web-based user interface. The entire insurance approval process was deployed four weeks later. The entire process was completed from start to finish within 14 weeks.

In this first Ultimus-based BPM solution for Celtic, early results indicated a 50-60% performance gain with time of insurance application processing being reduced by days. To achieve this significant improvement, more than 60% of the previously manual tasks were automated. A mere eight lines of ASPcode helped maintain a consistent look and feel throughout the process, including third-party components that are related to, but outside of, the Ultimus process.

To accomplish these gains, the Celtic process makes extensive use of Web Services and XML. Tasks are automatically distributed using built-in group and queue load distribution for task assignment using Active Directory integration. The time-based monitoring system enforces legal time limits throughout the process, which ensure that all tasks are handled quickly.

Anecdotally, process participants have indicated that the UI is now significantly more intuitive than the pre-Ultimus system.

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