Digi-Swasth - Digital pre-insurance medical check-up process Qorus Innovation in Insurance Awards 2021

Insurance is an essential service. As the largest private player in the general insurance industry in India, we have a special focus on Health portfolio (~7 Million Health & PA policies in year 2019-20 with 30% growth annually). Our mission is to make Health Issuance process Simple & Connected at every touch point with real time and seamless flow of transactions & information between all stakeholders such as Customers, Agents / brokers, RMs, Operations team etc. The current medical check-up process in the industry is completely broken and we wanted to stitch all the broken ends and make it a kid’s job for the customer & partners to transact for a health policy. Digi-Swasth is a Mobile App Based digital platform developed with AI, Internet of Things (IOT), EDI by integrating with four partner systems, Auto configurator and app-based appointment booking system for giving power to customer’s hand. In health insurance business you need to perform customer’s health risk assessment, check pre-existing diseases and validate health declaration which is performed by doing customer’s medical assessment & various medical checks as per product, sum insured, declaration etc. The Digitized process has helped the company in converging its E2E digitization process strategy, smart and seamless steps and swift execution to conclude the issuance instantly. It has helped the company to move from archaic pre-issuance medical checkup process to innovative AI & ML integrated IoT based data transmission process with quality results During the Covid-19 crisis, the pre-policy medicals were successfully completed with Tele/Video underwriting process through 3 TPAs and 3500+ DCs, which is conducted remotely through phone call by TPA doctors. Tele/Video MER is a part of DIGI-Swasth process, which is very convenient and a contactless process for the customers. The process is conducted at the customer’s residence hence the customer doesn’t need to travel to the centre or step outside their house for the pre-policy medicals. The entire process is conducted in less amount of time hence not just keeping the process safe for the customer but also valuing customer’s time. In this project we have digitized E2E Pre-Insurance Medical checkup process “without any single manual intervention” - Integrating with 3 TPA systems, 3500+ DCs and their mobile Apps using System Integration - Digital transfer of data/ measurement values using Internet Of Things (IOT) & end-to-end Integration of Mobile App/ Portals of 3 TPAs with our Apps / Portals & CORE Policy Administration System. - Digital transfer of proposal details / information / medical records & vital data from our system to 3 TPAs and vice a versa. - Tele/Video Underwriting/MER (Medical Examination Report) - Automated routing of cases basis underwriting validations - Auto health risk assessment using digital data conversion by ICR/OCR & AI analytics - Instant Digital link to customer for self-appointment booking - Instant e-delivery of medical report to customer - Real time status updation between Bagic & TPAs providing real time view to customer & Before this digital initiative / automation the entire Pre-insurance medical check-up process was handled manually with a lot of dependencies and interventions from various teams: The earlier process included >15 manual processes. As per current practices in the market, the Prepolicy medical check-up process is handled manually. Arranging calls to customer and fixing appointment is done through call centre executives. The procedure is manual for ECG, BP reading is taken manually and maintained physically which causes delay in completion of medicals. Medical reports and readings are scanned or dispatched through courier - Manual referral by underwriters - Manual extraction of medical test advised data from BAGIC system - Cleaning the medical test advised data by adding and deleting some columns and fields as TPA system requirement - Manual Registration - Case registration which involved manual typing of customer details into the TPA system for each and every case and to forward the file to vendor - Manual data upload – Manually upload the data on TPA site which was time consuming - Manual Status updation – User had to update the scrutiny status manually against each and every case by switching into multiple windows from 4 different partner portals - Manual upload Reports – complete manual process from follow-up with TPA & diagnostic centers to download / receive medical reports on emails and manually upload the same into our system for each case. Cost reduction - Resource requirement has reduced- FTE cost – 20 FTEs (by automating >15 activities) (Saving INR ~60 Lacks annually) - Introduction of automated Tele MER process within Pre-Insurance check-ups has helped in cost saving of approximately 2.5 crores annually - Saving of printing & courier cost by sharing of medical records via emails and via web downloads rather than hard copy - Due to self-fixing of appointments, cost spent on calling / reminding the customer has been saved - With an integrated software system, expansion to different locations, the policy/proposal status updation for sales and marketing channels has been made easier. Due to improved access to information and the ability to analyze the data in more detail – businesses can benefit from upselling and cross-selling to their customers more effectively. - Effective volumes handling capacity - Risk assessment cost - Reduction of data processing TAT from 5 to 7 days to instant processing and completion of medicals with reports / data upload from 5 -7 days to same day and automated Tele MER in 90 Min. - Customer Satisfaction - Productivity enhancement The most critical success factors that made this initiative successful: • Digitization / automation of E2E process using AI / ML / IOT • Auto routing of cases to various partners basis AI based configurator • Auto flow / transfer of data from BAGIC to TPA site without manual interventions • Elimination of multiple handoffs & all Non Value Adds (NVAs) • System enhancements, development of workflows • App & Web support • Process Redesign The Digitized process has helped the company in converging its E2E digitization process strategy, smart and seamless steps and swift execution to conclude the issuance instantly. It has helped the company to move from archaic pre-issuance medical checkup process to innovative AI & ML integrated IoT based data transmission process with quality results. – The initiative included automation of >15 manual activities & interventions. • Digitization / automation E2E process – By effectively integrating the systems, you will reap the benefits of increased efficiency and effectiveness in the processes. BAGIC has constantly focused on automation of all manual actions / activities. Real time digital transfer of proposal details / information (where pre insurance medical check-up is required) from BAGIC to TPA system and eliminating all manual activities & interventions, such as- Manual recommending of medical tests by underwriters, manual extraction of medical test advised data from BAGIC system and manual uploading of medical test advised data into the TPA system • Elimination of multiple handoffs & all Non Value Adds (NVAs) – There were multiple manual process and dependency on the user and system which has been eradicated with this digitized process – Digi Swasth • Medical data transfer via Electronic Data Interchange (EDI) – The user had to put the data manually in the system. The data from proposal form was used to punch in the system and manually sent to TPA for calling • Self-appointment Digital link to customer to book medical appointments -Automated routing of medical cases basis underwriting validations from BAGIC to TPA system and real time sharing of the digital link to the customer for self-appointment booking of lab / home visits as per convenient date & time – Provide ease & Best class experience for the customers • Instant transfer of medical records / medical data – Instant transfer of medical records / medical data to Bagic system for instant underwriting decisions / rating by underwriters - Eliminating all manual activities & interventions • Real time status updation of cases in both Bagic & TPA system in case of any intervention by either teams providing real time view to customer & intermediaries / partners about the case status. Live status updation and availability of the same to customer / stakeholder 24/7 • Reduce dependency on particular user or team to update the scrutiny stat- By effectively integrating the systems, company to reap the benefits of increased efficiency and effectiveness in the processes without depending on any particular user • Stakeholder Experience: The new improved site is loaded with many industry firsts including – quick single click process. - The platform uses impressive technology where end to end process is automated without any manual intervention. And the biggest value add: In-built medical appointment booking slot and tracking of medical team visit. The entire process has been simplified to enhance the customer experience • Accelerated growth and innovation - With an integrated software system, expansion to different locations, the policy/proposal status updation for sales and marketing channels has been made easier. Due to improved access to information and the ability to analyse the data in more detail – businesses can benefit from upselling and cross-selling to their customers more effectively. • Volumes handling capacity: Since the E2E process is entirely digitized, wherein queries and deficiencies are being handled through app and portal with self-help process, the team is able to handle more volume effectively • Intermediary satisfaction - The documents can be uploaded by the intermediary while on move instead of visiting the branches and thus more time to focus on business and growth • Customer Satisfaction – End to communication at each stage of processing would be intimated to the intermediary via SMS and email. - Best in class digital experience provided to customers & intermediaries / partners Departments benefitted: Sales DIGI-SWASTH - Mobile App Based Digital Pre-insurance Medical Check-Up is helpful as the process will cater to higher volume of cases as per growing business, to conclude in less amount of time with accuracy and swiftness. The new improved site is loaded with many industry firsts including – quick single click process. - The platform uses impressive technology where end to end process is automated without any manual intervention. And the biggest value add: In-built medical appointment booking slot and tracking of medical team visit. The entire process has been simplified to enhance the customer and stakeholder experience Marketing – This initiative has helped marketing team to promote business. With an integrated software system, expansion to different locations, the policy/proposal status updation for sales and marketing channels has been made easier. Due to improved access to information and the ability to analyse the data in more detail – businesses can benefit from upselling and cross-selling to their customers more effectively. The documents can be uploaded by the intermediary while on move instead of visiting the branches and thus more time to focus on business and growth Customer onboarding The project “Digitized Pre-Insurance medical process” was initiated keeping in view of our company’s vision of moving to 100% digital & paperless process Pre-Insurance medicals is a part of customer onboarding process in Health Insurance which involves lot of manual activities like manual on-boarding, manual transfer of data & documents, offline screening & medical check-up, manual sharing & updation of medical parameters/ reports and physical dispatch of documents & reports. The digital process is creating seamless on-boarding experience for the customers and by empowering them with a self-guiding appointment system & Tele/Video Underwriting as per their convenience & at their home. The complete journey is paperless giving a WOW experience to our customers In this project we have done “Digitization of E2E Pre-Insurance Medical checkup process by: - Integrating with 3 TPA systems and their mobile Apps using System Integration - Digital transfer of data from medical devices using Internet Of Things (IOT) - Electronic Data Interchange (EDI) , AI , ML - End-to-end integration of Mobile App & portals of 3 TPAs with our Apps / Portals & CORE Policy Administration System. - Tele/Video Underwriting/MER (Medical Examination Report) - Automated routing of cases basis underwriting validations - Auto health risk assessment using digital data conversion using automation - Instant Digital link to customer for self-appointment booking - Geo Locator – to track medical home visit team - Instant e-delivery of medical report to customer - Real time status updation between Bagic & TPAs providing real time view to customer & intermediaries / partners. - End to communication at each stage of processing would be intimated to the intermediary via SMS and email. Targeted outcome – - Digitization / automation E2E process – automation of all manual actions / activities - Elimination of multiple handoffs & all Non Value Adds (NVAs) - Medical data transfer via Electronic Data Interchange (EDI) - Reduction of data processing TAT from 5 to 7 days to instant processing and completion of medicals with reports / data upload from 5 -7 days to same day. - Live status updation and availability of the same to customer / stakeholder 24/7 - Reduce dependency on particular user or team to update the scrutiny status Underwriting, DIGI-Swasth process can cater to higher volume of cases to conclude in less amount of time with accuracy and swiftness. Since business would be growing, the increased volume of cases can be turned into expected results within less amount of time and with seamless/ quick process - Automated routing of medical cases basis UW validations from BAGIC to TPA system and real time sharing of the link to the customer for self-appointment booking of lab / home visits as per convenient date & time – Provide ease & Best class experience for the customers - Instant transfer of medical records / data to Bagic system for instant underwriting decisions - Eliminating all manual activities & interventions. Customers- seamless process The new improved site offers a quick single click process appreciated by partners and customers. - Real time digital transfer of proposal details from BAGIC to TPA system - Self-appointment Digital link to customer to book medical appointments - GEO locator to track medical team - Tele/Video Underwriting - Auto health risk assessment using digital data conversion by ICR/OCR & AI analytics - Data transfer through connected / IOT devices from medical devices to apps - Real time case status updation in both Bagic & TPA system providing real time view to customer and stakeholders about the case status. - e-payment - Digital customer consent - Digital communication - Complete digital process at customer’s door step - Elimination of multiple handoffs & all Non Value Adds - Effective volumes handling capacity - Medical data transfer via Electronic Data Interchange (EDI) – Improved accuracy and faster data processing and quality service - Reduction of data processing TAT from 5 to 7 days to instant processing and completion of medicals with reports / data upload from 5 -7 days to same day