NewgenONE Platform for
Modern Policy Administration for Health Insurance
Streamline and centralize health insurance business functions with a low code platform.
Digitize and automate the entire health insurance customer journey across business functions, including customer/partner onboarding, underwriting, policy administration, and claims processing. The digital core system built on Newgen’s low code framework enables faster pre-authorization and approvals, efficient medical scrutiny, streamlined billing & finance, and improved claim processing. The configurability and flexibility of the solution ensures compliance with regulatory guidelines, operational efficiency, and faster time-to-market.
“With Newgen, we achieved a 75% improvement in operational efficiency through end-to-end automation, a 65% reduction in policy administration time, and a 70% increase in retention rates by enhancing customer experiences across the policy lifecycle.”
Operations Director, Top Health Insurance Company
Learn what Newgen’s Core Policy Administration Solution can do for you
Policy Lifecycle Management
Manage the entire policy lifecycle from issuance to renewal and termination, with seamless data flow across all stages. Leverage AI/ML algorithms to detect fraudulent activities, with Fraud Waste and Abuse (FWA) checks for customer and provider validation.
Flexible Product Configurator
Customize health insurance products effortlessly with a built-in configurator. Tailor coverage options, riders, and premiums to meet customer-specific needs, making it easy to introduce new product variations.
Claims Automation & Servicing
Automate claims settlement with straight-through processing for approved claims. Provide a unified policy servicing experience across web, mobile, and call center channels, allowing customers to access policy details, request endorsements, or make changes anytime, anywhere.
Automated Billing and Payments
Integrate with payment gateways to automate premium calculations, billing, and collections. Send timely reminders, process payments digitally, and reduce collection time with auto-reconciliation capabilities.
Policy Lifecycle Management
Manage the entire policy lifecycle from issuance to renewal and termination, with seamless data flow across all stages. Leverage AI/ML algorithms to detect fraudulent activities, with Fraud Waste and Abuse (FWA) checks for customer and provider validation.
Flexible Product Configurator
Customize health insurance products effortlessly with a built-in configurator. Tailor coverage options, riders, and premiums to meet customer-specific needs, making it easy to introduce new product variations.
Claims Automation & Servicing
Automate claims settlement with straight-through processing for approved claims. Provide a unified policy servicing experience across web, mobile, and call center channels, allowing customers to access policy details, request endorsements, or make changes anytime, anywhere.
Automated Billing and Payments
Integrate with payment gateways to automate premium calculations, billing, and collections. Send timely reminders, process payments digitally, and reduce collection time with auto-reconciliation capabilities.
Features of Modern Policy Administration Solution for Health Insurance
Product and Plan Definition
Seamlessly set up product plans in the system through the master data management module. Configure product parameters, including plan details, premium frequency, refund logic, and cover mapping. Utilize maker/checker capability with an audit trail to ensure accuracy and accountability. Simplify the data entry process with bulk data upload.
Policy Management
Achieve a comprehensive view of policy along with financial, claim, and servicing details and apply policy-level changes. Facilitate the maintenance and management of member data, including member cancellation, ID card replacement, member re-activation, ownership transfer, and the addition of dependents.
Underwriting and Policy Binding
Efficiently create, modify, and implement underwriting guidelines based on specific underwriting requirements. Utilize a rule engine for automated classification of straight-through (STP) and Non-STP (NSTP) cases to fast-track decision-making. Configure business rules in the underwriting rule engine to achieve consistent evaluations. Manage both medical and non-medical requirements and facilitate seamless policy issuance and kit generation. Enable omnichannel proposal registration through portals, mobile platforms, and email.
Billing and Finance
Enable premium payment through FPD, DFC, and Automatic Policy Loan (against cash value). Ensure accuracy through a payment posting against relevant head – billing premium, premium for change, FPD, DFC. Bill policies are based on billing frequency, billing mode, payment mode, and other payment scenarios. Seamlessly integrate with general ledger system for financial reconciliations. Generate the billing of files and schedule the billing process. Benefit from a transparent workflow for payment recording and posting. Easily generate billing reports and maintain transaction entries created in the system.
Provider Management
Automate communications to distributors and customers. Handle different provider types such as clinics, hospitals, doctors, and pharmacies and easily handle new provider enrolment, generate new provider ID, provider updation, and termination. Facilitate cross-department referrals during enrolment, conduct accreditation checks, and upload rate lists.
Claims Management
Establish traceability of each request, including corresponding documents and audit log of all transactions and processes. Benefit from logic-based case allocation with a pre-defined approval matrix. Make the most of easy availability of document checklists and auto-adjudication of cases based on limits and coverages to streamline decision-making and ensure the efficient distribution of tasks. Maintain flexibility through access to re-opening of claims.
Product and Plan Definition
Seamlessly set up product plans in the system through the master data management module. Configure product parameters, including plan details, premium frequency, refund logic, and cover mapping. Utilize maker/checker capability with an audit trail to ensure accuracy and accountability. Simplify the data entry process with bulk data upload.
Policy Management
Achieve a comprehensive view of policy along with financial, claim, and servicing details and apply policy-level changes. Facilitate the maintenance and management of member data, including member cancellation, ID card replacement, member re-activation, ownership transfer, and the addition of dependents.
Underwriting and Policy Binding
Efficiently create, modify, and implement underwriting guidelines based on specific underwriting requirements. Utilize a rule engine for automated classification of straight-through (STP) and Non-STP (NSTP) cases to fast-track decision-making. Configure business rules in the underwriting rule engine to achieve consistent evaluations. Manage both medical and non-medical requirements and facilitate seamless policy issuance and kit generation. Enable omnichannel proposal registration through portals, mobile platforms, and email.
Billing and Finance
Enable premium payment through FPD, DFC, and Automatic Policy Loan (against cash value). Ensure accuracy through a payment posting against relevant head – billing premium, premium for change, FPD, DFC. Bill policies are based on billing frequency, billing mode, payment mode, and other payment scenarios. Seamlessly integrate with general ledger system for financial reconciliations. Generate the billing of files and schedule the billing process. Benefit from a transparent workflow for payment recording and posting. Easily generate billing reports and maintain transaction entries created in the system.
Provider Management
Automate communications to distributors and customers. Handle different provider types such as clinics, hospitals, doctors, and pharmacies and easily handle new provider enrolment, generate new provider ID, provider updation, and termination. Facilitate cross-department referrals during enrolment, conduct accreditation checks, and upload rate lists.
Claims Management
Establish traceability of each request, including corresponding documents and audit log of all transactions and processes. Benefit from logic-based case allocation with a pre-defined approval matrix. Make the most of easy availability of document checklists and auto-adjudication of cases based on limits and coverages to streamline decision-making and ensure the efficient distribution of tasks. Maintain flexibility through access to re-opening of claims.
Solution Built On NewgenONE Platform for Health Insurance
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