Honest Data in Insurance

Business processes are built on rules – thousands of rules – for underwriting, claims adjudication, qualifying compensatory entitlements, determining your producers and what they can sell, and what to offer your policy holders. These rules are enforced by conventional rules engines and sometimes rules management through digital process automation. Sometimes the rules come from human judgment or Kentucky windage by putting your finger in the air with a smart, intuitive guess.

But, the hard reality is this: all of your rules are based on human judgment. This is without regard for whether the rule is authored, enforced, or automated by technology. The rules expressed across enterprise processes were conceived and communicated by a person. And because they are human-based, decisions can be subjective. We learn something new every day. We learn and improve from our mistakes.  We, as people, are fallible.

The data, however, never makes a mistake, always speaking the truth. By harvesting the annals of history, our rules do not need to be ignorant to the reality of trends and predictions that never came to pass. This is valid across the board. We have the technology to automate decisions based on elegantly aggregated data through models that have the agility to adapt from an incorrect prediction.

If, for instance, your primary underwriting application is enabled by rules (decision trees, decision tables, et al), one should interrogate the nature of those rules and the decisions they make. Are they always the right decisions? What are the claims patterns of similar personas?  Are those patterns empirical or anecdotal? And how are those facts available to you should you need to modify your decision criterion? What happens when imperative conditions change?

These things are indeed knowable. In fact, they’re known. We only need to gather their insights. Every transaction is garnished with payloads of metadata that describe the preconditions, behaviors, decisions, timings, context, handlers, and outcomes. This data is, historically, completely untapped.

We have the technology to refactor the rules of your business using the insights of your data by interrogating your static rules network. You’ll never be able to say, “I didn’t think of that” again.

Gregory (Greg) Price

Sr. Director, BPM Insurance Partner, BPM Strategist - Virtusa Greg is a consulting and technical services leader providing delivery leadership leveraging skills surrounding strategic execution, applications architecture, and program leadership with greater than 20 years of experience in each phase of the software development life cycle utilizing agile and waterfall development methodologies against a broad range of technology at expert proficiency.

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