Cincom In-depth Analysis and Review

Claims Correspondence Made Easy!The Benefits of Dynamic Document Automation in theInsurance Product Lifecycle

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SIMPLIF ICATION THROUGH INNOVATION ®

Table of Contents

Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Dynamic Document Automation for Successful ClaimsCorrespondence Creation . . . . . . . . . . . . . . . . . . . . . . . . . 3

What Is Dynamic Document Automation? . . . . . . . . . . . . 4

Automating Claims Correspondence Creation . . . . . . . . 5

Design Claims Correspondence that Is Customized and Personalized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Deploy Personalized Claims CorrespondenceGeneration throughout the Enterprise, Seamlessly . . . 6

Deliver Timely, Persuasive Claims Documents . . . . . . . 7

Manage All Your Claims, Easily . . . . . . . . . . . . . . . . . . . 7

Cincom Has the Claims Correspondence Solution forToday’s Insurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Benefits Realized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Case Study: Wisconsin Physicians Service . . . . . . . . . . . . 9

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

About Cincom Document Solutions . . . . . . . . . . . . . . . . 10

About Cincom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Cincom In-depth Analysis and Review

Claims CorrespondenceMade Easy!

The Benefits of Dynamic DocumentAutomation in the Insurance ProductLifecycle

WHITE PAPER

1

Abstract

The contemporary business environment has undergonesignificant changes over the past few years. The increaseduse of one-to-one communications has pushedorganizations to modify the way they interact with theircustomers and focus on building customer loyalty. Theonly companies that will thrive are those that are able todevelop and maintain relationships with their customers.

The main driver of customer relationships is personalizedcommunication. Statistics show that 90% of organizationsface the dilemma of communicating efficiently with theircustomers without compromising the quality ofpersonalized contact. This is where dynamic document-automation applications come into play.

Dynamic document automation allows organizations toefficiently produce documents in large volumes whilesimultaneously personalizing content for each individualdocument and automatically store and index thosedocuments for later retrieval. More than just databasemanipulation, dynamic document-automation applicationshelp organizations improve customer acquisition, reducecustomer churn, and increase cross-selling opportunities –all while providing the kind of personalization customerscrave.

While technologies for accumulating content areimportant, the place to start is with the applications thatactually deliver content to customers – this is the domainof dynamic document automation systems.

Retention

Exte

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Acquisition

Full Customized Care Lifecycle

2

Introduction

“Spending on document production,distribution, storage, retrieval, anddocument/content repurposing consumes1% to 5% of an enterprise’s annualrevenues.”– IDC

Insurance is about information, and much of thatinformation enters, leaves, and lives in the insurancelifecycle as printed documents. A typical insurancecompany interacts with customers through a wide range ofcommunications, including proposals, illustrations,contracts, policies, claims correspondence, letters, andother paper-based documentation that underpin theindustry. With multiple handoffs and touch points involvedin every interaction, this paper-intensive environment canbe a drag on the transactions that move through it and, asa result, take longer to effect those transactions.

As documents continue to overwhelm the insuranceindustry, so do the technological solutions designed tohelp it deal with those documents. With a plethora ofinformation about enterprise content management (ECM),information lifecycle management (ILM), documentcomposition, and document management, many insurersare still unsure of where to focus their attention and whichsolutions are relevant for them.

It is critical to adopt a solution that meets all of the diverseneeds of documents in each phase of the insurancelifecycle. Understanding how dynamic documentautomation supports and benefits the Insurance ProductLifecycle will help insurers make some of these criticaldecisions.

This paper examines how dynamic document automationsupports policy generation in the retention phase of theproduct lifecycle.

Distribution / Proposal Policy Issuance / Billing Service / Claims

Insurance Product Lifecycle

• Assemble proposal components including illustrations, quotes, etc., by individual state, by specifics of individual situation• Print and mail• Archive

Process Steps:1. Sales/marketing completes application forms2. Application forms are sent to underwriting for rating/quoting3. Underwriting sends guidance/decision back to sales/marketing4. Proposal assembled5. Proposal printed6. Proposal mailed/presented to customer7. Proposal archived

• Handle incoming communications from policyholders; make changes, request information, challenge claims denials, etc.• Resolve issue, generate and send reply• Archive

Process Steps:1. Receive mail, or handle inbound call2. Image or record receipt3. Route to service personnel4. Service personnel consults other internal sources if necessary to resolve issue or gather additional information5. Service personnel composes reply; templated responses as much as possible6. Reply printed7. Reply mailed8. Reply archived

• Assemble policy components including all necessary riders, etc., by individual state, by specifics of individual policy• Print and mail• Archive

Process Steps:1. Policy details entered into policy administration system2. Policy administration system generates policy document (Word, PDF, or print- stream)3. Policy printed4. Policy mailed5. Policy archived

Claims ManagementPolicy AdministrationProposal Administration

Acquisition Retention / Extension

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Dynamic Document Automationfor Successful ClaimsCorrespondence Creation

If your business deals with claims processing, dynamicdocument automation can help streamline the claimscorrespondence creation process and reduce youroperational costs. By enabling customer-facing users togenerate claims documents “on the fly” whilesimultaneously interacting with claimants over the phone,document automation allows your organization to processclaims faster and with fewer errors.

Dynamic document automation solutions can also helpcomply with industry regulations. As long as centrallymanaged and controlled claims document models arecompliant, every claims document generated from themwill also be compliant.

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What Is Dynamic DocumentAutomation?

In general, insurers’ document needs fall into twocategories: document composition and documentmanagement. Together these solutions provide thestructure for a complete document-automation solution.

Document composition is the authoring or automatedgeneration of documents used to communicate withexternal parties. As the first phase of the document-automation process, document composition encompassesthe design, deployment, and delivery of high-volume andinteractive personalized communications (i.e., proposals,policies, and claims).

Design personalized content: Document automationallows you to easily design sophisticated documentmodels with complex business logic that can bedynamically applied to all of your documentcommunications. Everything from simple letters to highlypersonalized proposals – complete with bar codes,logos, charts, and variable data – can be generated in avariety of formats (e.g., ODBC and XML) from any sourcewithin your enterprise.

Deploy timely communications: New document-automation solutions are being engineered as singlesolutions that can be deployed across your enterprisevia a service-oriented architecture (SOA). This 100%commitment to open standards optimizes your legacyinfrastructure investments while providing efficient, rapidintegrations, multiple delivery channels, and outputs inseveral formats (e.g., PDF, AFP, and XML).

Deliver compelling documents: Document-automationsolutions combine the scalability to produce structureddocument communications in high-volume batch withthe flexibility to generate highly personalized, free-formdocuments on demand. This allows you to interact withcustomers in real time, and deliver documents in theform that each customer prefers – print, fax, e-mail, orweb.

Document management includes routing, storing,indexing, archiving, and retrieving documents that containinformation needed to underwrite policies, process claims,and communicate with customers. Documentmanagement solutions enable companies to achieve thefollowing results:

• Gain visibility into their business.

• Acquire and retain customers.

• Reduce costs.

• Increase productivity.

These results can be achieved by implementing a solutionthat captures content and provides an archive withpowerful indexing technology.

Document automation incorporates both dynamicdocument composition and document-managementsolutions. This allows you to eliminate manual processes,thus speeding production time, lowering production costs,and improving document accuracy.

Document issues continue to plague insurers. Fortunately,there are now document-automation solutions that areeasy to use, easy to integrate, and easy to maintain. Thesesolutions will help insurers cut costs and still meet theircustomers’ needs and expectations.

DESIGNDocument Automation

DEPLOY DELIVER MANAGE

Data

RulesLogic

Format/Schema

Interactive

Print Email

Web

Batch

Fax

Archive

Index

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MODEL

Automating ClaimsCorrespondence Creation

The level of care that claims organizations provide is anintegral part an insurer’s overall product delivery. Today,customers choose insurers for more than just great ratesand coverage. They also want great service, particularly atthe time of a claim when the customer is often in astressful situation and hoping for a painless process.Therefore, delivering the right information in the rightformat to the right audience at the right time and for theright reason is critical to customer satisfaction and,ultimately, the insurer’s ongoing success.

The key to delivering superior customer care in claimsorganizations is responding faster to claims inquiries anddelivering an exemplary customer experience. Claimsrepresentatives must be able to get answers and solve

issues quickly and accurately. In short, every customer’sexperience needs to be easy, fast, and thorough.

While it sounds simple enough, the challenge for mostclaims organizations lies in implementing solutions thatsimplify all of the complexities involved in harnessingcontent generated by claims management systems andapplying formatting and business logic to that content insuch a way that non-technical, claims resources – not justIT personnel – can easily assemble, generate, and deliverclaims documents that are accurate, timely, andpersonalized to each customer. This level of documentcomplexity requires dynamic document compositiontechnologies.

Dynamic document composition applications provideclaims organizations the tools needed to deliver a highlypersonalized customer experience through documents.Claims representatives can quickly and easily assemble,design, generate, and deliver personalized claimsdocuments, even while interacting with claimants in realtime.

5

Product branding and corporate identityelements are automatically merged toensure proper usage.

Variable information is included in the document including:address block components, and effective date.

Dynamic graphics includingsignatures are added based uponpre-configured rules logic builtdirectly into document modules.

Variable placeholders arepredefined with XML schema.

Transaction-driven tables and personalizedcharts of all types are built for dynamicincorporation into documents.

6

Design Claims Correspondence that IsCustomized and Personalized Sophisticated document models can be easily created,tested, and edited within a familiar Microsoft Word-baseddesign environment and incorporate complex logic,guided workflows, and real-time data from a variety ofsources, including claims management and policyadministration systems. Dynamic document compositionhelps streamline claims interactions while delivering thepersonalization and accuracy that customers demand.

• Personalization: Drive deeper personalization withinclaims documents by embedding sophisticated logicand real-time, customer-specific data from any source orformat, including mainframe. Rules-based logic providessophisticated functionality within document models,including data-driven logos, regulatory language,paragraph dependencies, and signature inclusions.

• Time-to-Market: Dramatically shorten the time it takesto move claims documents into production throughcomprehensive testing and preview capabilities builtdirectly into the design environment. Easily move fromdocument design to production without manualintervention or complex programming from IT.

• Quality: Automated data acquisition, version control,and reusable content components provide the simplestand easiest pathway to claims document quality andnear-error-free performance.

• Compliance: Significantly reduce the burden and costsassociated with regulatory compliance throughcentralized management and monitoring of contentcomponents, as well as comprehensive audit facilities.

Deploy Personalized ClaimsCorrespondence Generation throughoutthe Enterprise, SeamlesslyDocument composition is making insurance a faster, moreflexible, and more customer-focused industry. With onesolution, companies are able to design, deploy, deliver,and manage the full range of communications – includingletters and status reports – and easily modify them tomeet changing requirements, while leveraging all of thedata within the organization. Document compositionachieves this in the following ways:

• Single Solution: Simplify the IT infrastructure through asingle, comprehensive solution for batch automationand interactive document generation.

• Rapid Integration: Provide efficient, rapid integrations,support multiple delivery channels, and streamlineworkflows with consistent, progressive, and flexible rulesimplementation through a solution architected entirelyon published, open standards and utilizing a 100% XMLcore.

• Extensibility: Extend the value of investments in coreapplications and technologies with adherence topublished, open standards and a services-orientedarchitecture that promotes agility and flexibility.

• Enterprise-Wide Access: Provide business-line userswith easy access to document model repositories fromanywhere across the enterprise.

• Multiple Support: Simplify the management andmaintenance of document repositories by utilizingpublished, open XML-based technologies that minimizethe number of document models required to supportmultiple delivery channels, outputs, jurisdictions, andlanguages.

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Deliver Timely, Persuasive ClaimsDocuments Simple, intuitive interfaces, such as a web browser, giveclaims representatives “point-and-click” access to acentral repository housing sophisticated document modelscontaining pre-approved components (e.g., compliantlanguage) and pre-configured workflows that easily guidethe assembly of documents. Claims representatives canthen quickly assemble documents by selecting frompredefined paragraphs, logos, and signatures or supplyingfree-form text ensuring that claimants get the exactinformation they need, when they need it – even in realtime.

• Interactivity: Dynamically assemble, generate, anddeliver highly personalized claims documents withvarying degrees of complexity while interacting withclaimants in real time.

• Ease of Use: A thin-client interface, point-and-clickaccess to documents, and guided workflows provide ahighly intuitive environment that significantly reducesthe training burden across the enterprise.

• Timely Response: Improve responsiveness with point-and-click access to a multitude of claims documents anddocument packs that provide single customer delivery ofmultiple documents.

• Multiple Delivery Channels: Automatically adjustdocument characteristics to the respective deliverychannel, providing turn-key, point-and-click support formultiple delivery channels.

• Output Management: Simplify output managementstrategies while significantly reducing post-processingcosts by combining grouping and sorting capabilitieswith open and published native Microsoft XML schemas.

Manage All of Your Claims, EasilyDocument management offerings support the high-volume capture, management, indexing, archiving, andpresentation associated with claim processing. Fullyautomated archiving and retrieval of documents easilyfacilitates the mining of target information from across theenterprise. And when it comes to compliance, document-management offerings can provide complete documentlifecycle management to ensure that claims documentsare timely and accurate, and that schedules are strictlyenforced. The right document-management solutionprovides organizations with a content-centric foundationto deliver application-specific solutions that solve businessproblems with two critical features:

• Indexing: Answering customer questions, spotting salestrends, or performing analytical research is much easierwhen you have a common data-mining user interface fordeveloping powerful queries. Robust data-miningcapabilities allow users to mine target information fromall content types across the entire enterprise, regardlessof where it is located.

• Archiving: A document management solution providesfully automated archiving and retrieval of all data storedin its repository. The archive process is triggeredautomatically, based on migration parametersestablished to leverage hardware and networkresources. The restore process automatically locates thedocument from any storage media and presents theuser with the data upon request. Users are no longerrequired to focus on the increasingly complex burden oflocating information, and are able to focus on analyzingthe information itself.

Document automation offers a way for enterprise-levelorganizations to meet contemporary customer carechallenges in an efficient, effective, and profitable manner.By streamlining the process by which claims documentsare designed, deployed throughout the enterprise,delivered to customers, and managed, organizations canstrengthen and expand their customer relationships, aswell as gain significant savings in production cost andtime.

Benefits Realized

Global insurance clients like Prudential Life Insurance, MTLInsurance, Anthem Blue Cross Blue Shield, MolinaHealthcare, and Wisconsin Physicians Service Insurancehave achieved the following benefits:

• Acquired, strengthened, and expanded customerrelationships by dynamically personalizing documentcontent and presentation to each individual customercommunication

• Accelerated time-to-market for new products andcommunications by as much as 90% by movingdocument design and generation out of the ITdepartment and onto the desktops of non-technical,business-line professionals via a highly intuitive interface

• Realized cost savings equivalent to 1%-5% of revenuesby streamlining document processes, while exploitingand extending legacy investments

• Reduced document errors to near-zero by automatingthe entry of data and inclusion/exclusion of contentbased upon embedded rules logic

• Reduced compliance risk by centralizing themanagement and monitoring of all document models,content components, and generated documents

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Cincom Has the ClaimsCorrespondence Solution forToday’s Insurer

Cincom Document Solutions is unique in the industry forthe way it engages with prospective clients. Cincom learnsyour business, analyzes your needs, and builds a solutiontailored to your specific requirements. Cincom’s solutionsadapt to – not radically alter – your existing, mission-critical document communications processes.

Cincom Eloquence, the most intuitive, dynamic document-composition offering in the industry, helps globalinsurance companies enhance and strengthen customerrelationships, minimize compliance and regulatory risks,and reduce operating costs by simplifying themanagement of business-critical, document-automationprocesses.

Cincom Eloquence helps you optimize enterprise-widelegacy investments by effortlessly integrating with corebusiness applications, databases, and information-technology infrastructures. This ease of integration ismade possible by Eloquence’s open, J2EE/XML service-oriented architecture (SOA), which utilizes IBM®’s industry-leading WebSphere® technology.

Cincom Eloquence’s easy-to-use interface was co-developed with Human Factors International, globalexperts in the area of user-centered design. The interfaceleverages the features, content editing, and formattingcapabilities of Microsoft Word, including WordML(Microsoft’s published, open XML schema). This enablesyou to move document design and generation out of theIT department and onto the desktops of non-technical,line-of-business professionals for more timely, accurate,and relevant document communications.

Cincom Eloquence™

Data

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Case Study: Wisconsin PhysiciansService

Wisconsin Physicians Service Insurance (WPS) learneddynamic document automation’s value to claimsprocessing when their workload tripled from newcontracts. Thanks to Cincom Document Solutions, theyare easily able to handle 25,000 calls flooding in eachday and generate the resulting 4.5 million documentsper year – 1.5 million of which are produced “on thefly.” The intuitive design environment enabled theirauthors to easily manage and control access todocument repositories, update document models, andenhance the professionalism and accuracy of alldocument communications, both batch and interactive.By moving to a document-automation solution byCincom Document Solutions, WPS has been able torealize the following benefits:

• An improved ability to efficiently handle increasedclaims processing, generating up to 4.5 milliondocuments per year

• A reduced edit time on document models from daysto minutes

• Average document generation times and claimantcall times that are over 40 percent faster

• A reduction in document automation user trainingtime from five days to two

“Cincom Document Solutions is better,faster, and easier to use ... reducing ournew-hire training time by 60%.”– Terry Runkle, TRICARE Customer

Service Supervisor

Conclusion

The insurance industry needs fast, cost-effective documentcomposition and document management across systemsand processes; the flexibility to support traditional paperand electronic communication channels; and the ability tooffer choices to their customers, not just in terms ofproducts and services, but also in how those products andservices are delivered.

Document-automation solutions streamline the process bywhich documents are designed, deployed throughout theenterprise, delivered to customers, and managed overtheir lifecycle. This can lead to significant production-costsand time savings. In some cases, companies have:

• Reduced production costs by up to 80 percent

• Improved production time by nearly 90 percent

• Virtually eliminated document errors

From acquisition and retention to extension, dynamicdocument automation offers a way for you to meetcontemporary customer-care challenges in an efficient,effective, profitable manner. Organizations utilize dynamicdocument automation to drive greater personalization,respond to customer inquiries more quickly, and achievegreater response rates from extension campaigns.

Dynamic document automation makes it simpler for youto keep customers satisfied, increase growth, enhancecustomer loyalty, and decrease defections to yourcompetitors – all while reducing costs.

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About Cincom DocumentSolutions

Cincom Document Solutions delivers the most intuitive,dynamic document automation solutions in the industry,designed to simplify the management of business-criticalprocesses from document automation through documentmanagement. By streamlining the design, deployment,delivery, and management of high-volume, highlypersonalized document communications, CincomDocument Solutions has helped hundreds of businessesworldwide acquire, strengthen, and expand customerrelationships, minimize compliance/regulatory risks,reduce operating costs, and accelerate time-to-market forall their document communications. With over twodecades of experience, Cincom Document Solutions leadsthe industry in providing dynamic document solutions thatare easy to integrate, easy to use, and deliver a rapid andcontinuous return on investment.

Cincom, the Quadrant Logo, Cincom Eloquence, and Simplification ThroughInnovation are trademarks or registered trademarks of Cincom Systems, Inc.

IBM and WebSphere are registered trademarks of International BusinessMachines Corporation.

All other trademarks belong to their respective companies.

© 2007, 2008 Cincom Systems, Inc.FORM DS070308-2 05/08Printed in U.S.A.All Rights Reserved

World Headquarters • Cincinnati, OH USA • US 1-800-2CINCOM Fax 1-513-612-2000 • International 1-513-612-2769E-mail info@cincom.com • http://www.cincom.com

About Cincom

Cincom delivers and supports innovative software andservices that simplify complex business processes. Cincomspecializes in the areas of business where simplificationbrings the greatest value for companies that want to growrevenue, control cost, minimize risk, and achieve rapid ROIbetter than their competitors. For nearly 40 years, Cincomhas helped thousands of clients worldwide simplify themanagement of complex business processes. Cincomserves clients around the world, including Barclay’s Bank,Prudential Life Insurance, Christian Children’s Fund, MTLInsurance, Anthem Blue Cross Blue Shield, WisconsinPhysicians Service Insurance, and the U.S. Social SecurityAdministration. For more information about Cincom'sproducts and services, contact Cincom at 1-800-2CINCOM(USA only), send an e-mail to info@cincom.com, or visitthe company’s website at www.cincom.com.