MediRisk: Underwriting Software for Medical Insurance
MediRisk is a medical underwriting decision-support system that evaluates information submitted with conventional medical questionnaires by applicants for life, medical or disability insurance policies. MediRisk applies a Sapiens technology core and specifically tunes it to medical needs based on expert definition by a select team of medical specialists. It provides fully automated business processing, expert underwriting, and managerial solution for the life and health insurance industry.
MediRisk is a sophisticated, flexible and adaptable solution for the medical underwriting process. It combines the expertise of medical specialists with medical, pharmacological, cultural and demographic data to produce an accurate, objective and reliable underwriting "score". This score, based on both the individual's definitive health status and specific insurer underwriting philosophy, provides in minutes the essential input for any life, health, or disability insurance application. Using flexible rules technology, MediRisk enables carriers to innovate at every point in the underwriting process.
This can start from deployment at the point of sale, taking advantage of Medirisk's expedited, accurate application analysis, through scoring, rating and decisions.
The system offers real time process quality refinements through data analysis, management reporting, and risk modelling. MediRisk's unique adaptability and flexibility enable clients to reduce application processing time and cost by 80% or more, and process a single application for multiple life, health, and disability products or coverage in a single transaction. And since every customer's case can receive a score (avoiding the wait until an underwriter reviews and processes it), more cases are likely to be accepted at the initial stage – saving time, money and manpower for each such success.
Innovative Scoring and Modeling System
The rules in Sapiens Medirisk are factors within tables within the database. Application questions, Tele-underwriting scripts, medical reports and supplementary questionnaires are all created as factors, thus enabling decisions and requests for information to be applied to each factor. This revolutionary way of applying the rules using a factor matrix means that far more rules are created with each new factor that is applied.
Underwriting manuals can either be applied using the factor matrix, mapping the prognostic factors and results to factors within MediRisk, or invoked using the ICD listing.
A ground-breaking aspect of the Medirisk solution is the scoring mechanism, which determines the customer's individual risk. Not only does MediRisk provide the underwriting decision but it also opens up a wealth of management information about the individual risk factors on the case.
Cases are no longer grouped into categories such as O/R, rated or rejected. Every case can receive an individual score, so even O/R cases have their own level of risk. This provides the actuaries with an in depth picture of the O/R cases where to date they have only known that they were accepted on standard terms.
So in contrast to many underwriting systems where rating is the end of the process, the unique score for each case produced by Sapiens INSIGHT™ for Underwriting facilitates detailed statistical analysis and business modelling, allowing you to evaluate previous and explore future underwriting strategy.
Dynamic Questionnaires Obtain Exact Information
Questions are dynamically generated by the module to capture only the relevant proposer information. Sapiens Medirisk is supplied with a database of over 4,000 closed questions for initial underwriting that can be used in any combination based on your company's specific underwriting philosophy. But the ease of creating questions and scripts within MediRisk means that you can edit or delete any of the existing questions and create new ones in a user friendly fashion, allowing you to have a new application set of questions and the rules behind them completed within a matter of days.
Crucial underwriting decisions can now be made using this reliable scientific system that incorporates the knowledge that will always produce the right assessments, for both the proposer and your business.
In addition to the questions for initial underwriting MediRisk is provided with a full range of questions and statements that make up the contents of traditional underwriting manuals for use within the technical underwriting process of substandard cases.
Operational Benefits
Aside from its strong functionality scope, Medirisk provides significant operational benefits to the insurance carrier:
- Uniform Underwriting Criteria - designed to circumvent the subjective variations between different physicians and how their diagnoses on the same situation may differ. It also applies limits on possible options and input, thus avoiding maverick underwriters or agents.
- Central Control – underwriting activity at any location can be monitored centrally, providing the home/central office a greater degree of timeliness of data, as well as central control of underwriting criteria.
- Streamlining of all processes – aside from basic underwriting processes being managed more quickly and objectively, additional highly time-consuming processes are speeded up. For example - corrective rate action to input newly provided data to correct faulty underwriting due to faulty data.
