Team INCHES offers critical, intellectual inputs to DeRisk a new concept

Given the huge upfront investments in a new insurance product launch, it is imperative each product consumes intellectual capital before significant monetary (financial) capital and effort is invested. New products should be rolled out only after testing assumptions & validating proxies.

At INCHES, we De-risk your novel concepts and ideas before you implement your expansion strategy. We convert your assumptions into knowledge of riders & identify loopholes that help launch your product with lower risk that increases value and provides unprejudiced opinion on how the product will make you succeed or fail quickly - all this with an Indian perspective.

Our bouquet of offerings include:

• Assistance in fine-tuning of Product offerings/ deliverable
• Designing documents pertaining to medical process (UW, Claims)
• Review of policy documents
  • Health
  • CI & other riders
• Digital sourcing & associated fraud
• Pre-filing policy documents to the regulator
• Review of policy documents to identify future areas of customer grievance / specific concerns to compliance, legal and claims
• Periodic review of products vis a vis projection at launch and loss ratio to suggest modifications/ other actionable
• Underwriting
  • Medical matrix
  • Creating/ Evaluating the SOP/ Manual
• Claims
  • Establishing end-to-end Claims Manual
  • Claims process with levels of escalation
  • Decision matrix, as well as
  • A medical adjudication process

Underwriting has become an integral part of the overall offerings from INCHES. We always envisaged that underwriting would be one of our core product propositions, we were busy sharpening the edges and finally we launched a full-fledged underwriting vertical a year ago. While the world was obsessed about Data Driven Underwriting Models and Automated Underwriting Systems, we concentrated on building a core team with strong domain knowledge and hands on underwriting experience. Judicious combination of Doctor’s who are in Insurance domain since more than two decades & Underwriting experts (SME’s) who have been in the field of Underwriting since long, was the winning formula for our concise product.

Having built our own indigenous Rules engine for Claims, we also know what critical aspect(s) to focus on when catering to the Underwriting portfolio, as using the reverse engineering, we were best poised to deliver what the market required.

Our unique propositions in Underwriting are:

• We follow a four eyes approach in underwriting. This means even before recommending for issuance or otherwise decisioning, a second underwriter independently evaluates the case. This is of course for randomly sampled cases.
• Our current team composition in Underwriting is such that almost 50% of the team members are doctors. This means non-medical underwriters have immediate referral points when it comes to critical medical inputs.
• Offering critical inputs for Insurance Risk Management has been the specialty of INCHES for two decades now. Every Underwriter has got this gene in them, which helps them making well informed decisions.
• We also have a CMO team consisting of MBBS doctors, who are doing ECG/TMT/Echo/USG/CXR/PFT opinion cases for various companies. CMO’s are also skilled in giving complete medical opinion in accordance with reinsurance manuals and company guidelines. Underwriters have access to these set of CMO’s as well. This only means decision making become even more robust.
• Beyond this, there are certain medical conditions & findings where specific rating or guideline is not available. CMO’s judgement & assessment becomes very important in these cases. Underwriters can always check with CMO’s for these cases. This CMO & Underwriter collaboration saves time, moves business forward.
• Maintaining Turn Around Time (TAT) is critical for our business and underwriters are well trained on this aspect.

INCHES is offering full-fledged underwriting services with its experienced talent pool consisting of doctors, management professionals and SME’s.

INCHES adapts a multilevel approach to provide support to underwriting function deploying a judicious mix of Tech and human intelligence towards more prudent Underwriting decisions

• Team is skilled in End-to-End Underwriting & Post Issuance Quality Check
• Strong Team consisting of Doctors, Management Professionals & SME’s
• Our well-trained underwriting personnel ensures that all the requisite documents (proposal forms details, KYC Documents, financial documents, labs & respective investigations done reports) are meticulously screened & analysed as per said guidelines.
• Term & Non -Term Underwriting
• Health Underwriting
• Financial Surrogates Analysis
• Understanding of Reinsurance Manuals
• Support through VDI or Onsite

Opinion & ECG & TMT Interpretation Led by domain-experts that come with a cumulative experience of over 200 years, there's no ground uncovered.

i. ECG & TMT Interpretation

• An innovative & smart solution for assessing the ECG & TMT reports, from an insurance perspective & providing a concise & accurate output with the important markers in lieu of UW guidelines.
• With best-in-class processing time frame, the process ensures that these critical reports are minutely analysed before passing the verdict on them.
• This assists the Insurance companies in improving the TAT’s for processing the cases, arresting business leakage, along with huge savings, as outsourcing of these services directly results into implying lesser manpower.
• 100% Dependable process, Tried & tested for its efficacy.

ii. CMO Opinion

• Vintage trained resources, well versed with UW guidelines & Reinsurance Manuals.
• Quickly scalable & customizable process.
• Combination of Medicos & Non-medicos for focussed approach to complete the target in Min TAT.
• Easy to deploy module, with Tech friendly approach.
• We are the only proving Complete Medical Opinion which fast tracks decision making process.
• Reporting on ECG, TMT, X-Ray, Spirometry, Stress Echo/ Stress Thallium, 2-D Echo, Ultrasound Abdomen, etc.
• Providing complete medical opinion in accordance with company specific guidelines and reinsurer’s manual.

iii- End to End underwriting
Underwriting cases for identification of risk factors helps save companies from adverse selection and identify fraudulent intent.

Objective

It helps the insurance company to decide the terms on which the insurance will be provided.

To protect against over insurance, anti-selection, and moral hazard.

It helps the Insurance company understand the quantum of risk, it has undertaken.

To protect the company’s book of business from risk that will make loss in future.

To justify that the insured must have an insurable interest in the subject matter of insurance contract.

Process of Underwriting

Scrutinizing Proposal form:
Check for Name, Age, Date of Birth, Gender, Location (to rule out Negative
location), Nominee Details (insurable interest), Existing & Simultaneously Applied Insurance details.
Check for Income, Occupation, Avocations, Family history and disclosures made in proposal form.
Checks for Plan details and Premium with SIS or BI.

KYC (Know Your Customer’s), AML (Anti-money Laundering) and DRC (Dynamic Risk Score) guidelines adherence:
Underwriter establishes the proposer’s identity and financial credentials by assessing various documents like- Pan Card, Aadhar card, Driving License, Passport, Voter ID, Photograph etc.
Adequate financial documents are called as per company’s guidelines (Company’s specific guidelines to be followed).

DRC or Similar guidelines to be checked, High Risk, Medium Risk, Low Risk. Appropriate due diligence to be done.

Financial Underwriting

If case is eligible for financial waiver (Credit Score, Occupation & Income Criteria), then financial viability is calculated by considering the lowest of declared Annual income or Credit Bureau income.

If financial waiver is not applicable,

For Salaried, Financial viability is calculated after assessing salary slips, form 16, form 26 AS, ITR with Computation of Income, Appointment letter with details of employment Bank statement showing salary credits.

For Self- Employed, Financial viability is calculated after assessing Form 26 AS, ITR with Computation of Income, Profit and loss statement, Balance sheet.

Other sources can be evaluated if required - Financial Questionnaire, Sales Report, Risk checks carried out through external source, Internet search, Surrogates.

Earned & Unearned Income needs to be differentiated.

Medical Underwriting

Underwriter checks Proposal form for any disclosures.

As per company’s specific grid, NML (Non- Medical Limit)/ TELE MER / Pre- Policy medical check-up reports are assessed by UW.

Disease or System specific questionnaire if any (DM Q., HTN Q. Back and neck Q, Gastrointestinal Q) are assessed.

Final Decision is given as per company’s Underwriting Philosophy and Reinsurer’s Manual.

Terms at standard rates or accepted with exclusion and or loading or decreased Sum assured, or policy is postponed or declined.

Post issuance QC

At INCHES, we offer post issuance QC. For audit purpose. To understand the area of training required for the underwriters to improve the quality of underwriting.

Underwriting Support—Tech Enabled Services-Road Map

• Medical Digitization
• Smart data extraction (OCR-ICR-NLP)
• Video MER & Tele MER
• Inhouse developed Rule Engine, which is incorporated with Unique Rules, which are a combination of UW guidelines & Numerous scenarios regarding potential risk to life vis a vis disclosures/ Pre- Insurance Medicals
• Precision Check-100% precise, an RPA based decision engine does risk categorization of proposals into -
  • Low risk
  • Medium risk
  • High risk
  • Very high Risk

Underwriting@ INCHES has so far been a success story. We are learning with each transaction. As a company, we are heavily investing in this vertical and well poised to move to a position of strength to deliver the highest quality underwriting/risk management services to the industry.

Claim related worries are a thing of the past!

X-Claim is an Evidence based Medical Adjudication application!

INCHES has designed a path breaking, IT integrated system developed on established and accepted Standard Treatment Guidelines with Rule based analytics incorporating the entire care pathway and fraud/ abuse triggers driving an intelligent scoring platform to perform medical adjudication of health insurance claims in real time.

Driven by a team of generalist and specialist medicos with an enviable IT team, X-Claim will benefit the health insurance industry in several ways:

• Address the perennial shortage of well qualified doctors to handle health claims. Well-trained non-medico Data Entry Personnel and an insurer specific slider is enough for X-Claim to deliver upto 70-75% STP results
• Large numbers of claim assessors giving EXACTLY the same results – unheard of in Health Insurance Claim settlement!
• Reduce time taken to process a claim
• Contain leakage and thus fraud and abuse
• Continual update of medical guidelines, drugs database and truant providers
• Covers 14,000+ ICD related clinical rules
• Soon to add PCS codes to 78,000+ ICD codes

INCHES Calls 4 U

THE ULTIMATE FILTER: Tele-underwriting

The outlook on underwriting and new business procurement has been challenged since the implementation of Section 45 of Insurance Act 1938. Prudent underwriting has once again regained its value not only in the Life insurance ecosystem but in health and CI products as well.

The entire success of a robust underwriting platform rests on the credibility of the proposal data +/- medicals done, basis which the decisions are taken. This is a certified nemesis of the underwriters.

The solution - Tele-underwriting!

Tele-underwriting, a path breaking underwriting innovation, is a streamlined, complete and intelligent fact finding tool. It aims to strengthen and eventually transform the traditional underwriting proposal completion process.

The anchor element of Tele-underwriting is the proprietary interview process based on a structured medico algorithm. Trained professionals who follow a structured protocol, aimed to collect key information to arrive at a sharp assessment, drive this.

70% insurers in the developed western markets like US, UK, Ireland, ANZ and South Africa use Tele-interviewing / Tele UW in some form or the other.

Tele-underwriting is effective in the Life Insurance segment to predict mortality. In the health insurance space & stand-alone CI products, it is perhaps the most efficient tool to predict morbidity. In both cases it can be used as a first filter, even prior to medical tests, to

INCHES Academy Offers:

INCHES Academy provides the latest in medical and quasi medical education. We empower individual in various fields- be it risk management in insuarance, research in health/insaurance or clinical practice - with the singular aim of honing their skills and thus reforming quality of care.

Training and Empowerment