About Helsana

The Helsana Group is a health and accident insurer, offering both individuals and enterprises a complete health and prevention service. With over CHF 6 billion in earned premiums and 3,000 employees, the company is one of the leading providers in the Swiss insurance market.

Checking insurance contracts

Underwriting is a Core Sales Process

Within the scope of the sales process, underwriting is taking on a key role in the insurance industry. It has the objective of checking insurance contracts and assessing risks before insurance is issued. However, numerous criteria, calculations and weights make underwriting an extremely complex decision-making process. With the aid of state-of-the-art software, Helsana aimed at simplifying the risk pre-check processes.

Challenge

Strategic Underwriting

To achieve its goals, the project team at Helsana evaluated various vendors for business rules management technologies. Requisite criteria for this were the technical capabilities as well as the user friendliness. The business users of the Strategic Underwriting department needed to independently adapt, test and activate their risk models, as and when required.

Objectives

  • Efficiency and transparency in underwriting
  • Pre-assessment of risks
  • Process management
Solution

Assessing Insurance Risks Correctly

In a proof of concept, ACTICO convinced the Helsana project team of the efficiency of its business rules management system (BRMS). As an integrated platform, ACTICO Rules supports users consistently throughout the life cycle of modeling, implementing and checking rule sets.

The risk check implemented is now firmly anchored within the Helsana IT architecture under the name of “Decision Broker”. The Decision Broker retrieves internal and external data, performs a risk pre-assessment and transfers the calculated result to the downstream underwriting process.

  • Creating risk models by the „Strategic Underwriting“ department
  • More transparency
  • Consistent support throughout the life cycle of modeling, testing and implementing of rules
  • Visual maintenance of risk models guarantees user-friendliness
IMPACT

Modeling Rules Graphically

For the project implementation, the project team at Helsana started with defining the risk models. These were modeled in the form of decision tables and flow rules using the graphic editor ACTICO Modeler. The risk models can be automatically executed after quality assurance has taken place. Helsana decided to use web services for the automated execution.

ACTICO Rules

Assessments in the area of underwriting using business rules management

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