1 / 8

Health Insurance Capabilities Model: Payor capabilities list

<br>The Health Insurance Capabilities Model is a straw model of payor business capabilities customizable to the needs of any health insurer. Visit: https://www.ciopages.com/store/health-insurance-capabilities-model/<br>

ciopagescapabilitymodel
Download Presentation

Health Insurance Capabilities Model: Payor capabilities list

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Health Insurance Business Capabilities Model https://www.ciopages.com/store/health-insurance-capabilities-model/

  2. Health Insurance industry is transforming. With rising costs and lack of access, payors are shifting to outcomes and value-based care.

  3. Bridge the Strategy to Execution Gap. Business Capabilities are a Structural Blueprint of an enterprise. They capture the Essence of What a Business Does.

  4. Health Insurance Business Capabilities Map Health Insurance Business Capabilities Map 1. Product Development and Management 2. New Business Development 3. Underwriting and Risk Management 4. Policy Administration 5. Claims Management 6. Network Management 8. Distribution Management 9. Business Operations and Management 7. Customer Management

  5. HEALTH INSURANCE BUSINESS CAPABILITIES MAP LEVEL 1 AND 2 HEALTH INSURANCE BUSINESS CAPABILITIES MAP LEVEL 1 AND 2 6. Network Management Provider Contracting and Negotiation 1. Product Development and Management Provider Relationship Management Quality Assurance and Improvement Coverage Options and Benefit Design Pricing Strategy and Rate Development Product Design and Innovation Provider Credentialing and Accreditation Network Performance Monitoring and Reporting Product Portfolio Management Product and Business Model Management Regulatory Compliance for Product Offerings Product Performance Analysis and Reporting Referral and Authorization Management Prescription Drug Manufacturer Relationships 7. Customer Management 2. New Business Development Customer Relationship Management (CRM) Market Research and Analysis Sales Channel Development Lead Generation and Prospecting Sales Training and Enablement Annual Enrollment Management Omnichannel Customer Service Customer Segmentation and Targeting Customer Retention and Loyalty Programs Customer Feedback and Satisfaction Analysis Partnership and Collaboration Management Marketing Strategy and Campaign Execution Nested Visualization of two levels. Marketplace Participation Management Customer Communication and Engagement Customer Experience Management Network and Coverage Guidance 3. Underwriting and Risk Management Premium Pricing and Quotation Risk Mitigation and Control Reinsurance Management 8. Distribution Management Insurtech Partnerships Management Performance Monitoring and Evaluation Incentive and Compensation Management Application and Eligibility Assessment Medical Underwriting and Risk Evaluation Decomposition to third level is included for additional granularity. Distribution Channel Strategy and Planning Agent and Broker Recruitment and Onboarding Group Medical Insurance Management Regulatory Compliance in Underwriting Distribution Channel Compliance and Risk Management Distribution Partner Training and Support 4. Policy Administration Marketing Collateral and Tools for Distribution Partners Communication and Collaboration with Distribution Channels Policy Issuance and Documentation Policy Renewal and Cancellation Management Premium Billing and Collection Policy Endorsement and Modification Regulatory Reporting and Compliance Policyholder Communications 9. Business Operations and Management Digital and Business Transformation Marketing and Sales Finance and Accounting 5. Claims Management Claims Investigation and Verification Coverage and Benefit Determination Compliance and Risk Management Claims Intake and Registration Human Resources Management Data Management and Analytics Public Affairs and Government Relations Claims Adjudication and Settlement Claims Appeals and Dispute Resolution Corporate Strategy and Planning Sustainability Management Fraud Detection and Prevention Emerging Technologies and Innovations Management Information Technology and Systems Management First Notice of Loss Subrogation Claims Limits Management 2023 PRESENTATION TITLE 5

  6. Value of Business Capabilities: •Foster alignment between business and IT. •A Capability-anchored Transformation Roadmap eliminates redundancy and focuses on capability evolution •Juxtaposing capabilities and systems/applications provide a footprint analysis for optimization. •And so much more.

  7. Business Capabilities Map Snapshot: • About 385 Capabilities decomposed into Three Levels. • Capability Definitions • KPIs aligned to Capabilities. • Editable PowerPoint, Excel, and Word Formats. And bonus files.

  8. TO PURCHASE THE CAPABILITY MAP VISIT: https://www.ciopages.com/store/health- insurance-capabilities-model/ 20XX PRESENTATION TITLE 8

More Related