Documentum or Alfresco – Insurance – extending existing data driven systems

Recently, TSG has seen an increase in the number of insurance clients looking to extend or replace components of their existing policy or claim systems with document management capabilities.  Many of our recent insurance related posts have been focused on claim processing , policy and claim management  as well as migration approaches like our recommendation for a rolling migration.  For most clients, while they would like to update their document management capabilities, they are either very happy with the data management applications or would like to keep the new data management systems separate from the document management.  This post will present a background on the data management systems as well as a strategy for augmenting with document management.

Existing Data-Driven Systems

Many clients are very comfortable with their existing systems for management of claim and policies.  These systems insure that the heavy lifting data required for creating and processing policies and claims include consistent and correct data including items like claim number, policy number, insured, claim date, policy date, renewal and other data related activities.  Many of these systems have been in operation since the 80’s and could be based on the AS400 or mainframes.  Often times, the data management of these systems has evolved over time and clients, focused on the bottom line, don’t see benefit in rewriting a system that currently manages all of their client data accurately and reliably.

Why only update Document Management?

What many clients can easily see is the need to update the document management capabilities for their existing systems.  Most systems have been extended over their lifespan to include either a custom database and file pointer type document management or were tied to a legacy image system (example: FileNet).  Other reasons driving for a new document architecture could include:

• File Types – many claim and policy systems were originally created back in our “imaging days” where TIFF file types ruled.  Clients typically want a variety of file types as well as TIFF files migrated to PDF for consistency, annotation capabilities, viewing support as well as print processing capabilities.
• Browser Viewing – many image systems were very focused on simple viewing of TIFF files.  With browser based systems, the ability to view a variety of file types from any machine benefits users, third parties as well as reduced IT support.
• Third Party Viewing – Many users want the ability to extend document management, particularly viewing, to others outside of the organization that would have limited or no ability to view the existing data management system.
• Email – email dominates the way documents are shared.  Users want the ability to track and process emails in claim and policy folders.
• Search and Relate – the ability to search across claim and policy folders with full-text search or to automatically allow for related folders to be displayed adds features to reduce folder processing time.

Integrating an Existing Data Management to Document Management System

We typically suggest to clients that their existing data driven systems “own” the data behind policy and claim data points and that the document management system extend that ownership rather than attempt to update any data components.  As an illustration, let’s walk through a typical policy and claim scenario:

• Policy is set up in existing data system.  Policy Number 1234 and Policy Holder – ACME.
• Underwriter wants to add policy documents to the system.  From the data system, the Underwriter selects “View Documents” button from the Policy Screen to launch the document management system.
• Document Management system is passed the Policy Number, Policy Holder and other relevant policy information, creates the policy folder and places the Underwriter in the empty folder.  The system can show related policies (previous years or other policy types) as a related folder as well as claims based on the policy information.
• The Underwriter adds emails, bulk loads policy files, scans paper documents.  When the policy is complete, the Underwriter updates the data system as well as places the final policy in the policy folder.
• Later, a claim is processed against the policy.  The Claim Analyst sets up the claim in the data system.  Claim 78901, Policy Holder ACME and Policy 1234.
• Claim Analyst wants to add documents to the claim.  From the data system, the Claim Analyst selects “View Documents” from the Claim Screen to launch the document management capabilities.
• Document Management system is passed the Policy Number, Policy Holder, Claim Number and other relevant policy information, creates the claim folder and places the Claim Analyst in the empty folder.  The system can show related claims, policies (previous years or other policy types) as a related folder.

In the manner described above, the data for the claim and policy is “owned” by the data system but passed at the appropriate time to the document system.

Summary

Many Insurance providers currently have existing infrastructure for claim and policy data management built and enhanced over decades of successful and critical day to day processing of customers information.  Insurance providers would like the ability to keep their successful data processing capabilities while easily leveraging new and updated tools for document processing.

By leveraging an integration architecture that allows the data system to launch the document processing system, successful clients can isolate and allow the data system to continue to manage the data components while the document system can provide modern features including:

• Transparent access from existing data systems
• Intuitive browser based Policy and Claim interfaces
• Easy Capture and Filing of email, documents, third party hosted and other documents for inbound communication
• Robust export, email and print capabilities for outbound communication
• Migration options for reduced implementation costs and efforts

TSG is hosting a webinar with Alfresco on August 21^st at 1:00 EST on this topic if you are interested in additional information.