Medical Insurance Company Underwriting Process

If grassroots property insurance companies want to survive and develop, they have to improve their insurance operating capabilities, and underwriting is a prerequisite. This article briefly discusses the existing problems and solutions in the underwriting work of grassroots property insurance companies through several aspects such as insurance business philosophy, underwriting system construction, underwriting work processes and underwriting personnel team building. Underwriting and claim settlement in insurance operations, also referred to as two-core, is the core link of insurance operations. The two-core process is the core process of insurance companies, and underwriting is at the center of the two cores. Especially in the face of the urgent situation of continued low rates in the property insurance market and the sharp decline in average premiums per vehicle in the auto insurance market due to disorderly competition after the liberalization of rates, grassroots property insurance companies have to improve their own capabilities if they want to survive and develop. Insurance operating capabilities, and in this process, underwriting is the prerequisite. Without underwriting, it is impossible to improve operations and increase efficiency. This article intends to do some research on the underwriting work of grassroots property insurance companies. 1. Problems existing in the underwriting work of grass-roots property insurance companies 1. Focus on business development and ignore business quality. For a long time, the phenomenon of emphasizing speed over efficiency and emphasis on scale over management has been quite common during the planned economy period. However, to this day, this stubborn problem has not been completely eradicated. my country's property insurance companies generally use salary expenses and The method of linking premiums and profits, especially the premium assessment, has a ratio of premiums to profits of about seven to three or even higher. The consequence is that if grassroots property insurance companies want to survive and develop, they must first have a considerable amount of premiums. Without premiums, It is impossible to survive and develop. Therefore, irrational phenomena such as "racing to occupy waste" and pursuing market share without focusing on quality over quantity are inevitable. As a result, the insurance business developed has a lot of junk business and loss-making business, and the operating efficiency One thing grows and the other fades away. 2. The underwriting system is imperfect. To do a good job in underwriting, grassroots property insurance companies must establish and improve underwriting systems and improve underwriting management. However, there are still many shortcomings in the underwriting system of my country's grassroots property insurance companies. First of all, there is no guarantee of institutional mechanisms. The separation of underwriting and claims and business development is still in its infancy for my country's property insurance companies. Therefore, in underwriting The system construction is not yet sound and complete, and the unique obedience and wait-and-see characteristics of grassroots property insurance companies determine that the underwriting system construction of grassroots property insurance companies is relatively backward; secondly, there is no guarantee of operation mechanism, and each property insurance company is relatively backward. Insurance companies generally implement a policy of increasing underwriting authority. Some grassroots property insurance companies no longer set up professional underwriting departments. The underwriting functions are affiliated to the claims department or business development department. They even do not have full-time underwriting personnel to ensure the underwriting work. The third is that there is no guarantee of an assessment mechanism. Because the system construction is backward and responsibilities are unclear, it is difficult to implement the assessment mechanism. In many grassroots property insurance companies, how to assess underwriting personnel is up to the managers. It is a dilemma. The most difficult thing to solve is to balance fairness and efficiency. If the incentive level is high, it will be difficult to suppress the complaints of the development department. If the incentive level is low, it will be difficult to retain excellent underwriting personnel. Then there are many grassroots property insurance companies. All companies have business pressure problems. In order to be able to complete various task indicators assessed by superior companies, the "all-employee development" policy is generally implemented. The company not only implements performance appraisals for front-line development personnel, but also conducts performance appraisals for underwriting personnel's wages, bonuses, and even The welfare part is linked to personal premium tasks. Driven by profit, underwriting personnel are inevitably unbalanced. In order to ensure that they complete the assessment tasks, it is easy to have lax underwriting controls. 3. The underwriting process is imperfect and unreasonable. In the true sense, underwriting mainly includes: verification of the policy holder's qualifications, that is, verification of whether the policy holder has insurable interests; verification of the insured subject matter; verification of the insurance amount; verification of whether the applicable rates are correct and reasonable; and review of the creditworthiness of the insured.

In actual work, the underwriting work of grassroots property insurance companies generally remains at a low level, focusing only on whether the insurance elements are complete, without considering the insurance interests, underlying risks, premium levels and risk control conditions, and whether it can There are deep-seated issues such as underwriting and how to control underwriting risks. Moreover, because grassroots property insurance companies do not have a set of underwriting process implementation plans, there are no specific regulations on the underwriting of various businesses, especially high-risk subjects, and underwriting personnel have no rules to follow. During the insurance period, the underwriting opinions of the handling personnel were left unchecked and could not be effectively controlled and controlled. Daily underwriting was just like daily business quality inspection, or even post-underwriting. It did not fully explore the connotation of the underwriting mechanism and fully exert the true role of the underwriting position. functions. 4. There are deficiencies in the quality of underwriting personnel and team building. Underwriting is a comprehensive technology that requires specialized knowledge and talent. However, among the personnel responsible for underwriting work in grass-roots property insurance companies, there are old, young and disabled people. A large number of grassroots property and casualty insurance companies place some employees who are facing retirement, new employees or even employees who are not qualified for other jobs in underwriting positions. The undesirable result is that the relationship between underwriting personnel and business operators is not harmonious. Or a layman controls an expert, which seriously affects the seriousness and authority of the underwriting work. 2. Solutions to the underwriting work of grass-roots property insurance companies 1. Changes in insurance business thinking. Good operating efficiency is the cornerstone of the company's continuous development and growth, and is also the basis for remaining invincible in market competition. Moderate scale is the prerequisite for achieving certain operating benefits. All grassroots property insurance companies should prioritize benefits and control risks. Under the premise of continuously expanding the scale of high-quality business and realizing the growth of effective premiums, we can truly achieve the coordinated development of scale and efficiency. First of all, it is crucial to change the concept of the upper-level company, especially the top decision-making level, because its concept determines the company's business ideas and direction, affects the formulation of various internal operating policies of the company, and also directly affects the operations of grass-roots property insurance companies. The guiding ideology and business operation policies also determine the policy direction and style of business underwriting. Therefore, we must adhere to the concept of "efficiency first", and all operating assessment indicators for grassroots property insurance companies are based on efficiency, and from the perspective of business philosophy. First, establish the importance of business underwriting; secondly, we must have clear business goals, which means we must understand what the company's business goals are, whether it is to pursue quick success and instant profits regardless of efficiency and blindly pursue the immediate market share, or to work steadily and focus on results to maintain the company's sustainable development. , to all of these, the nature of commercial insurance companies pursuing profit maximization has answered in the affirmative. In practice, we must adhere to this goal and not deviate from it. 2. Construction of underwriting management system. The construction of the underwriting management system of grassroots property insurance companies includes establishing, improving and implementing the underwriting management system; implementing the independent underwriter system to manage and assess professional underwriters; referring to or formulating the "Detailed Underwriting Rules for Various Insurance Types", Establish practical and feasible underwriting basis; implement a unified legal person system and implement an underwriting authority management system.

The first is the construction of the underwriting management system. The construction of the underwriting system of grassroots property insurance companies has a principle of compliance. It must not only follow and obey the underwriting management system of the superior company, but also combine the actual conditions of the grassroots property insurance companies to establish and Improve the underwriting management system; secondly, implement an independent underwriter system and separate the underwriting and exhibition departments so that the underwriting work can independently, effectively and fully play the role of controlling business risks, and implement the combination of responsibilities, rights and interests. A professional underwriting system. As the company's risk management executor, the underwriting department or personnel are responsible for identifying the pros and cons of the underwriting business and making choices that are beneficial to the company. At the same time, they are related to the exhibition department. The exhibition department through exhibition activities, Understand and understand the risk status of potential customers and provide relevant insurance services to customers. At the same time, the exhibition department provides the customer's underwriting information, requirements and other market information to the underwriting department or personnel, and the underwriting personnel will use these Risk assessment and review of the data, and then tailor-made insurance quotes for customers, and the salary of underwriting personnel is directly linked to underwriting efficiency and risk control quality; thirdly, refer to or formulate the "Underwriting Detailed Rules for Various Insurance Types" and underwriting detailed rules The key lies in its operability, which requires following the following principles: First, efficiency. The internal cause of insurance companies pursuing efficiency determines that this is the starting point and end point of underwriting. The operation of the company must be responsible to employees and shareholders. We must also be responsible to customers and society. Without benefits, everything is empty talk. Therefore, the formulation and implementation of underwriting details must be based on the principle of benefits. The second is controllability. The kind of customer you choose is the kind of risk you choose. Therefore, you must act within your ability and use your own ability to bear risks as the standard and measure. You cannot choose blindly regardless of the consequences. The third is to be operable. After the regularity is found through data analysis, it should be reflected in the underwriting details, so that different underwriting conditions can be determined according to different subjects. The underwriting details should be strictly based on the rules, be highly targeted, and Market environment factors should also be considered and be realistic. Otherwise, the detailed rules formulated are either just principles, full of empty words and clichés, and cannot be implemented in practice; Due to the form, it cannot play its due role; fourth, implement a unified legal person system and implement an underwriting authority management system. At this stage, all property insurance companies implement a unified legal person system, which requires grassroots companies to strictly follow the unified legal person system. It is required that all insurance business operations be carried out according to the scope of authorization and size specifications, especially the implementation of highly centralized, unified and standardized underwriting, in order to eliminate all irregular behaviors and fundamentally control and prevent business risks. 3. Improvement of underwriting work process. The business process that underwriting personnel carry out to perform their work responsibilities and play their due role is the underwriting process, which is actually the risk management process for the underwriting subject matter. The underwriting personnel of grass-roots property insurance companies can only underwrite business in three ways: ex-ante underwriting, during-event underwriting and ex-post underwriting. Therefore, the improvement of the underwriting work process is centered on the above three links.

The first is ex-ante underwriting, which includes risk identification and risk estimation. There are many ways to identify risks. For example, it can be through on-site inspections, analysis of the insured's financial statements, discussions or questionnaires, and information obtained from risk management consultants and other sources. Identify potential loss risks of the insured subject. Risk estimation is based on risk identification, by analyzing a large amount of collected data, and using probability and statistical theory to estimate and predict the probability and magnitude of all risks that may cause losses. It mainly includes the estimation of loss probability and the extent of loss, that is, the estimation of probability distribution of loss amount, loss expectation value, loss magnitude, etc. This requires full use of various data and reports, including historical underwriting and claims data, to combine risk identification and risk estimation. The process and results are quantified with data and analyzed through a combination of statements, and then the occurrence and development patterns of potential risks are found. On this basis, a choice is made whether to underwrite or not; secondly, in-event underwriting, including risk evaluation and risk selection Management technology, risk assessment refers to comprehensively considering the probability of risk occurrence, degree of loss, and other factors on the basis of risk identification and risk estimation, assessing the possibility of risk occurrence and its degree of harm, and comparing it with recognized safety standards. Indicators are compared to measure the degree of risk and determine whether appropriate measures need to be taken. In the actual underwriting work of grassroots property insurance companies, risk management technical methods mainly include increasing insurance rates, underwriting underwriting, stipulating deductible rates (amounts), and using commercial reinsurance mechanisms to spread underwriting risks; third, ex post facto Underwriting is a comprehensive evaluation of the effect of underwriting management before and after the event, that is, the analysis, inspection, correction and evaluation of the applicability and profitability of risk management technology. Based on the risk status, disaster information and claims data of each insured subject accumulated in disaster prevention and loss prevention and claims settlement, early warning mechanisms such as "blacklist", "grey list" and "whitelist" can be implemented, and the companies listed in the "blacklist" can be The underwriting subject matter listed in the "grey list" must be strictly limited underwriting, and the underwriting subject matter listed in the "grey list" must be underwritten with higher underwriting conditions as appropriate. And attract more high-quality customers, so as to carry out new insurance subject selection and risk control processes through a new round of underwriting process. Therefore, in a strict sense, underwriting before, during and after the event is not a fixed sequence, but a risk management process that is constantly changing and circulating. 4. Cultivation of underwriting personnel team. The effective implementation of the underwriting work of grassroots property insurance companies ultimately requires a team of underwriting personnel with certain professional skills and a high sense of responsibility. No matter how good the method is, it will ultimately be implemented by people. Therefore, the construction of a team of underwriting personnel Very important.

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