Description:FORM 2
The Patents Act, 1970
(39 of 1970)
&
The Patents Rules, 2003
(See sec 10 and rule 13)

COMPLETE SPECIFICATION

“System for providing Revenue Assurance in Insurance”

1. Claptek Private Limited, an Indian,
having address at Der Deutsche Parkz, 31, Subhash Nagar Rd, near Nahur Station, Nahur West, Mumbai, Maharashtra 400078, India.

&

2. iCAST Analytics Private Limited., an Indian, having address at 403, KVR Enclave – Padmaja Construction, 7 – 1 – 201 - 207, Ameerpet, Hyderabad – 500016, India.

The following specification describes the invention:

FIELD OF THE INVENTION:
The present invention relates to a system for providing Revenue Assurance in Insurance. More particularly, the present invention relates to a system which works parallel to the Policy Administration System of Insurance Company and enables validation of all Pay-outs and Charges, through independent mechanism, on real time basis, before the payment is made to the customer or the charge is levied, to the Policy.
BACKGROUND OF THE INVENTION:
Insurance industry is committed to its customers, for accuracy in Pay-outs and Charges as per prescribed terms and conditions of the product. They do have Policy Administration System, to manage day-to-day transactions, under the policies. While there are existing checks & balances in form of processes & manuals, there is scope for improvement in the areas of testing, covering functionalities, computation, logic and business rules. Not all scenarios, are being checked. This coupled with changes made by customers & statutory authorities, results in breach of Regulatory Guidelines. Eventually, the innocent customer is overcharged, and/or, deprived of accurate Pay-out. This leads to customer grievances, non-compliance of terms & conditions and regulatory non-compliances, thus defeating the overall philosophy of Insurance. This condition in Insurance industry, warrants for, more robust and independent mechanism in validating transactions, affecting policyholders’ interest.
Industry Problem:
The main objective of the present invention is to Protect Policyholders’ interest. It is the prime aim of Insurance industry and the Regulatory authority. There are certain elements which result in inaccuracies, thereby diluting the main goal of Insurance. Some of these problem statements, which are faced by these Organizations, and their impact are:
• Anomaly in Terms & Conditions interpretation.
? Errors in Pay-outs & Charges calculation.
? Testing not fully done.
? Inaccurate Data Quality checks.
• Time consuming RCA for corrective actions.
These problems results in Revenue loss to the Organization (Overpay), Reputational Loss (Underpay), Regulatory & Statutory non-compliance, Repetitive & Expensive corrective mechanisms, Apprehensive confidence level of stakeholders (from board members to employees) and errors continue in perpetuity.
While there are various control mechanisms adopted by Insurance companies, to monitor the liability side of the insurance business, these do not provide assurance and concurrent monitoring. Validation of pay-outs & charges is necessary by Considering the innumerable policyholders, whose interest is to be protected. The present invention supports the insurance industry by providing Revenue Assurance and identify Terms & Conditions gaps and Product feature gaps, at Product level and can check Product Eligibility Criteria at Policy level and verify Module-wise consolidated gaps in value. The present invention provides the Product innovation through Product Performance Monitoring.
The present invention works parallel to the Policy Administration System of Insurance Company. It enables validation of all Pay-outs and Charges, through independent mechanism, on real time basis, before the payment is made to the customer or the charge is levied, to the Policy. It facilitates Protection of Policyholders’ interest, through accurate Pay-outs and Charges.
OBJECTIVE OF THE INVENTION:
The main objective of the present invention is to Plug inaccuracies and provide Concurrent Revenue Assurance to the Insurance Company and to provide a system which works parallel to the Policy Administration System of Insurance Company and enables validation of all Pay-outs and Charges, through independent mechanism, on real time basis, before the payment is made to the customer or the charge is levied, to the Policy.
Another objective of the present invention is to facilitate Root Cause Analysis of anomalies.
Yet another objective of the present invention is to have traceability of transactions in a policy, from inception.
Summary of the invention:
Accordingly, a system for providing Revenue Assurance in Insurance is disclosed. The present invention relates to a system which works parallel to the Policy Administration System of Insurance Company and enables validation of all Pay-outs and Charges, through independent mechanism, on real time basis, before the payment is made to the customer or the charge is levied, to the Policy. It facilitates Protection of Policyholders’ interest, through accurate Pay-outs and Charges. The present invention, not only allows for complete assurance on the Pay-outs, but also builds trust with customers and Regulators, to foster sustainable growth. This present invention allows for strengthening of the key pillars of sustainable growth in revenue assurance in Insurance, through concurrent monitoring.
Description of the drawings:
Fig 1 is the Architecture Diagram of the system for providing Revenue Assurance in Insurance.
Fig 2 is the Implementation Diagram of the system for providing Revenue Assurance in Insurance.
Fig 3 is the Process Flow of the system for providing Revenue Assurance in Insurance.
Detailed description of the invention with respect to drawings:
The present invention supports the insurance industry by providing Revenue Assurance in insurance and identify Terms & Conditions gaps and Product feature gaps, at Product level and can check Product Eligibility Criteria at Policy level and verify Module-wise consolidated gaps in value. The present invention provides the Product innovation through Product Performance Monitoring. The present invention works parallel to the Policy Administration System of Insurance Company. It enables validation of all Pay-outs and Charges, through independent mechanism, on real time basis, before the payment is made to the customer or the charge is levied, to the Policy. It facilitates Protection of Policyholders’ interest, through accurate Pay-outs and Charges.
In one embodiment, the process of the present invention is carried out in three steps:
1)Detailed and Independent study of Terms & Conditions - Creation of Module-wise Requirement Document, covering all rules / conditions, independently, by domain experts, will provide assurance that all the required features of the product, are built in, correctly.
2. Validation of past one-year transactions (including Charges, Pay-outs & Accruals) - The rules / conditions on past one year transactions. RCA assistance on Exceptions, by techno-functional domain experts’ team, will enable, identify gaps (Interpretation/Product Set up/Omission Errors).
3.Batch / Concurrent mode assurance run of transactions, to prevent leakages - RCA assistance on Batch / Concurrent mode exceptions by techno-functional experts’ team will enable, prevention of under/over pay outs & charges.
The present invention is a system for providing Revenue Assurance in Insurance. The present invention is a system which works parallel to the Policy Administration System of Insurance Company and enables validation of all Pay-outs and Charges, through independent mechanism, on real time basis, before the payment is made to the customer or the charge is levied, to the Policy.
In another embodiment, the present invention provides : Plugs inaccuracies and provide Concurrent Revenue Assurance to the Insurance Company - By taking a module in full-mode, leakages are plugged in, Values are fully cross verified which adds to multiple benefits like audit readiness, inaccuracies elimination etc. Inherent benefits, derived through the present invention are:
1. Easy RCA: As the project is taken up based on database way, fully verified by data points as available in the Data Base, RCA becomes easy. The code level problems in Policy Administration System are plugged-in which helps in arresting further leakages.
2. Traceability from inception: Every Policy is brought into full traceability. So, at any point of time, like a bank passbook or mini-statement, entire actions on the Policies, is taken out on an individual transaction level, making it a kind of Policy passbook, involving every action with reverified numbers. In the case of Policy funds, traceability to daily fund values is possible as part of this statement.
In another embodiment, the present invention, not only allows for complete assurance on the Pay-outs, but also builds trust with customers and Regulators, to foster sustainable growth. This solution allows for strengthening the key pillars of sustainable growth in the following ways: The application, not only allows for complete assurance on the Pay-outs, but also builds trust with customers and Regulators, to foster sustainable growth. This solution allows for strengthening the key pillars of sustainable growth in the following ways:

a. Financial Prudence
Companies achieves highly efficient cost management & zero tolerance towards customer commits, through reduction of complaints & service costs, in view of accurate pay-outs and charges, being paid to the customers.
b. Compliance
Zero non-compliance for internal and external regulations is achieved, as the systems are in sync with the Terms & Conditions of the product. The present invention incorporates and validates any changes to the product, changes in modules, changes in Statutory laws, Regulatory guidelines etc., on continuous basis to help Insurers, achieve zero non-compliance.
c. Assurance
Higher confidence to all stakeholders including Board Members, due to increased transparency.
d. Value-Driven
Effective product design to provide real & sustainable value to customers, as the application also assists companies in innovation, through Product Performance Monitoring.
e. Integrity
Ultimately all this leads to fostering trust with all the stakeholders, through good governance.While Insurance companies have deployed various validation mechanisms, the same are not comprehensive. While Insurance companies have deployed various validation mechanisms, the same are not comprehensive. Placed below is the comparison, showing effectiveness of Traditional Methodology viz-a-viz present Methodology:

The present invention works parallel to the Policy Administration System of Insurance Company. It enables validation of all Pay-outs and Charges, through independent mechanism, on real time basis, before the payment is made to the customer or the charge is levied, to the Policy. It facilitates Protection of Policyholders’ interest, through accurate Pay-outs and Charges.
While Insurance companies have deployed various validation mechanisms, the same are not comprehensive. Placed below is the comparison, showing effectiveness of Traditional Methodology viz-a-viz present Methodology:
Sr. No. Anomaly Category Anomaly Type Anomaly Identification Scope through Traditional Methodology Anomaly Identification Scope through present Methodology
1 Data Quality Error Alterations done during servicing stage without doing AFI (Altered from Inception). Up to 20% 100%
2 System Processing Error Processing error in Policy Administration System. Up to 10% 100%
3 Interpretation Error Incorrect logic set-up in Policy Administration System. Up to 40% 100%
4 Product set-up Error Product set-up errors resulting into incorrect calculations. Up to 50% 100%
5 Process gap Error Errors due to the process gap. Up to 10% 100%
6 Errors of Omission Errors due to complete omission of module / feature, in a product. Up to 20% 100%

Table 1
Table 1 denotes bonus results.

Table 2
Table 2 denotes maturity pay out exception report.

Table 3
Table 3 shows mortality charges exception report.
Advantages of the Product/ Process / Concept / Invention:

1. Identification of Terms & Conditions gaps and Product feature gaps, at Product level
Revenue Assurance Application, is built on independent approach and works parallel to Policy Administration System. Business Rules built in, are based on independent study of terms & conditions of a Product. Transactions are validated on real-time, concurrent basis, highlighting the anomalies, before pay-out is made to the customer. This helps in understanding, the product set up gaps in Policy Administration System, be it incorrect set up of rules, rates, etc., and omission to set up a feature, in system.
2. Product Eligibility Criteria checks at Policy level
In addition to, validation of pay-outs and charges, it validates key Product Eligibility Criteria parameters, as per approved terms & conditions of the product. Policies, which breach the eligibility boundary conditions, both, at Inception stage and at servicing stage, are highlighted as anomalies.
3. Module-wise consolidated gaps in value
Transactions are validated, module-wise. This enables consolidation of exception value, noted under each module. Resultantly, it facilitates Organizations, to pass necessary corrective entries in Policy Administration System.
4. Component wise break up of anomalies
In the process to validate transactions on real-time, concurrent basis, Anomaly Report is generated, highlighting exceptions. These exceptions highlight, component-wise value, where the gap is noted. Such a granular information, facilitates RCA process and enable quicker resolution.
5. Policy level view of all the above put together
The present invention, enables Insurers, to view the impact of the discrepancies noted, at Policy level. Appropriate corrective & preventive action can be taken, in the Policy Administration System, to ensure that accurate communication, is shared with the Policyholders, at prescribed intervals.
Additional Value derived from the Solution:
The application supports the Insurers, on below additional areas:
1.Product innovation through Product Performance Monitoring

As the products are completely configured on the platform, insights are gained regarding the performance of the existing products. Some examples of the insights which the application provides are:
1. Product-wise performance under specific parameters like geography, channel, customer profile, etc.
2. How sales is targeted using specific parameters like channel, age-group, occupation – Help in segmentation
3. Customer behavior for products
The application is further extended to simulate permutation and combination of features desired in the new product. This enables, to deep dive and understand different scenarios, for the various combination of features. This intelligence will enable prudent decision making of a new product/version design and launch.
2.Creating Golden copy of the data
By connecting to varied data sources – structured and unstructured, the application is able to retrieve information through its model and is able to provide insights on many different areas by creating a single version of truth, enabling business intelligence. It enables creation of digital repository of rules & conditions, for all functionalities.
3 . Data Reporting, Analytics & Graphical Representations
The application provides the story of data, generates insightful reports and analytics. It also provides parameterized graphical representation, based on relevant dimensions, for better monitoring and decision making.

, Claims:Claims:
We claim:
1) An AI/ML based System for providing Revenue Assurance in Insurance for validation of pay outs and charges, comprising of;
a. Inbuilt optimized predefined components for data processing by considering the Policy Administration in Insurance company.
b. a database for storing of the data;
c. Predefined data distribution components operating on intranet;
d. central processing unit for decision making.
Wherein the said system works parallel to Core Policy Administration System of Insurance Company on real time basis.
2) The AI/ML based system for providing Revenue Assurance in Insurance for validation of pay outs and charges, as claimed in claim 1, wherein the said system enables validation of all Pay-outs and Charges, through independent mechanism, on real time basis, before the payment is made to the customer or the charge is levied, to the Policy.
3) The AI/ML based system for providing Revenue Assurance in Insurance, as claimed in claim 1, wherein the said system for validation of pay outs and charges process comprising the steps of:
a. Creating of Module-wise Requirement Document, covering all rules / conditions, independently, by domain experts and providing assurance that all the required features of the product, are built in, correctly;
b. Validating of past one-year transactions (including Charges, Pay-outs & Accruals) enables, identify gaps (Interpretation/Product Set up/Omission Errors);
c. Assisting Batch / Concurrent mode assurance run of transactions, to prevent leakages, RCA assistance on Batch / Concurrent mode exceptions by techno-functional experts team enables, prevention of under/over pay outs & charges.