Policy administration billing and premium operations practice
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DesignGOV-01
Policy operations AI policy and objectives
Set approved uses, outcomes, prohibited actions, governance, controls, records, and escalation for AI in policy and premium operations.
PilotGOV-02
Transaction and decision authority map
Assign authority for quotes, binds, issuance, endorsements, renewals, terminations, billing, refunds, commissions, adjustments, and exceptions.
OperateGOV-03
Use case boundary and risk tier
Define intended use, affected parties, AI influence, autonomy, risk, exclusions, human review, and unacceptable outcomes.
ImproveGOV-04
Portfolio sequencing and value
Sequence initiatives using service, accuracy, compliance, financial control, data, technology, vendor, workforce, and customer dependencies.
DesignPRD-01
Product rule and eligibility control
Apply approved product eligibility, underwriting, coverage, limit, deductible, class, territory, and referral rules.
PilotPRD-02
Form endorsement and version control
Use the approved form, endorsement, edition, language, filing, product, and policy version for each transaction.
OperatePRD-03
Jurisdiction and effective date control
Confirm state, risk location, effective period, notice rule, filing status, and other jurisdiction-specific requirements.
ImprovePRD-04
Rate rule tax and fee synchronization
Keep approved rates, algorithms, factors, taxes, assessments, fees, minimum premium, rounding, and billing rules aligned.
DesignISS-01
Quote to bind transaction integrity
Preserve applicant, quote, coverage, pricing, conditions, disclosures, approvals, expiration, and transaction history from quote through bind.
PilotISS-02
Bind authority and coverage confirmation
Restrict binding to authorized people and systems and confirm coverage, limits, forms, premium, conditions, and effective time.
OperateISS-03
Policy issuance and document accuracy
Verify declarations, schedules, forms, endorsements, named insureds, locations, vehicles, classifications, limits, deductibles, and premium.
ImproveISS-04
Delivery acknowledgement and record retention
Deliver required policy documents and notices through approved channels and retain proof, versions, consent, and exceptions.
DesignPOL-01
Endorsement request and impact assessment
Authenticate requests, determine coverage and premium effects, apply authority, issue correct documents, and preserve the audit record.
PilotPOL-02
Renewal review offer and acceptance
Review exposure changes, experience, terms, price, notices, options, authority, acceptance, and policy continuity before renewal.
OperatePOL-03
Cancellation and nonrenewal control
Apply current reason, timing, notice, delivery, refund, moratorium, jurisdiction, approval, and documentation requirements.
ImprovePOL-04
Reinstatement lapse and gap prevention
Validate eligibility, payment, underwriting conditions, coverage dates, notices, gaps, authority, and downstream accounting before reinstatement.
DesignBIL-01
Billing plan invoice and due date accuracy
Generate accurate installments, invoices, due dates, amounts, taxes, fees, balances, notices, and changes under the selected billing plan.
PilotBIL-02
Payment authorization allocation and posting
Authenticate payment instructions and accurately allocate, post, reverse, reconcile, and acknowledge funds without exposing payment data.
OperateBIL-03
Delinquency collections and hardship handling
Apply approved reminders, grace periods, returned-payment rules, collections steps, accommodations, referrals, and escalation.
ImproveBIL-04
Refund return premium and dispute resolution
Calculate and authorize refunds, return premium, credits, cancellations, disputes, recoveries, timing, payment method, and accounting.
DesignFIN-01
Written earned billed and collected premium reconciliation
Reconcile policy transactions to written, earned, billed, collected, unearned, deferred, returned, and outstanding premium.
PilotFIN-02
Producer commission fee and adjustment control
Validate producer, agreement, rate, basis, split, timing, hierarchy, adjustment, chargeback, statement, and approval.
OperateFIN-03
Receivable aging suspense and write off control
Age receivables, resolve suspense and unapplied cash, document disputes, approve write-offs, and track recoverability.
ImproveFIN-04
Close reporting and financial evidence
Support period close with reconciled subledgers, journal evidence, estimates, adjustments, explanations, approvals, and reporting.
DesignTEC-01
Model data prompt and retrieval validation
Test model behavior, source data, rules, prompts, retrieval, document grounding, versions, uncertainty, and limits.
PilotTEC-02
Agent permissions transaction and communication limits
Constrain agents from binding, changing coverage, sending notices, moving money, issuing refunds, or posting entries without authority.
OperateTEC-03
Payment data identity access and security
Protect payment and identity data with access, authentication, encryption, tokenization, retention, monitoring, and incident response.
ImproveTEC-04
Vendor service continuity change and exit
Control vendor changes, service levels, incidents, subcontractors, evidence access, continuity, substitution, data return, and exit.
DesignMON-01
Transaction quality and exception monitoring
Monitor accuracy, timeliness, exceptions, overrides, rework, reconciliations, notices, payments, complaints, controls, and drift.
PilotMON-02
Consumer notice complaint and remediation review
Trace notices, communications, disputes, complaints, corrections, refunds, affected parties, outcomes, and remediation.
OperateMON-03
Market conduct compliance and assurance
Test compliance with policy, filing, notice, billing, payment, record, consumer protection, financial, and jurisdiction requirements.
ImproveMON-04
Outcome value and continuous improvement
Measure service, accuracy, continuity, complaints, financial integrity, control effectiveness, total cost, and realized value together.