BUSINESS CAPABILITY MAP - Health Insurance Policy Services
| Description | EN: Health Insurance Policy Services group all specific capabilities related to the administration and monitoring of health insurance policies and the oversight of insured portfolios. FR: La Gestion des contrats assurance santé regroupe l'ensemble des compétences spécifiques liées à l'administration et au suivi des contrats d'assurance maladie et à la supervision des portefeuilles assurés. |
|---|---|
| Name (FR) | Gestion des contrats assurance santé |
| Implementing Functions | 
Health Insurance Underwriting |
| Packaging Library | 
Insurance |
TREE VIEW
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Health Insurance Policy ServicesHealth Insurance Policy Services group all specific capabilities related to the administration and monitoring of health insurance policies and the oversight of insured portfolios.
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Health Insurance Policy Administration & Monitoring
Oversee and coordinate all actions related to the lifecycle of insurance contracts, from implementation to renewal, ensuring regulatory compliance, policyholder satisfaction, and continuous alignment between coverage, risks, and client expectations.
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Active Health Coverage Adjustment
Adjust the maximum reimbursement limits of health insurance contracts based on insureds' needs. This includes tailoring coverage ceilings to match benefits and guarantees. The expected outcome is adequate coverage while maintaining the insurer’s financial balance.
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Contractual Rights Administration (*)
Encompasses all operational activities aimed at managing, monitoring, and updating the rights and obligations of stakeholders (insurer, policyholder, beneficiaries) throughout the life of the contract.
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Insured Portfolio Management (*)
Analyze, monitor, and optimize insured portfolios to ensure a balance between profitability and risk exposure.
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Insurance Product Profitability
Assess the financial performance of insurance products by analyzing loss ratios and technical margins.
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Monitoring of Solvency Reserves
Involves monitoring and adjusting technical reserves to ensure the insurer’s ability to meet future obligations in compliance with regulatory requirements.
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