Health Insurance Workflow Charts

Health Insurance Business Process Definitions & Templates

  • Workflow Template / Health Insurance / Policyholder Services

    Bill Collection (Insurance Premiums)
    The Bill Collection (Insurance Premiums) process involves the collection of outstanding insurance premiums from individual clients. This process includes discrepancy identifications, account information updates and verification, payment processing (all payments are reconciled during this process) and account cancellation (if the outstanding amount is not collected or the customer wishes to cancel the account).
    File Formats Available: PDF, Visio, PowerPoint | See More >
  • Workflow Template / Health Insurance / Member Services

    Health Insurance Customer Service
    The Health Insurance Customer Service process involves coordination between health plan customers, customer service representatives and customer service specialists to field, understand and resolve customer issues or requests. This process includes inbound customer call and/or email processing, customer communication (to determine if they are a new or existing member and understand the nature of their request), issue resolution, escalation (if required), and any subsequent customer account adjustments.
    File Formats Available: PDF, Visio, PowerPoint | See More >
  • Workflow Template / Health Insurance / Claims Processing

    Medical Claims Processing
    Medical Claims Processing involves receiving, processing and approving/denial of medical insurance claims. This process includes a case review (policy, type of injury, treatment of injuries, etc.), assessment of medical coverage, adjustments, payment request (if approved) and client notification (medical management reports, etc.). Though a number of people involved and the length of this process may be long, it is generally good practice to keep customers up to date.
    File Formats Available: PDF, Visio, PowerPoint | See More >
  • Workflow Template / Health Insurance / Member Services

    Prospect-to-Issue
    Prospect-to-Issue is a process that involves the processing of new business and/or renewals from insurance policyholders. This process includes the inspection of member ID cards (corrections are made where necessary), member ID card creation (database updates, appropriate ID card code integration, ID card printing) and the final approval of rates and provider contracts by Underwriting/Actuarial staff. Ensure that feedback from sales is analyzed to determine group rate changes or compliance.
    File Formats Available: PDF, Visio, PowerPoint | See More >

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