Insurance KPIs & Benchmarking Data

Insurance Metric Definitions, Benchmarking Data & Reports

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KPI NAME
KPI DEFINITION
DATA
(NUM. OF DATAPOINTS)
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Showing results 1 through 31 of 255 records
Percentage of Charges Transferred Percentage of charges, such as co-insurance, deductibles, or non-covered services, that are transferred from the primary insurer to the next responsible party. See data (369)
Claims Denial Rate The total number of claims that are denied divided by the total number of claims processed over the same period of time, as a percentage. See data (352)
Claims First Pass Resolution Rate The total number of claims resolved on the initial submission divided by the total number of claims resolved over the same period of time, as a percentage. See data (334)
Cycle Time: Provider Enrollment Request The average number of days required for a company to return the request to enroll in an EDI system. See data (273)
Combined Ratio Combined Ratio is the sum of loss ratio (claims paid out divided by premium earned; referred to as "Medical Loss Ratio" for health insurance providers) and expense ratio (cost of sales, underwriting and customer service divided by premium earned). See data (66)
Underwriting Expense Ratio Total expense incurred by the underwriting function over a given time period divided by the total amount of premium earned over the same time period. See data (36)
Net Premiums Written Total written premium for the insurance company, minus ceded reinsurance and commissions, over a certain period of time. See data (25)
Cycle Time: Underwriting The average number of days required to perform an underwriting final action, from the time the application is received until the decision has been made. See data (22)
Total Expense: Claims, Benefits and Operations Total benefits and claims paid out to policyholders, plus total operating expenses incurred by the insurance firm over a certain period of time. See data (20)
Cycle Time: New Business Processing The average number of calendar days from the receipt of the original insurance application until the initial bill is mailed to the policyholder. See data (20)
Unit Cost: Claim Processing The total cost of processing claims divided by the total number of claims processed over a certain period of time. See data (20)
Cycle Time: Claims Settlement The average amount of time (in days) required to settle an insurance claim, from the time the claim is reported up until it is paid out. See data (18)
Loss Ratio The total amount of claims paid out to policyholders divided by total premium earned over the same period of time, as a percentage. See data (16)
Percent of Claims Requiring Rework The total number of claims processed that require back-end reworking divided the total number of claims processed over the same period of time, as a percent. See data (16)
Total Headcount: Insurance Agents The total number of insurance agents (captive and independent )selling the firm's products at a certain point in time. See data (15)
Percentage of Applications Approved The number of applications submitted by potential policyholders that are approved and paid (first month's premium) divided by the total number of applications submitted by potential policyholders over a certain period of time, as a percentage. See data (12)
Claims Auto-Adjudication Rate The total number of claims that are automatically adjudicated (no need for manual intervention) divided by the total number of claims adjudicated (manual and auto) over the same period of time, as a percentage. See data (12)
Unit Cost: Application Processing The total cost of processing insurance applications divided by the total number of applications processed over a certain period of time. See data (12)
Percentage of Claims Requiring Manual Resolution The number of incoming claims from plan members that are removed from the general claims adjudication process for manual resolution due to missing, erroneous or questionable data divided by the total number of incoming claims from plan members over the same period of time, as a percentage. See data (12)
Percentage of Insurance Applications Received Electronically The number of new applications that are received by the company through the internet divided by the total number of new applications received by the company, as a percentage. See data (11)
Total Volume: Policies and Certificates In-Force The total number of active insurance policies and certifcates (proof of insurance) managed by the insurance firm at a certain point in time. See data (10)
Application Wastage Rate The number of insurance applications received that were not approved and did not pay the first month's premium (i.e., incomplete or denied applications) divided by the total number of insurance applications received over a certain period of time, as a percentage. See data (10)
Percentage of Claims Completed Within 31-45 Days The total number of claims processed within 31 to 45 days after receiving the claim divided by the total number of claims processed over the same period of time, as a percentage. See data (10)
Percentage of Claims Completed Within 16-30 Days The total number of claims processed within 16 to 30 days after receiving the claim divided by the total number of claims processed over the same period of time, as a percentage. See data (10)
Percentage of Claims Completed Within 15 Days The total number of claims processed within 15 days after receiving the claim divided by the total number of claims processed over the same period of time, as a percentage. See data (10)
Percentage of Claims Completed Within 60+ Days The total number of claims processed 60 or more days after receiving the claim divided by the total number of claims processed over the same period of time, as a percentage. See data (10)
Policies and Certificates In-Force per Insurance Agent The total number of active insurance policies and certifcates (proof of insurance) managed by the insurance firm at a certain point in time, divided by the number of agents (captive and independent) selling the firm's products. See data (9)
Management Levels: Insurance The total number of management levels, or layers, within the insurance company. See data (9)
Policies In-Force: Total The total number of active insurance policies (across all insurance products/lines) managed by the insurance firm at a certain point in time. See data (8)
Cycle Time: Claim Payment Remittance The average number of days required to complete payment following the receipt of a claim. See data (8)

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