Synpulse has a long tradition of conceptualizing and implementing future-proof business models. This practical experience enables Synpulse to see complex projects through to their successful conclusion, from the preliminary study, through design and analysis, to successful introductions in health insurance (e.g. Adcubum SYRIUS®), reinsurance (e.g. SICS), life and non-life insurance.
«Efficient processes are the basis to fulfill the manifold promises made to customers while, at the same time, reducing costs of the insurance business. Together with standard software producers, we master the tension between agile front- and stable backend. For successful introductions of large-scale projects, we offer tailor-made project methods and industry-specific process models.»
In non-life as in health insurance, fraudulent claims account for around an estimated 10% of total insurance payments. Fraud detection therefore continues to be a source of huge potential for lowering the cost of insurance claims/benefits. Synpulse has fraud detection experience – in data, systems, and processes.
Our experience shows that action to combat fraud must be taken on several levels if it is to be successful:
Processes and Organization
Combating fraud does not begin with claims management but much earlier, in product development. It is at this stage that measures must also be implemented to make it very difficult to manipulate cover, deductibles, etc. Equally, steps to prevent fraud must also be taken in marketing & sales, underwriting, and portfolio management in order to achieve overall success.
Trained and aware employees and reliable data resources are the basis of successful fraud prevention. Often, data must be combined from several different sources, harmonized and cleaned before it can be used for modeling and regulatory purposes. There is also a growing tendency to bring in external sources, which presents additional hurdles in terms of quality and evaluability.
Activities and measures to combat fraud must be introduced at both central and localized level. The systems infrastructure must therefore be equipped to meet the demands on availability, scalability and functionality to the full. The choice of system determines the fundamental framework within which action can be taken to combat fraud.
Synpulse has fraud detection and prevention experience in process modeling (the INSURANCEINABOX® process reference model can serve as a guideline), in developing appropriate sets of regulations and models (cf. Predictive Modeling), as well as in evaluation and implementation of corresponding systems. Synpulse is your partner for the implementation of measures to successfully combat fraud.
For the tightly-regulated health insurance companies, it is essential that the cost of benefits, as the most important lever for the combined ratio, is kept under control – and at lower process costs. In an environment in which digitalization and big data play a major role, automatic invoice verification contributes significantly to efficient claims management. Pattern recognition and strict rules are applied to identify claims that invite closer inspection and manual handling.
It is in the insurers’ interests (and in some sectors prescribed by law) that all claims are scrutinized carefully. In health insurance especially, service providers charge for the benefits they provide according to tariffs and service catalogues. In modern systems, coverage, general and special terms of contract, policyholder details and any particular information relating to them (for example exclusion from cover due to prior claims), and historical data on benefits provided to the insured person and by the service provider, are directly available in structured form.
Regulations and Increased Levels of Automation
It is possible on the basis of this data to formulate automatable verification rules. Only «questionable» invoices have to be presented to a claims adjuster (goodwill, ambiguous or missing data) or to a medically trained claims specialist (interpretation, disputes). By far the largest proportion of claims is verified and approved automatically. Any corrections, reductions or refusals are handled and documented automatically.
Pattern Recognition and Combating Fraud
Simple rules, such as total treatment duration in a single day, and pattern recognition make it possible to detect potential insurance fraud at an early stage and also in this area reduce the (unwarranted) costs associated with it.
One major Swiss health insurer is saving several millions of francs a year after switching from its previous solution to an optimized software module and a modified manual process for invoice verification. More claims warranting further examination can be handled by fewer employees, while those that are correct or «correctible» are processed automatically.
Synpulse has many years of experience in claims management and invoice verification and helps you to optimize verification processes that work according to «questionable» invoices rather than specific limits. Technical implementation of the rules, definition of (new) escalation processes, and putting in place monitoring for the effectiveness and use of rules are integral parts of the solution.
Target Operating Model
Business models are increasingly under pressure and the long-term competitive success of a company depends primarily on how it prevails in consistently aligning strategic success factors along the value chain – and the Target Operating Model (TOM) is the lever serving that purpose. The TOM is the «how» to turning business strategy into reality.
A target operating model provides a vision of the desired state of operations for a company and is necessary for the sustainable success of the business. The TOM follows the strategy of the company and is important to define when starting a new business, entering a new market, selling a new product or acquiring other firms.
The impacts of having a well-defined TOM are wide ranging and include:
- Flexibility to deal with ever changing market situations - shorter time to market
- The ability to scale up capacity quickly
- Lower risks from having a stable operations environment
- Long term cost savings from an efficient operating model
Synpulse can support national and international financial service providers with the definition, implementation, and adaptation of their TOMs for mergers and acquisitions, business field expansion, and market entry. We look specifically at the four building blocks of a TOM: Organization, partnerships, services and technology.
Some of the key elements we examine at as we guide you along the journey of building your TOM:
- Your value chain and associated processes
- Outsourcing possibilities
- Structures and responsibilities
- Workload modelling
- Cooperation models
- Vendor evaluation and options
- IT architecture and data flows
- Online versus offline sales
Synpulse has created TOMs for our clients in banking and insurance and has the expertise, tools and experience to ensure you succeed with your goals. We understand the challenges. We have solutions. We work together with you.
Enterprise Architecture (EA) recently gained much more attention with our clients as it is about increasing operational efficiency and enabling business growth while keeping flexibility and robustness of the enterprise wide architecture. Synpulse helps clients to setup or modernize their EA Practices, run EA initiatives and provide an exchange platform for Chief Enterprise Architects.
Today’s financial service markets are rife with rapidly changing customer demands, steadily emerging new products, and radically disruptive new technologies.
To enable future business growth in this volatile environment, financial service companies must increase their operational efficiency: e.g., simplify their application landscape, increase their automation and integration levels, or ensure process modularization and standardization, in combination with outsourcing/offshoring. Companies must simultaneously capitalize on such emerging trends as social media, mobile technologies, smart analytics, machine learning, cloud business, and new operating models.
Synpulse Enterprise Architecture services ensure that our customers achieve all of these goals, and more. We believe that EA must always be business outcome-driven and integral to our clients’ business strategies, such that it facilitates and visualizes those strategies without governing them. EA must also involve partners outside of the company and sharpen clients’ awareness of upcoming trends in their markets.
Your partner for Enterprise Architecture
Synpulse helps clients across the financial service industry in the following areas:
- We assist in building high-performing EA organizations. Our team provides expertise in the implementation, transformation, organizational design and governance setup of EA, as well as the definition of its visions, principles, standards and methodologies according to the client’s business goals.
- We conduct EA Maturity Assessments to give our clients an overview of their current EA Maturity. Then we help them to make steps forward in organizing and executing high-quality EA programs tailored to their particular business need.
- We run EA initiatives together with existing EA teams for our clients.
- We provide a popular bi-yearly exchange platform, the Synpulse Insurance Enterprise Architecture Summit, for Chief Enterprise Architects to network and exchange ideas.
Synpulse has conducted more than 30 Enterprise Architecture projects for financial services clients with its large pool of consultants specifically trained and experienced in Enterprise Architecture. The client will also benefit from the best-practice material and standard approach to EA that Synpulse has developed and refined over time.
Syrius Services (Operational Excellence)
Old systems and their documented customer processes serve as a starting point of several planned projects. Whether these are available in detail, outdated, or unavailable, our approach supports process re-engineering projects and old system solutions using, for example, a standard software package such as SYRIUS - the leading platform for patients in Switzerland - and accident insurers.
The process model developed by Synpulse over the course of several implementation and optimization projects is inspired by agile project methods, and breaks away from the classic waterfall approach. From the outset, notable changes made by the customer are documented, and the specific requirements of the customer are recorded using system processes and workflows. In iterative sprints, one issue after another is processed, addressed in depth, and transferred to specific sub-projects such as parameterization or document specification. The resulting uniform documentation can be used as internal process documentation, as well as in test cases and in the maintenance and operating phase.
Standard software packages, e.g. SYRIUS, allow a great deal of freedom in the parameterization of business rules, object occurrences, and process configurations and permissions. Some implementations are more efficient and can be processed automatically, whereas more conventional implementations are more complex or high-maintenance.
Synpulse provides support throughout the process, from gap analysis and business requirements engineering, to the parameterization and testing of Aducubum SYRIUS, and is consistently oriented toward standard processes. As a result of several years of experience in parameterization, parameterization management, and the application architecture of SYRIUS, our consultants can offer appropriate and efficient implementation solutions ranging from IT architecture and interface design to pure parameterization implementation, e.g. workflow, service, or authorization parameterization.
Our team of consultants can rely on the expertise gained from a number of successful SYRIUS rollouts, the reference process model INSURANCEINABOX®, and the dedicated project method SPEEDmethod® SYRIUS. Synpulse therefore enables the very fast, efficient and sustainable implementation of its projects based on a system- and process-oriented approach.
Business life continues to pick up speed and become more complex. That is why, more than ever, good advice today cannot end in strategies and concepts, but must take into account implementation as whole. At Synpulse Management Solutions AG, we combine all of the expertise necessary to translate your requirements into bespoke software solutions and integrate these into your business organization as optimally as possible.
In the following overview, we would like to present some of our offers in detail:
Information about one’s own clients must be compiled, analyzed, and the resulting information prepared in such a way that it offers added value; digitalization and increasing costs — not to mention time pressures — make this process increasingly difficult. Sales organizations need solutions that can be integrated clearly, quickly, and flexibly into the operational and organizational structure.
BusinessRadar is a selection and analysis tool that has been developed continuously in many projects since 2001. The Software Suite already incorporates more than 15 years of expertise from various companies, industries, and countries.
BusinessRadar also affords large sales organizations an end-to-end view of client data, from employee to the Board of Directors, from strategic KPIs to individual data records. By flexibly combining the widest range of modules, BusinessRadar complements existing system landscapes to suit your needs exactly.
What can BusinessRadar do for your business?
- Quick access to information for thousands of users from specialist departments and management
- Instant application of analytical findings by means of operative actions
- Prompt and accurate handling of sales processes
- Pinpoint allocation of the marketing and sales budget
In light of increasing competitive pressures in the financial services industry, the competitive ability of many sales divisions must be increased: this can only be achieved using strategic sales management. Integral elements of such management include dedicated sales planning, a clear commission system, and integrated sales controlling, which provides information in a timely and effective manner. Client and brand-related KPIs must be included in addition to the production-related KPIs, which were used almost exclusively in the past.
The Sales Compass is a sales management and planning system across all sales channels for use by management. Using the solution, all relevant business information, such as production, stock, remuneration, agency, performance, client and cost information, can be made available in real-time in various role concepts. Innovative KPIs and control parameters can be defined directly by the department and immediately updated (online) in the reports.
What can the Sales Compass do for your company?
- End-to-end control system involving all sales channels and management areas
- Integration of existing planning and control tools (avoidance of isolated solutions)
- Corporate guidelines and value orientation displayed in planning and control tools
- Significant increase in transparency and validity using cockpits and KPI design
- Efficiency gains as a result of a reduction in process run times, error prevention
- Compliance with audit integrity and Solvency II requirements
Dr. Dirk Arndt
Executive Director Synpulse Software Solutions
Banks and insurance companies are subject to constant organizational and technological change. Precisely where major restructuring or launch projects are concerned, professional training is key to success. In «Training Solutions», Synpulse has developed a methodology for mastering these challenges with modern and effective training solutions.
If you are facing the challenge of implementing a major change project in your organization, Synpulse is the ideal partner for your internal communication and training. «Training Solutions» is the methodology we have developed to prepare your organization well in advance for change.
Our first step is to explore with you your communication and training needs. Then we jointly decide on the most suitable training resources. Whenever possible, we use modern tools such as e-learning, webinars and e-classrooms. This gives you maximum effectiveness at minimal cost.
Precisely where international projects are concerned, it is essential that training can take place independent of time and place and that assessment is automated. Traditional training methods often break the agreed budget with the cost of travel alone, which frequentlyoften makes this option unviable.
We employ «Training Solutions» continually and successfully in projects and optimize it on an ongoing basis. Its pragmatic approach and the mix of training resources in particular mean that our clients can tailor the training process to their needs. It also means that we can make adjustments as and when they are required. Our customers additionally benefit from experienced Synpulse project team members, whose expert knowledge and skills from an insurance and banking background make them highly effective in putting together training packages.
«Training Solutions» is an ideal way of meeting a large-scale need for training. Our clients benefit from our many years of expertise. We help you to achieve maximum effectiveness from your training at minimal cost and working with modern tools and resources.