Optimization Of Medical Insurance Claims Business Process Of YB Hong Kong Limited

As the leader of Hong Kong life insurance industry,YB Hong Kong Limited has a large customer base and a long cultural heritage.Facing external customer service pressure and internal operational reform resistance,YB Hong Kong Limited is also encountering huge pressure from the competitors.In order to stand out in the fierce market competition,company must provide customers with better services.Claims is an insurance service directly facing customers.The customers’ claims experience will directly determine their satisfaction to YB Hong Kong Limited.According to statistics,more than 90% of claims cases are medical insurance claims.Hence,medical insurance claims service is crucial to YB Hong Kong Limited.At present,YB Hong Kong Limited mainly provides medical insurance claim services to customers through the medical insurance claim business process.In order to provide customer a better medical insurance claim services,YB Hong Kong Limited needs to optimize the medical insurance claims business process.Thesis first introduces the general situation of YB Hong Kong Limited,analyzes the current medical insurance claims business process by using the on-site observation and interview method,and finds out the existing main problems in the process,i.e.complicated claim application sub-process and claim processing sub-process.Secondly,it uses the method of brainstorming and process step analysis to diagnose the current medical insurance claims business process and find out the causes of process problems.Thirdly,it customizes the objective,principle and approach of process optimization,and leverages the ESEIA process analysis tool to complete the design of process optimization,e.g.the number of sub-processes is optimized from 3 to 2,and the one of process activities is optimized from 61 to 27.Finally,in order to ensure the effective implementation of the medical claims business process optimization for YB Hong Kong Limited,it plans the implementation steps and establishes the safeguard measures.The research in this thesis will help improve the efficiency of the medical insurance claims business process of YB Hong Kong Limited,and improve the customers’ claims experience as well as their satisfaction.In addition,it could also provide reference for other insurance companies under YB Group for similar medical insurance claims business process optimization.