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Underwriting Dashboard

The Underwriting Dashboard provides comprehensive tools for risk assessment, case evaluation, and coverage determination to support informed underwriting decisions.

Key Features​

Case Review & Evaluation​

  • New Case Queue: Pending cases requiring underwriting review
  • Risk Assessment Tools: Automated and manual risk scoring
  • Medical History Analysis: Comprehensive medical record review
  • Case Complexity Scoring: Standardized complexity evaluation metrics

Coverage Determination​

  • PCH Coverage Evaluation: Pre-Certification of Health coverage decisions
  • Coverage Limits: Setting appropriate coverage amounts and limits
  • Exclusions Management: Identifying and documenting coverage exclusions
  • Policy Terms: Defining specific terms and conditions

Approval Workflows​

  • Multi-level Approval: Tiered approval process based on risk levels
  • Approval Tracking: Status monitoring throughout approval process
  • Decision Documentation: Detailed reasoning for approval/denial decisions
  • Appeal Process: Management of coverage decision appeals

Risk Analytics​

  • Risk Profiling: Comprehensive risk assessment by case type
  • Historical Analysis: Past case outcomes and loss ratios
  • Predictive Modeling: AI-driven risk prediction and scoring
  • Portfolio Analysis: Overall risk exposure and diversification

Dashboard Widgets​

Summary Metrics​

  • Cases Pending Review
  • Average Processing Time
  • Approval Rate (%)
  • High-Risk Cases Count

Review Queue​

  • Priority cases requiring immediate attention
  • Cases approaching SLA deadlines
  • Complex cases needing senior review
  • Appeals and reconsiderations

Risk Analytics​

  • Risk distribution charts
  • Approval/denial trends
  • Case complexity analysis
  • Loss ratio tracking

Underwriting Workflows​

Standard Review Process​

  1. Initial Screening: Automated risk assessment
  2. Medical Review: Clinical evaluation of medical records
  3. Risk Scoring: Comprehensive risk calculation
  4. Coverage Decision: Approval, denial, or modification
  5. Documentation: Decision rationale and supporting evidence

Expedited Review​

  • Fast-track Criteria: Low-risk cases meeting specific criteria
  • Automated Approval: System-generated approvals for qualifying cases
  • Quality Assurance: Random sampling and review of automated decisions

Complex Case Review​

  • Senior Underwriter Review: High-risk or complex cases
  • Medical Director Consultation: Clinical expertise for difficult cases
  • Committee Review: Multi-stakeholder evaluation for significant cases

Risk Assessment Tools​

Automated Scoring​

  • Medical Complexity: Condition severity and treatment complexity
  • Legal Risk: Litigation history and legal precedents
  • Financial Exposure: Potential claim amounts and coverage limits
  • Provider Risk: Medical provider track record and credentials

Manual Review Tools​

  • Medical Record Viewer: Integrated medical record review interface
  • Risk Calculation: Manual risk factor adjustment and scoring
  • Decision Support: Guidelines and criteria reference tools
  • Collaboration Tools: Internal communication and consultation features

Reporting & Analytics​

Standard Reports​

  • Daily Review Summary: Cases processed and decisions made
  • Weekly Risk Report: Risk trends and portfolio analysis
  • Monthly Underwriting Report: Comprehensive performance metrics
  • Quarterly Loss Analysis: Claims experience and loss ratios

Custom Analytics​

  • Risk Segmentation: Custom risk category analysis
  • Profitability Analysis: Revenue vs. claims by segment
  • Underwriter Performance: Individual and team productivity metrics
  • Market Analysis: Competitive positioning and market trends

Quick Actions​

  • Review pending cases
  • Generate risk assessments
  • Export underwriting reports
  • Access medical records
  • Consult with medical directors
  • Update underwriting guidelines

Permissions & Access​

Chief Underwriter: Full access to all features and decisions Senior Underwriters: Complex case review and approval authority Underwriters: Standard case review and recommendation authority Medical Directors: Clinical consultation and medical review access Underwriting Assistants: Data entry and basic case preparation