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Call Center & Finance Meeting Notes

Date: Friday, October 7th, 2025
Departments: Call Center (By: Nasri) & Finance

Call Center​

Primary Functions:

  • Customer service
  • Customer retention (RT-001 to RT-013)
  • Emergency handling

Current Workflows​

Key Operations​

  1. Claim form list queries by:

    • Claim form number (UR-2712)
    • Member ID (UR-2501)
    • Provider (UR-2726)

  2. Manual verification (pain point) (UR-2301, UR-2302, UR-2303)

  3. Non-medical approval processing (UR-2304, CC-003)

  4. Member utilization tracking (UR-2720, UR-2721)

  5. Reporting:

    • Provider reports (with or without fingerprint verification) (UR-2301)

  6. Client approval for renewal (CC-001)

  7. Ex-gratia processing (CC-003, UR-2705, UR-2729)

  8. Wellness call handling (CW-016, CW-017, CW-018)

Finance Department​

Accounts Payable​

  • DBN (Debit Note) processing (UR-0601, UR-4002)

Accounts Receivable​

  • Invoice generation (UR-0602, UR-0603, UR-0608, UR-4003)
  • Receipt processing (UR-1101, UR-1102, UR-1107)
  • Tax handling (UR-0610, UR-0612)
  • Multi-currency challenge (major pain point) (UR-0302, UR-3411)
  • Reinsurance management (UR-2801, UR-2802)

Current Finance Workflow​

Major Pain Points​

Call Center Issues​

  • Manual verification process - time-consuming and error-prone (UR-2301, UR-2302, UR-2303)
  • Limited query capabilities for claim forms
  • Reporting may lack automation
  • Need for client approval functionality (CC-001)
  • Hospital-side claim processing needs improvement (CC-002)
  • Ex-gratia module functionality issues (CC-003)

Retention Department Issues​

  • No live claim ratio notifications (RT-001)
  • Missing online HR portal for corporate clients (RT-002)
  • HR cannot upload renewal lists or forms (RT-003)
  • CROs cannot view complete company information (RT-004)
  • Individual renewal workflow inefficient (RT-006, RT-007)
  • Cannot filter clients by status automatically (RT-008)
  • No live provider status reports (RT-009)
  • Missing unified feedback portal (RT-010)
  • Manual renewal letter generation (RT-011)
  • No chatbot/WhatsApp integration (RT-012)
  • Cannot track CRO activities systematically (RT-013)

Finance Issues​

  • Multi-currency challenge - significant operational complexity (UR-0302, UR-3411)
  • Manual processes for accounts payable/receivable (UR-4002, UR-4003)
  • Integration gaps with other departments (UR-4001)
  • No automated bank payment integration (UR-4001)
  • Payment status tracking issues (UR-4004)
  • Premium collection reporting challenges (UR-4005)

Required Features​

Call Center​

  • Automated claim form search and filtering (UR-2712)
  • Query by multiple parameters (claim form no., member ID, provider) (UR-2501, UR-2712)
  • Streamlined verification process (reduce manual work) (UR-2301, UR-2302, UR-2303)
  • Advanced verification methods (fingerprint, facial recognition, OTP) (UR-2301)
  • Offline verification mode (UR-2303)
  • Verification exception handling (UR-2302)
  • Non-medical approval workflow automation (UR-2304)
  • Member utilization analytics and tracking (UR-2720, UR-2721)
  • Automated reporting system
  • Provider performance reports with fingerprint tracking (UR-2301)
  • Ability to approve inactive clients on renewal (CC-001)
  • Hospital-side claim processing capability (CC-002)
  • Ex-gratia module improvements (CC-003, UR-2705, UR-2729)
  • Wellness call handling capability (CW-016, CW-017, CW-018)
  • Online feedback/query portal (RT-010)

Retention Department​

  • Live claim ratio dashboard for CROs (RT-001)
  • Online HR portal for corporate clients (RT-002)
  • HR upload capability for renewals and forms (RT-003)
  • CRO access to company information (contacts, address, HR details) (RT-004)
  • Online membership application with phone verification (RT-005)
  • Streamlined individual renewal workflow (RT-006)
  • Automated renewal processing after payment (RT-007)
  • Client status filtering (lost, renewed, delayed, new) (RT-008)
  • Live provider status report (RT-009)
  • Automated renewal letter generation (RT-011)
  • WhatsApp chatbot integration (RT-012)
  • CRO activity tracking system (RT-013)

Finance​

  • Multi-currency support and conversion (UR-0302, UR-3411)
  • Automated invoice generation (UR-0602, UR-0603, UR-0608)
  • Receipt processing automation (UR-1101, UR-1102, UR-1107)
  • Tax calculation and compliance (UR-0610, UR-0612)
  • DBN processing workflow (UR-0601, UR-4002)
  • Accounts Receivable management (UR-4003)
  • Reinsurance management system (UR-2801, UR-2802)
  • Treaty configuration (UR-2801)
  • Premium and Claims Bordereaux (UR-2802)
  • Integration with Call Center and Claims departments
  • Seamless Sage integration (UR-4001)
  • Automated bank payment integration (UR-4001)
  • Payment status reporting (UR-4004)
  • Premium collection reporting (UR-4005)
  • UPR and DAC report generation (UR-4006)
  • Exchange rate integration (UR-0615)
  • Premium register reports (UR-1103, UR-1104, UR-1105)
  • Invoice/receipt tracking (UR-1106, UR-1107)

Critical Insight​

"Challenge with Multi-currency" - Finance department struggling with multi-currency operations

Next Steps​

  • Map remaining requirement codes to Call Center workflows
  • Implement multi-currency solution (UR-0302, UR-3411)
  • Design automated verification process (UR-2301, UR-2302, UR-2303)
  • Integrate reporting across departments
  • Develop live claim ratio dashboard (RT-001)
  • Build online HR portal (RT-002, RT-003)
  • Implement CRO activity tracking (RT-013)
  • Setup automated renewal workflows (RT-006, RT-007)
  • Integrate Sage financial system (UR-4001)
  • Configure bank payment integration (UR-4001)
  • Setup reinsurance management (UR-2801, UR-2802)
  • Implement WhatsApp chatbot (RT-012)