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Wellness & Actuarial Meeting Notes

Date: Friday, October 8th, 2025
Departments: Wellness & Actuarial

Wellness Department​

Current State​

Major Pain Points​

  • No reporting - Cannot track wellness program performance (CW-011, CW-012)
  • No separation from normal insurance - Wellness programs not distinguished from standard insurance operations (UR-0613)
  • Most functionality not integrated - Operating outside the main system (CW-002)
  • Cannot record client information systematically (CW-001)
  • No case management workflow (CW-002, CW-003, CW-004)
  • Missing query tracking and reuse capability (CW-006, CW-007)
  • No reminder system for follow-ups (CW-009, CW-010)
  • Cannot identify paid wellness packages (CW-012)
  • No live booking system for wellness services (CW-013, CW-014, CW-015)
  • Call center cannot handle wellness calls effectively (CW-016, CW-017, CW-018)
  • No online quotation system (CW-019)
  • Missing booking notifications (CW-020)
  • No gym attendance tracking (CW-022)

Actuarial Department​

Reporting Requirements​

Required Reports​

Monthly​

  • Department-wise performance reports
    • Recipient: Operations office
    • Frequency: Monthly

Quarterly (3-monthly)​

  • Customer trends reports
    • Recipient: Retention department
    • Frequency: Every 3 months

As Needed​

  • Claims and premiums reports
    • Recipient: Finance department

Other Functions​

  • Capitation management and reporting (UR-2108)

Major Pain Points​

Wellness Department​

  • Complete lack of reporting infrastructure (CW-011, CW-012)
  • No system integration (most operations manual/offline) (CW-002)
  • Cannot distinguish wellness programs from regular insurance (UR-0613)
  • Unable to measure program effectiveness or ROI
  • No case management system (CW-002, CW-003, CW-004)
  • Missing comprehensive client information recording (CW-001)
  • No audit trail for case outcomes (CW-005)
  • Cannot add or reuse queries systematically (CW-006, CW-007, CW-008)
  • No automated reminder system (CW-009, CW-010)
  • Cannot identify paid wellness packages without finance follow-up (CW-012)
  • No live booking system for wellness services (CW-013, CW-014, CW-015)
  • Call center lacks wellness information access (CW-016, CW-017, CW-018)
  • No online quotation capability (CW-019)
  • Missing client notifications for bookings (CW-020, CW-021)
  • No gym module or attendance tracking (CW-022)

Actuarial Department​

  • Manual report generation process (implied)
  • Multiple stakeholders requiring different report types
  • Time-intensive report preparation
  • Data consolidation challenges across departments
  • No automated scheduling for recurring reports

Required Features​

Wellness Module​

  • Dedicated wellness program management system
  • Clear separation from standard insurance operations (UR-0613)
  • Comprehensive reporting capabilities (CW-011, CW-012):
    • Program participation tracking
    • Outcome measurements
    • Cost-benefit analysis
    • Member engagement metrics
    • Clients who paid for wellness packages (CW-012)
    • Customizable filter-based reports (CW-011)
  • Full system integration (CW-002)
  • Wellness-specific workflows and data structures

Client Information Management​

  • Record and store all wellness client information (CW-001)
  • Personal details capture
  • Consultation history tracking
  • Health-related data management
  • Secure storage with proper access controls

Case Management System​

  • End-to-end query/case processing (CW-002)
  • Real-time case status tracking (CW-003, CW-004)
  • Complete audit trail for all actions (CW-005)
  • Case outcome storage for compliance (CW-005)
  • Query addition and management (CW-006)
  • Query reuse capability (CW-007)
  • Authorization controls for query management (CW-008)

Reminder & Follow-up System​

  • Automated reminder system for wellness agents (CW-009)
  • Optional reminder setting (CW-010)
  • Follow-up scheduling capability

Live Wellness Services​

  • Provider listing (psychologists, wellness professionals) (CW-013)
  • Online booking system (CW-014)
  • One month advance booking calendar (CW-014)
  • Client psychologist selection (CW-015)
  • Live booking process visibility for agents (CW-015)
  • Booking cancellation capability (CW-015)
  • Call center booking access (CW-016, CW-017)
  • Call center access to booking information (CW-018)
  • Booking confirmation notifications (SMS/WhatsApp) (CW-020)
  • Client ability to change sessions/psychologists (CW-021)

Online Self-Service​

  • Online quotation system (CW-019)
  • Package selection interface
  • Payment option selection
  • Complete online service access

Gym Management​

  • Gym module with attendance tracking (CW-022)
  • Various gym-related reports (CW-022)

Actuarial Reporting System​

  • Automated monthly department performance reports (to Operations)
  • Quarterly customer trends analysis and reporting (to Retention)
  • Claims and premiums reporting to Finance (UR-2713, UR-2733)
  • Capitation calculation and management tools (UR-2108)
  • Report scheduling and distribution automation
  • Dashboard for real-time metrics (UR-3403)
  • Data export capabilities for further analysis
  • Claims analysis reports:
    • Member/Family utilization (UR-2720)
    • Corporate utilization (UR-2721)
    • Member/Scheme analysis (UR-2723)
    • Claim ratio (UR-2724, RT-001)
    • Average visit cost (UR-2725)
    • Claim experience per provider (UR-2726)
    • Benefit utilization (UR-2727)
    • Claim experience per age band (UR-2734)
    • Claim experience by region (UR-2735)
    • Claim experience per product (UR-2736)
    • Overall claim cost (UR-2737)
    • Fund utilization (UR-2733)

Cross-Department Integration​

  • Seamless data flow between Actuarial and Operations
  • Integration with Retention department systems
  • Connection to Finance for claims and premium data (UR-4002, UR-4003)
  • Wellness data feeding into actuarial analysis (UR-0613)

Critical Insights​

Wellness: "Most of it is not integrated into the system" - Operating in silos, limiting visibility and efficiency

Actuarial: Multiple departments depend on actuarial reports for decision-making - need for automated, timely reporting

Report Distribution Summary​

Report TypeFrequencyRecipientContent
Department PerformanceMonthlyOperations OfficeDepartment-wise performance metrics
Customer TrendsQuarterly (3-monthly)Retention DepartmentCustomer behavior and trends
Claims & PremiumsAs neededFinance DepartmentFinancial performance data
CapitationAs neededInternalCapitation arrangements

Next Steps​

  • Design wellness program module architecture (CW-001 to CW-022)
  • Build case management system (CW-002, CW-003, CW-004, CW-005)
  • Implement wellness reporting system (CW-011, CW-012)
  • Develop live booking platform (CW-013, CW-014, CW-015)
  • Setup automated reminder system (CW-009, CW-010)
  • Create online quotation interface (CW-019)
  • Implement gym module (CW-022)
  • Build booking notification system (CW-020, CW-021)
  • Define automated report generation workflows for Actuarial
  • Establish data integration points across departments
  • Create capitation calculation framework (UR-2108)
  • Separate wellness premium categorization (UR-0613)
  • Setup real-time dashboards (UR-3403, RT-001)
  • Integrate call center with wellness module (CW-016, CW-017, CW-018)
  • Configure claims analysis reports (UR-2720 to UR-2737)