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The Insurance Credentialing ES bundle provides a means by which insurance companies can manage credentials and licenses for their agents.

Such licenses are required for agents to sell insurance products and they vary by state, country, and province.
This bundle allows users to set up and manage licenses, appointments, and other qualifications for agents. The services can be used to update credential assignment information based on information from third-party providers or to inform government agencies about granted appointment credentials. In addition, the Insurance Credentialing ES bundle allows users to make use of services to enforce credential checks during processes such as policy issuing or commission calculation.
The Insurance Credentialing ES bundle leverages enterprise SOA through enterprise service--based communications between SAP Incentive and Commission Management for Insurance and third-party or government systems that record and report on the status of insurance credentials.

Audience

This ES bundle serves the insurance industry. Roles that will benefit from services in this ES bundle include credential catalogue managers and credential managers.

Insurance Credentialing (click to enlarge)

For details on Service Operations, Business Objects and Process Components, please check the ES Workplace.


How To Use This ES Bundle

In many industries, the old way of doing things manually has been giving way to automating processes in order to increase efficiency, improve accuracy, and cut costs, and the insurance industry is no exception.

In terms of credentialing in the insurance industry, in the past users had to connect other credentialing systems into their existing system environment in order to perform the necessary credential checks. And the maintenance of the credential assignment information often had to be done manually.

Licenses are credentials that are issued by a regulating body, and agents require current licenses to sell insurance in a given jurisdiction.

Appointments are credentials that are issued by an insurance company, appointing a given agent to sell insurance on their behalf. Appointments must be communicated to government agencies. Some states, including Michigan, Iowa and Wisconsin, require that appointments be filed electronically, and likely this requirement will become more widespread. In addition to services related to licenses, this ES bundle also provides services that handle appointments and communicating those appointments to the relevant government agency electronically.

The Insurance Credentialing ES bundle removes most of the manual steps involved in credentialing and replaces them with automated processes through the use of enterprise services. The bundle has interfaces to third-party information providers, which allow for automatic updates instead of manual ones. And the bundle also provides central storage and management of credential information.

This bundle also has check services that identify unauthorized transactions, can detect fraud action and unjustified commission payments, and keep insurance carriers from fine penalties if not able to identify unlicensed action

Use of the Insurance Credentialing ES bundle avoids the need for custom integration. The bundle can be connected to any commission system or any policy management system. The enterprise services can be integrated into any system that has the need to conduct credential checks.

This section will explore a series of use cases for the Insurance Credentialing ES bundle. Each use case will show how a series of steps used to achieve outcomes by using the enterprise services in different combinations. While these examples illustrate a few of the ways that this ES bundle could be used, the intention is to show the flexibility and reusability of these business objects and enterprise service operations so that you will have a clearer understanding of how to best deploy them in your own environment. This wiki is also a space for you to share knowledge and collaborate with others who are implementing the Insurance Credentialing bundle.

Use Case 1: Maintain Credential Assignment

An insurance agent applies for a license at the Department of Insurance for the state in which he will be licensed. He has successfully completed the requirements for the license, including testing, and so the Department of Insurance grants the license to the agent. The agent brings proof of the license to his credential manager, who enters it in SAP Incentive and Commission Management for Insurance. After the credential manager enters all the details and reviews them for accuracy, she creates the license by pressing the Create button, which invokes Maintain Credential. After successfully updating the license, the software invokes Confirm Credential, which confirms that the license information was updating. At this point, the service can trigger Notify of Credential so that other systems that require checks of licensing information can be updated if this is required by the insurance company's business process.

Use Case 2: Automatically Transferring Credential Information

Some government organizations can send information about licenses electronically. If this is the case, the Department of Insurance can send a message to the insurance company about an agent's license. Upon receipt of information, SAP Incentive and Commission Management for Insurance invokes the Maintain Credential enterprise service operation. After updating the information about the license, SAP Incentive and Commission Management for Insurance invokes Confirm Credential to confirm that the license information was successfully updated. If desired, this service can then trigger Notify of Credential so that other systems that require checks of licensing information can be updated if this is required by the insurance company's business process.

Use Case 3: Checking Credential Information before Paying a Commission

Other business processes are interested in whether an agent is properly licensed. For example, when SAP Incentive and Commission Management for Insurance calculates commissions, it must ensure that the license for Bob Jacobson, who sells life insurance, is up to date before paying the commission.

When processing commissions, SAP Incentive and Commission Management for Insurance checks to see if Bob's license is current (if multiple parties receive commissions, their licenses will be checked as well). SAP Incentive and Commission Management for Insurance invokes Find Credential by Elements, searching for Bob's license information. Bob's license has expired, which stops the processing of the commission.

Bob knows that he renewed his license in time, so he tracks down the information and brings it back to his credential information. (The Department of Insurance had a backlog of notifications to send, and Bob's was delayed.)

The credential manager updates Bob's credential information, which invokes Maintain Credential followed by Notify of Credential to inform any interested parties, such as the commissions processing application, of the update. The person working on commissions then releases the commission payout by invoking Change Commission Document Based on Credential Notification.

Use Case 4: Handling Credential Appointments

Licenses are managed by states and other government entities; an insurance company, as we've seen, must keep licensing information up to date. Appointments are communicated from the insurance company to the state or other government entity, saying, in essence, Iowa Life appoints Bob Jacobson to sell life insurance on our behalf.

Bob, or his manager, applies for an appointment and the credential manager, once the appointment is approved, enters it by invoking Maintain Credential. If the appointment is created successfully, Confirm Credential is invoked as well. At this point, the appointment must be sent out to the interested government agncy, which is sent to the state government using Inform of Credential Appointment. Since Iowa requires that appointments be sent electronically, the service communicates the necessary information to update the appointment in the Iowa Department of Insurance appointments database. The appointment will become a matter of public record.

System Requirements

Related ES Bundles

SOA Homepage on SDN

The National Insurance Producer Registry (NIPR)
NIPR FAQs
The Financial Industry Regulatory Authority (FINR)
The Financial Services Authority (FSR)