Key KPIs For Health Insurance Analytics

Important metrics to track and evaluate performance in health insurance data analysis.

Adhere to regulations, keep competitive pricing and improve profits

Increased competition and stringent regulations have created pressure on Health insurance companies to improve their products and enhance their operations. Customers are demanding more transparency in terms of product information and documentation and lesser time for claim disbursement. On the other hand, companies face fraudulent claims which are increasing at an alarming rate. This scenario has pushed insurance companies to have a business intelligence system that can help them in proper pricing of their product, manage assets and reduce risk.


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Insurance companies are rife with data

  • This data is being generated from disparate systems such as claims management and call centers.
  • Customer’s data through marketing channels and customer behavior.
  • Insurance application forms and data from brokers or agents.
  • The challenge here is how to empower leaders at various levels to use this data and make informed decisions.

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Benefits of Insurance Analytics Tools

  • Consistent, error-free selection of profitable individual risks thereby reducing leakage.
  • Prevention of fraudulent claim settlement by using online real-time scoring or daily batch scoring reduction fraudulent claims cost payments by 5% to 10%.
  • Improvement in Operational efficiency and employee productivity resulting in reduced expenses by as much as 10%.
  • Ability to target profitable renewal business and improve retention thereby accelerating the premium growth.

Sales & Distribution – KPI’s

  • New Business Premium ( NBP), Average Premium & Renewal Premium.
  • New customers acquisition & existing customer retention.
  • Agent licensing, Activation, case rate & Productivity.
  • Manager’s Performance & Productivity.
  • Branch Productivity and contribution.
  • Leaderboard ranking of Top 10, bottom 10 branches, Top 100 agents.
  • Sales Contest and Rewards & Recognition.

Marketing – KPI’s

  • Customer segmentation on various attributes.
  • Customer Profiling for up sell / Cross sell.
  • Market trend analysis.
  • Market Share & Competitors Analysis.
  • Product Mix Analysis.
  • Product Profit Analysis.
  • Customer Churn Analysis.
  • Marketing Campaign Analysis.


Claims – KPI’s

  • Claim Incident Rate & Claim Growth Rate.
  • Claim Closure Ratio, Claim Payout Ratio Loss Ratio.
  • Claim Cost Analysis, Average Claim per Cost.
  • Claim Paid by product line.
  • Claim by distribution Channel.
  • Claim Turn Around Time (TAT).





Underwriting – KPI’s

  • Profitability indicator ( Loss Ratio, Risk Cost per Policy).
  • Product Section Analysis.
  • Rate Monitoring.
  • Client Level Reporting.
  • Underwriting decision.
  • Claim detection on the basis of Underwriting decisions.

Operations – KPI’s

  • New Business Analysis.
  • Pending premium analysis.
  • Agent licensing.
  • Policy Owner Services (PoS).
  • Customer complaint & Resolution.
  • Customer Churn & Retention Analysis.
  • Policy Renewals & Persistency Analysis.

Actuarial – KPI’s

  • Experience Analysis.
  • Surrender rate.
  • Persistency Rate.
  • Withdrawal Rate.
  • Mortality rate.
  • Morbidity Rate.
  • Loss ratio.
  • Repayment Rate.
  • Claim Triangulation.
  • Product Profit Analysis.
  • Claim Cost Analysis.
  • Profiling of Risky segment.
  • Solvency Ratio.
  • Asset & liability.

Finance – KPI’s

  • Revenue Analysis – Actual Vs Budget.
  • Revenue Trend (Month on Month, Quarter on Quarter & Year on Year ( YoY).
  • Portfolio Analysis of various funds and customers.
  • Company Reserves & solvency margin.
  • Cost Analysis by each expenditure heads.
  • Cost expenditure by each cost centers.
  • P&L account for each branch as separate cost Centre.
  • EBITDA & Profit after Tax.
  • Ratio Analysis (Liquidity Ratio, Asset Ratio, Profitability & Debt Ratio).

Reinsurance – KPI’s

  • Reinsurance Portfolio Analysis (direct or ceded margin, Treaties etc.).
  • Risk Exposure Analysis.
  • Exposure Monitoring & Reporting.
  • Reinsurance claims v/s Reinsurance premium.
  • Loss ratio by each Product line & customer portfolio.

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