Pega Underwriting for Insurance Commercial Lines

Transcription

1 Pega Underwriting for Insurance Commercial Lines 7.13 USER GUIDE

2 Copyright 2015 Pegasystems Inc., Cambridge, MA All rights reserved. This document describes products and services of Pegasystems Inc. It may contain trade secrets and proprietary information. The document and product are protected by copyright and distributed under licenses restricting their use, copying, distribution, or transmittal in any form without prior written authorization of Pegasystems Inc. This document is current as of the date of publication only. Changes in the document may be made from time to time at the discretion of Pegasystems. This document remains the property of Pegasystems and must be returned to it upon request. This document does not imply any commitment to offer or deliver the products or services provided. This document may include references to Pegasystems product features that have not been licensed by your company. If you have questions about whether a particular capability is included in your installation, please consult your Pegasystems service consultant. PegaRULES, Process Commander, SmartBPM and the Pegasystems logo are trademarks or registered trademarks of Pegasystems Inc. All other product names, logos and symbols may be registered trademarks of their respective owners. Although Pegasystems Inc. strives for accuracy in its publications, any publication may contain inaccuracies or typographical errors. This document or Help System could contain technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Pegasystems Inc. may make improvements and/or changes in the information described herein at any time. This document is the property of: Pegasystems Inc. 1 Rogers Street Cambridge, MA Phone: (617) Fax: (617) Document: Pega Underwriting for Insurance Commercial Lines User Guide Software Version: 7.13 Updated: January 2015

3 CONTENTS About This Document... i Intended audience... i Guide organization... i Reference documents...ii Overview Benefits of PUI Getting Started Understanding PUI terminology Portals Underwriter portal Account owner portal Case manager portal User portal Sample data Log-ins Pre-configured rules Underwriting rules Assignments Working with PUI Personal bundle submission Stages and steps Stage 1: Applicant identification Stage 2: Agent and agency information Stage 3: Quote Stage 4: Application Stage 5: Underwriting Stage 6: Issue Commercial Package Submission Stages and Steps Stage 1: Applicant Identification Stage 2: Risk Evaluation Stage 3: Agent Intake

4 Stage 4: Account Data Stage 5: Application Stage 6: Underwriting Stage 7: Issue ACORD Import Listener Renewal Insurance Information Foundation Managing a Customer Account (MCA) Agency and Agent Management (AAM) Landing Page Searching Agent and Agency Create Agent and Agency Global addressing Implications at run time Reporting

5 About This Document The Pega Underwriting for Insurance Framework is designed to be a development and implementation accelerator to provide a lift to leading insurance organizations that want to deploy a rule-based system with which their users can interact to perform their work. The framework supports new business transactions in the Commercial Property, General Liability, and Commercial Package lines. The framework is not an out-of-the box solution, but a core scaffold from which carriers can reuse preconfigured rules and construct the processes and flows to meet customer-specific needs and market requirements in order to allow carriers to leverage existing competitive advantages and develop new ones. The framework capacity addresses Agent, Underwriter, Management, and Consumer Direct interactions. The framework integrates with back-end supporting systems such as rating engines, policy administration systems, form generation, and agent portals to support the processing of work throughout the organization. The framework contains rules that define many different ways of performing the same function, allowing insurance customers to benefit from the flexibility that a rule-based system provides, and allowing for deployment of a system that meets the requirements of each individual market and workforce that leverages the system. For more information, see the PUI 7.13 Implementation Guide. Intended audience This guide is intended for all PUI users including any Insurance professionals specializing in new business, Underwriting, and the Business Analyst. This guide is intended for business users and gives a conceptual overview of the framework s basic concepts and the configured use cases. Guide organization This guide contains these sections. Chapter 1: PUI Overview Chapter 2: Getting Started Chapter 3: Working with PUI Chapter 4: Commercial Package Submission Chapter 5: Reporting Provides a business overview of the framework. Describes how to navigate the user interface, basic user functions, portal layouts, and pre-configured rules. Describes how to process interactions and work with commonly used PUI features. Provides detailed information about the Commercial Package Submission process. Describes how to access, review and work with reports. Pega Underwriting for Insurance Commercial Lines User Guide i

6 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Reference documents In addition to this document, the Pega Underwriting for Insurance documentation set includes: Pega Underwriting for Insurance Installation Guide Describes how to install PUI in your environment. Pega Underwriting for Insurance Commercial Lines Implementation Guide Describes how to implement PUI in your environment. Pega Underwriting for Insurance Implementation Guide Describes how to implement PUI in your environment. Pega Underwriting for Insurance Upgrade Guide Describes how to upgrade PUI from a previous release Pega Underwriting for Insurance Opportunity Value Tech Note Pega Underwriting for Insurance ACORD XML Quote Tech Note The latest version of these guides can be found on the Pega Developer Network at Pega Underwriting for Insurance Commercial Lines User Guide ii

7 1 Overview Insurance carriers, whether they are large multinational publicly-traded corporation or mutual companies, offer many different products to individual and commercial customers. These products include Personal and Commercial line, Property & Casualty coverage, and Life and Disability products to individuals and groups. The Pega Underwriting for Insurance (PUI) Framework is designed to manage the addition of new contacts, products, quotes, and policies for corporate and individual insurance customers, as well as set up brand new policies, billing accounts, and transactions against back-office systems. The PUI Framework is intended to handle this work whether submitted directly from the insurance customer, agent, or carrier backoffice resources. Crucial to this process is the ability to manage many complex steps that reach out to many different internal and external legacy systems. Some of the processes must be performed sequentially, while others can happen in parallel. The insurance Customer, Agent, and Underwriter must always be able to see the progress of the case, and keep various parties representing both the customer and carrier management informed on the progress. The framework provides the capabilities to: Add one or more new policies to an existing or new customer Assign work to underwriters based on line of business Add new insurance products and coverages to carriers offerings Add or update policy, product, and service-level authorizations Communicate with customer, agent, and other carrier staff about submitted cases Configure insurance products and coverages with Product Builder for Insurance Benefits of PUI The PUI Framework helps reduce underwriting costs and improve underwriting efficiency through a process-driven approach that helps resolve submissions quickly. The business problems found in the typical insurance carrier environment often include: Volume-centric approach - Carrier resources are forced to review everything and look at risks focused on short- instead of long-term results Inadequate visibility on channel production - Submissions come in from many different sources and many different agencies. Carriers cannot determine which sources and agencies bring in the most profitable risks. Underwriting capacity consumed by low margin, low value risks - Underwriters are not focused on the right risks or the right things for submissions. The rules are in their heads or on sticky notes on their monitors, taking up time that could be better spent on other things. Pega Underwriting for Insurance Commercial Lines User Guide 1-1

8 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Limited ability to intervene and proactively address pipeline management - Carrier resources are stretched thin performing manual tasks, and do not have the time to devote to working more closely with agents and discuss the types of risks for which they have an appetite. The PUI Framework helps carriers address these issues: Faster Time to Value - Pre-built framework, targeting core data and processes in high ROIyielding areas offering flexibility for easy customization and adaptability for the future. Improve Solution Quality - Reuse a broad portfolio of industry standards and best practices so that changes are implemented in one place and can affect many. Reduction in Project Cost - Allowing the Pega framework to rest on top of existing systems means no costly rip and replace of existing environment behavior users that leverage process templates as part of a business application implementation will have 30% lower project costs and higher project success rates than those who do not. - Gartner Other systems are railroad lines, requiring the current legacy systems to be replaced and force a large amount of data conversion, drastically restricting adaptability for new products, new regulations, and new pipelines in the future. The framework approach of working alongside existing systems complements their benefits and allows the business the flexibility to expand, either within the legacy systems, or introducing new systems that easily integrate with the PUI framework. Pega Underwriting for Insurance Commercial Lines User Guide 1-2

9 2 Getting Started This chapter introduces the PUI desktop and describes the navigation basics. Topics in this chapter are: Understanding PUI terminology Portals Case Manager Portal Understanding Icons and controls Sample data User logins Pre-configured rules (Underwriting and Business Rules) Assignments Understanding PUI terminology To begin working with PUI, it is useful to become familiar with the following application terminology: Application A form providing the insurer with certain information necessary to underwrite a given risk. Case (work item or service request) A unit of work in PUI. PUI assigns Submission IDs such as SUB-124, PB-100 and so on, which are Pega Case IDs. These are configured in the application rule. OOTB Out of the box Risk The insured or property to which an insurance policy relates. Service level Time interval to complete a request. PUI assigns a service level to each unit of work within the system. A service level defines one or two intervals known as goals and deadlines. The intervals indicate the expected or targeted turnaround time for the assignment or the expected amount of time to resolve the case. Submission A proposal for insurance presented to an underwriter. Workbasket A centralized, shared pool of cases from which users can select work. Cases available to a user depend on the user's role. When cases are created, PUI routes them to named workbaskets to wait for further processing and automatically retrieves them when users request work. Worklist A list of case items assigned to a user. PUI routes work from workbaskets to users who are most qualified to process that work. Users can also pull new case items directly to their worklist. Pega Underwriting for Insurance Commercial Lines User Guide 2-1

10 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Portals PUI has four pre-configured portals available to users: Underwriter portal Account Owner portal Case Manager portal User portal The sample users, shipped with the framework, use the appropriate portal for their purpose by default. When logged in as the PUI System Administrator, you can access all portals. Underwriter portal The PegaInsurePACLVerify71:Underwriter access group in PUI is configured to use the Underwriter portal by default, which means that any user associated with this access group, when logged in, is taken directly to the Underwriter portal automatically. The PegaInsurePACLVerify71:Administrators access group also uses this portal. Examples of users shipped with the PUI framework associated with the Underwriter access group are: Dan.V.Sax John.V.Henderson Log in to PUI as Dane.V.Sax with the password install to view the Underwriter portal. The portal contains the following tabs: Dashboard Contains charts and mini-lists of My Submissions and Worklist. Also contains Pega Pulse. My WorkList - Contains the work objects assigned to the user with the urgency and deadline for a case to work upon. My Submissions Contains information pertaining to submission cases for which the underwriter is responsible. Reports Contains various reports, both OOTB and custom. Customer Management Enables a quick search of contact information of both individual and business customers. Pega Underwriting for Insurance Commercial Lines User Guide 2-2

11 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt The My Submissions tab contains a list of all the submission cases that have been attributed to the underwriter. PUI assigns submissions to underwriters by line of business and each underwriter works with an underwriting assistant. While the underwriter is ultimately responsible for reviewing the submission, there may not be a current work assignment on the submission for the underwriter; however, the underwriter wants to track them. The current work assignment on a submission may be for the underwriting assistant to review the submission for completeness prior to the underwriter s review. Of particular interest is the Opportunity Value assigned to each submission. Submissions are sorted descending by Opportunity Value. The Opportunity Value presents to the underwriter a calculated measure of how important this submission is to provide guidance to the underwriter on what work should be done. Pega Underwriting for Insurance Commercial Lines User Guide 2-3

12 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Account owner portal The PegaInsurePACL71Verify:AccountOwner access group in PUI is configured to use the Account Owner Portal by default, which means that any user associated with this access group, when logged in, is taken directly to the Account Owner Portal automatically. The PegaInsurePACL71Verify:Administrators access group also uses this portal. An example user shipped with the PUI framework associated with the Account Owner access group is: Mark.V.Hamilton Log in to PUI as Mark.V.Hamilton with the password install to view the Account Owner portal. The portal contains the following tabs: Dashboard Contains charts and mini-lists of My Submissions and Worklist. Also contains Pega Pulse. My WorkList - Contains the work objects assigned to the user along with the urgency and deadline for a case. My Accounts Contains information pertaining to agencies and brokers for which they are responsible. My Opportunities Contains information pertaining to submission cases for which the account owner is the responsible salesperson. Reports Contains various reports, both OOTB and custom. Customer Management Enables a quick search of contact information of both individual and business customers. Pega Underwriting for Insurance Commercial Lines User Guide 2-4

13 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt The My Opportunities tab contains a list of all the submission cases that have been attributed to the account owner. PUI assigns submissions to account owners by the state of the associated agency. While the account owner is ultimately responsible for closing the business with the agency and customer, there may not be a current work assignment on the submission for the account owner; however, the account owners l want to track them. The current work assignment on a submission may be for the underwriting assistant or underwriter. Of particular interest is the Opportunity Value assigned to each submission. Submissions are sorted descending by Opportunity Value. The Opportunity Value presents to the account owner a calculated measure of how important this submission is to provide guidance to the account owner on what work they should be doing. Review the Opportunity Value Tech Note for more information. Pega Underwriting for Insurance Commercial Lines User Guide 2-5

14 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt The My Accounts tab is a list of all the agencies for which the account owner is responsible. Account owners are the sales or relationship managers that work with the agencies to build the carrier s book of business. You can expand each agency row to view all the pieces of business that have been submitted to the carrier by the agency and include loss ratios for each agency and the earned premium for each issued policy. Case manager portal The following access groups in PUI are configured to use the Case Manager portal by default, which means that any user associated with these access groups, when logged in, are taken to the Case Manager portal automatically. PegaInsureNBB71:Administrator PegaInsureNBB71:Underwriter PegaInsureNBB71:Manager An example user shipped with PUI framework associated with these access groups is: PABSysAdmin Log in to PUI as PABSysAdmin with the password install to view the Case Manager portal. The Case Manager portal contains the following tabs: Dashboard - Contains information pertaining to employees within the manager s workgroup along with various metrics. Also contains Pega Pulse. My WorkList - Contains the work objects assigned to the user along with the Urgency and Deadline for a Case to work upon. My Cases Contains information pertaining to cases that the user has originated Calendar Contains SLAs depicted on a calendar Reports Contains various Reports both OOTB and custom Customer Management Enables quick search of Contact information of both Individual and Business Customers Pega Underwriting for Insurance Commercial Lines User Guide 2-6

15 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt The My Cases tab contains all the cases created by the logged in user. In addition to this, PUI has My Account section which contains all the customer cases followed by the user. 1. Click the Customer Management tab, search for a customer, and open the case. In the right corner of the CA case, click Follow to follow the case. 2. Return to the My Cases tab to see the followed case under My Account section. This functionality has been implemented by overriding the PRPC OOTB report definition written for retrieving all cases. You can modify filter conditions per the requirement. For more technical Pega Underwriting for Insurance Commercial Lines User Guide 2-7

16 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt information refer to the Pega Underwriting for Insurance Implementation Guide or the help system. Launches the assignment having the highest urgency from the work list. Lists all the starting flows defined in the application rule. Launching any process from the Create menu launches a new submission process. Starting flows should be modified by a system administrator. For more information on configuring new work types, refer to the Pega Underwriting for Insurance Implementation Guide. User portal The User portal is the default portal for the access group named PegaInsureNBB71:User. The User portal is also available to users configured with access to the following access groups as a secondary portal. PegaInsureNBB71:Administrators PegaInsurePACLVerify71:Users Log in to PUI as pabsysadmin with the password install. Click Launch in the developer portal to display the User portal as shown below. Pega Underwriting for Insurance Commercial Lines User Guide 2-8

17 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Alternatively, log in as pabuser with the password install to directly access the User portal. The User portal in PUI is similar to the Case Manager portal. The only difference is that the Case Manager portal allows you to view the work items assigned to other users in the same work group (shown below). The Team Members pane lists all the operators within the same work group. Clicking on any user opens up the worklist for that user. But the User Portal does not have access to this section, which means that the case workers can only view their worklist or the work items in a workbasket to which they are assigned, as shown below. Pega Underwriting for Insurance Commercial Lines User Guide 2-9

18 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt You can extend the User portal to have any site-specific modifications as well. Sample data PUI ships with sample data such as contacts, business units, and policies that you can use to test different types of submissions. This data is loaded during the install into the sample database tables. Details are provided below. Sample Contacts Name Address ID Natalie Song 1000 Washington St Boston, MA Wade Jones 100 Long Hill Dr. Stamford, CT Sample Business Units Name Address Phone Number Buten Bearings 246 McAllister St Boston, MA Chunky s Cheeseburgers 1 Rogers St. Cambridge, MA Pega Underwriting for Insurance Commercial Lines User Guide 2-10

19 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Sample Agency Name Address Phone Number A1 Insurance Agency 101 Main St. Cambridge, MA Sample Agent Name Address ID Ashley Jones 101 Main St. Cambridge, MA Carl Johnson 101 Main St. Cambridge, MA Sample Policies Policy ID Policy Type Policyholder PA Personal Auto Natalie Song PA Personal Auto Wade Jones CP Commercial Property Buten Bearings GL General Liability Buten Bearings LF Term Life Natalie Song CPP Commercial Package Chunky s Cheeseburgers Log-ins The framework is installed with a sample set of users, access groups, and portals. The password is set to install. These allow you to access the Designer Portal to view and configure the underlying processes and rules or launch business processes from a variety of user roles including managers and users. Select the Designer Studio > Org & Security> Organization > Operators landing page option to display a list of users. Select the Designer Studio > Org & Security > Security landing page option to display a list of access groups and access roles. This table lists the shipped operators, access groups, and their associated portal rules. Operator ID Access Group Default Portal Pega Underwriting for Insurance Commercial Lines User Guide 2-11

20 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt PABSysAdmin PegaInsureNBB71:Administrators Developer Dane.V.Sax PegaInsureNBB71:Underwriter Underwriter John.V.Henderson PegaInsureNBB71:Underwriter Underwriter Mark.V.Hamilton PegaInsureNBB71:Underwriter Account Owner Chris.V.Stephens PegaInsurePACL71:Manager pycasemanager7 Pat.V.Miller PegaInsurePACL71:Underwriter Underwriter Terry.V.Johnson PegaInsurePACL71:Underwriter Underwriter Alex.V.Morris PegaInsurePACL71:Users User Victor.V.Hines PegaInsurePACL71:Underwriter Underwriter PegaInsureNBB71:Agent pycasemanager7 pabuser PegaInsureNBB71:User pycasemanager7user Pre-configured rules Underwriting rules SIC Code Standard Industry Classification (SIC) Codes are an internationally accepted set of codes for the standard classification of all economic activities. The SIC was designed for the classification of establishments according to the kind of economic activity they perform, and provides a standardized framework for the collection, tabulation, analysis and presentation of statistical data on establishments The SIC code consists of a 5 digit number with each digit of the code having the following significance: First Digit = Major Division Second Digit = Division Third Digit = Major Group Fourth Digit = Group Fifth Digit = Sub-Group In PUI, only a 4-digit number is considered a SIC code. The major division is excluded. During the risk evaluation stage, the division, group, industry code & SIC code were taken as inputs. Based on the Division selected, a list of groups shown and based on the group chosen, industry codes will be shown. Once we select the industry code, the SIC code is obtained. Below screenshot shows the UI for this step in risk evaluation stage. Pega Underwriting for Insurance Commercial Lines User Guide 2-12

21 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Risk Evaluation The SIC code is then used to determine the carrier s appetite for the risk and recommendations are presented. Pega Underwriting for Insurance Commercial Lines User Guide 2-13

22 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Opportunity Value The Opportunity Value is a calculated value objectively assigning importance to each submission. The rule is in the Decisioning ruleset called DefineScore. Business Rule Demonstration (MVR / Credit Score) Underwriting (UW) is the process of assessing the risk of an individual or organization applying for insurance cover with an insurance company. Underwriting rules are business rules defined in the underwriting process to classify or rate, auto approve or reject, and route to appropriate underwriters for manual decision or rating. These rules can be based on several factors such as line of business, age, face amount, health style, medical history, financial history, driving record, loss history, and industry. Multiple rules can be defined and executed to come up with a consolidated result and decision or rating. Underwriting has been configured as an independent stage in each of the submission processes with the expectation that each customer modifies it to meet their unique needs. Below is the case type rule for Personal Auto Submission. Notice the underwriting stage highlighted. For personal auto submission, within the underwriting stage, a flow has been provided as an extension point where the Credit Score or MVR Score can be populated. Based on the results of these reports, a decision can be made whether manual underwriting is required. If manual underwriting is required, the ExecuteUnderwriting flow is called. Currently this flow has a single assignment with two flow actions emerging from it for the underwriter to either accept or reject the application. See the flow below. This flow can be further extended to support more complex underwriting processes. Pega Underwriting for Insurance Commercial Lines User Guide 2-14

23 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Assignments In the commercial submission process, the underwriter is assigned based on line of business selected. The underwriter is automatically determined by using a Decision Table rule, which takes the line of business as parameter and returns the corresponding underwriter. By default, the Commercial General Liability Submissions are assigned to the underwriter John.V.Henderson. Commercial Property Submissions are assigned to the Underwriter Dane.V.Sax, with all other work objects assigned to the Victor.V.Hines. Pega Underwriting for Insurance Commercial Lines User Guide 2-15

24 3 Working with PUI Personal bundle submission The Personal Bundle Submission enables the carrier to collect submission data from the applicant more conveniently by grouping all the lines of business (LOBs) together. Some carriers may offer a Personal Bundle policy containing coverage for one or more LOBs such as Personal Auto and Personal Umbrella within the same policy contract. The Personal Bundle policy allows for great flexibility to design a policy specifically for the needs of each individual customer, enabling carriers to provide almost all their coverage in one convenient package. The Personal Bundle Submission is the top-level case and it may contain one or more application subcases for other lines such as Auto and Umbrella. Applications may also then contain subcases. This nested case structure is demonstrated in the end-to-end process explained below through the Personal Bundle Submission. The framework also lets you generate mono-line submissions for Personal Auto, Personal Umbrella, and Life. In this use case, the demonstration includes all the LOBs in the Bundle submission. After logging in, from the portal, select +Create > Start Personal Bundle Submission. A new work object for the Personal Bundle Submission is generated. Pega Underwriting for Insurance Commercial Lines User Guide 3-1

25 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Stages and steps As one of the new features of Pega 7.1, PUI leverages Stage-Based Case Management. The PUI framework has been designed to reuse stages and steps throughout the process where applicable, so that the stages for each process are very much the same. The stages and steps for the Personal Bundle Submission are shown below. Stage 1: Applicant identification The initial stage in the process is the Applicant Identification stage. The purpose of this step is to collect and identify the customer applying for coverage. The first step is Customer Intake to enter the customer-identifying information including name, address, and . With the customer information, the framework looks up the values entered to search for possible existing entries to avoid duplicate creation. The framework uses the Last Name, First Name, Pega Underwriting for Insurance Commercial Lines User Guide 3-2

26 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt and Zip Code of the customer as its primary identifier and returns a list of possible duplicate entries from which you can select and compare against the data entered in the previous screen. The screen is divided into three sections, Existing Customers, Selected Customer, and Personal Information. The Existing Customers section displays the list of individual customers already found in the system that may be a match for the applicant. When you select a row of one of these existing customers, that customer s data appears in the Selected Customer section. The Selected Customer section allows you to view all relevant comparable data for the selected account. The Personal Information section displays the data for the applicant entered in the previous screen. The side-by-side comparison allows you to review information for different existing accounts and compare the information directly against the information for the entered applicant. Once you decide, use one of three buttons below, Use Selected, Create New, and Back. If you determine that: The applicant is a duplicate of a selected existing customer. Click Use Selected to move to the next stage. The applicant is a new customer and not an existing account, select Create New and the framework adds this account to the data and moves forward to the next stage. I There was an error in the data entry and you need to correct the data before moving on or search again. Click Back to return to the Customer Intake screen. In this example, click Use Selected so you do not create a duplicate account. Pega Underwriting for Insurance Commercial Lines User Guide 3-3

27 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Stage 2: Agent and agency information The Agent Intake stage lets you associate an agent with the submission. Select the agency from the Agency Name drop-down list. The list of agents is filtered to display only agents that are associated with the agency and have an active license to sell policies for the LOB being applied for in that jurisdiction. For information on the creation and management of agent data, see the Agency and Agent Management (AAM) topic in Chapter 4. Stage 3: Quote In Personal lines, the Quote stage provides an opportunity for the carrier to present an initial premium value to the customer for the covered risks without incurring expenses and qualifying the prospect lead. Policy dates On the first screen, indicate the effective date of the submission. Select the desired policy effective date from the drop-downs lists, or use the calendar widget by clicking the icon to the right. The system defaults to the current date. Verify that the customer name appears above the Personal Bundle Submission. Pega Underwriting for Insurance Commercial Lines User Guide 3-4

28 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Personal LOB product selection With this release, Personal Automobile and Personal Umbrella LOBs are configured. Select the products from the available list. LOB-specific information A series of LOB-specific data collection screens are displayed, depending on the selection you made in the Product Selection screen. Personal umbrella Pega Underwriting for Insurance Commercial Lines User Guide 3-5

29 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Household details Enter the Household member information in this screen. You can enter an unlimited number of household members. To add additional household members, click Add Household Members. At least one member is required to proceed. General information The General Information screen leverages the Pega Survey to ask a series of questions. If you answer Yes to any question, you must enter an explanation. The General Information questions pertain to the customer s household item details and general background information. Pega Underwriting for Insurance Commercial Lines User Guide 3-6

30 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Quote The Quote screen displays the all possible product variants information. Select the coverage limit desired for Liability coverage and click Calculate Premium. Click Accept Quote to select the quote. Once selected, a green check mark appears next to the selected product variant. Click Finish. Once you select the Coverage for the Personal Umbrella coverage, Individual Life coverage data collection screens appear. Personal automobile The Personal Automobile flow appears. Pega Underwriting for Insurance Commercial Lines User Guide 3-7

31 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Vehicles The first screen in the flow is the Vehicles screen. Select the vehicle make, model, and year from the drop-down lists, and enter the address for the main garaging location. Add a new vehicle by clicking the Add New link. You can add an unlimited number of vehicles on a policy. Enter all the details and click Next. Pega Underwriting for Insurance Commercial Lines User Guide 3-8

32 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Drivers Customer details entered in the Customer Intake screen are copied to the initial Driver screen. Add a new driver by clicking the Add New link in the tab. You can add an unlimited number of drivers on a policy. Enter all the details and click Next. Pega Underwriting for Insurance Commercial Lines User Guide 3-9

33 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Quote The Quote screen displays all the possible product variant data. For Personal Auto, the system displays two pre-configured offerings: Gold and Silver, with pre-selected limits and rated premium. This setup allows a carrier to provide recommended coverage combinations, combined with Next Best Action Advisor (NBAA) or independently, or just the most often selected combinations, to assist customers in their coverage decision. There is no limit to the number of pre-configured offerings a carrier can provide for any LOB. The new Custom tab lets customers make changes to their limits and coverages to fit their specific coverage needs and budget. You can select the coverage limit for each specified coverage and click Calculate Premium. Click Accept Quote to select the quote. Once selected, a green check mark appears next to the selected product variant. Click Finish. Pega Underwriting for Insurance Commercial Lines User Guide 3-10

34 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Confirm quote The Confirm Quote screen displays the Quote information (LOB name, Product Variant, and Premium amount) of the selected LOBs. Stage 4: Application In the Personal Bundle Submission, only the Personal Auto Line has screens for the Application stage. Here, you capture additional details related to vehicles and drivers. The Application stage captures additional details related to insured covered items. The reason the Application stage appears after the Quote is to help prevent carriers from spending on unnecessary expenses due to lack of customer interest. When the customer is presented with the initial quote and elects to proceed, the carrier effectively has a qualified lead for which it becomes more appropriate to incur underwriting expenses with a high expectation of a sale. Vehicles Once the initial premium is calculated, based on the information provided in the Quote stage, you add vehicle details, which help calculate the appropriate premium and underwrite the policy. Additional information includes VIN, Vehicle Primary Use, estimated annual mileage, and vehicle ownership details, which affects the underwriting decision. If you select Lease in the Ownership field, additional fields appear for entering the leasing information. Likewise, if you indicate financing for the vehicle, information on the finance company is requested. You can add vehicle-level Anti-Theft discounts on this screen, which includes Non-Passive Alarm, Passive Alarm, Vehicle Recovery System, VIN Etching, and Fuel Cut Off. This discount affects the final premium amount of the personal auto policy. Pega Underwriting for Insurance Commercial Lines User Guide 3-11

35 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Drivers Here, you add additional driver details including Driving License state, Driver License Number, and Social Security Number. Driving history and driving certificates are associated with Driver License Number and Social Security Number. To get the required information from third parties, you need to ask for these details. Pega Underwriting for Insurance Commercial Lines User Guide 3-12

36 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Quote The selected quote in the Quote stage appears with a green check mark representing the selection. The premium of the quotes is adjusted based in the additional information collected such as driving history or credit score. You can change the product variant or coverage limits. Change the coverage limits and click Calculate Premium. Click Accept Quote to confirm quote selection. Pega Underwriting for Insurance Commercial Lines User Guide 3-13

37 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Confirm application Similar to the Confirm Quote screen, the Confirm Application displays the updated Quotes information (LOB name, Product Variant, and Premium amount) of the selected LOBs. Billing You can collect the billing information for premium payment at the end of the application process prior to underwriting to fully prepare for issuance. The down payment is automatically calculated as 10% of the premium. When you select the billing frequency, the screen refreshes to automatically calculate the amount to be billed in each period as the total premium minus the down payment, divided by the frequency of bills. Billing frequency can be monthly, quarterly, semi -annual, and annual. Pega Underwriting for Insurance Commercial Lines User Guide 3-14

38 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt The billing method selection impacts the section displayed for entering the appropriate billing information. Billing methods are ACH, Credit Card, and PayPal. Each billing method has a separate screen to collect the specific data. ACH Automated Clearing House (ACH) is an electronic network for financial transactions. Using this method, the insurance premium is automatically paid to insurance companies. Input the required details for automatic premium payments under ACH. Credit card Enter the credit card details for the premium payments. Select the Billing Address Same as Policy Address check box to copy the address details of policy holder. Pega Underwriting for Insurance Commercial Lines User Guide 3-15

39 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt PayPal Enter the PayPal User ID and password for the premium payment through PayPal. Stage 5: Underwriting Review screen The Review screen provides the overview of the case contents. You can assign each LOB to a specific LOB underwriter for approval. In this use case, Personal Auto has a straight-through process and does not require any underwriting. Other LOBs require a manual underwriting approval from the LOB-specific underwriter. Pega Underwriting for Insurance Commercial Lines User Guide 3-16

40 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Approve personal umbrella underwriting Stage 6: Issue The Personal Lines Bundle, including all the selected LOBs, is issued as a single process. Policy issuance Click the Proceed TO Policy issuance link (Underwriting) to proceed. Click Submit to issue policies. Pega Underwriting for Insurance Commercial Lines User Guide 3-17

41 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Once the process is completed, policy numbers are generated for each LOB. Policy verification To verify the policies generated for the selected customer, open the MCA work object by clicking the customer link. Pega Underwriting for Insurance Commercial Lines User Guide 3-18

42 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Navigate to the Policy List tab. Observe the policies displayed. Click the arrow symbol to expand and view the policy details. Pega Underwriting for Insurance Commercial Lines User Guide 3-19

43 4 Commercial Package Submission The Commercial Package Submission enables you to create a submission for the common Commercial Package Policy containing coverage for one or more LOBs providing both property and liability coverage within the same policy contract. This type of submissions is typically written for medium-sized business accounts. The Commercial Package Policy allows for great flexibility to design a policy specifically for the needs of each individual customer, enabling carriers to provide almost all customer coverage in one convenient bundle. The Commercial Package Submission is the top-level case and it may contain one or more submission subcases for other lines such as Property and General Liability. Applications may also then contain subcases, such as the Proposal and Loss Control Survey. This nested case structure is demonstrated in the end-to-end process explained below. The framework also lets you generate mono-line submissions for Commercial General Liability and Commercial Property. In this use case, the demonstration includes both of those in the package submission. Log in as clverificationsysadmin. After logging in, open the Underwriter portal and then select +Create > Start Commercial Package Submission. A new work object for the Commercial Package Submission is generated: Pega Underwriting for Insurance Commercial Lines User Guide 4-1

44 Stages and Steps PUI leverages the Stage-Based Case Management feature introduced in Pega 7.1. The PUI framework has been designed to reuse stages and steps throughout the process where applicable, so that the stages for each process are the same. The stages and steps for the Commercial Package Submission are shown below. Stage 1: Applicant Identification The initial stage in the process is the Applicant Identification stage. The purpose of this stage is to collect and identify the company applying for coverage. The first step is Customer Intake. Enter the company-identifying information including name, address, and . Only the customer name is required. Pega Underwriting for Insurance Commercial Lines User Guide 4-2

45 With the customer information, the framework uses the values entered to search for possible existing entries to avoid duplicate creation. The framework uses the name of the company as its primary identifier and returns a list of possible duplicate entries from which you can select and compare against the data entered on the previous screen. Pega Underwriting for Insurance Commercial Lines User Guide 4-3

46 The screen is divided into three sections: Existing Customers, Selected Business, and Customer Intake Information. The Existing Customers section displays the list of accounts already found in the system that may be a match for the applicant organization. When you select a row of one of these existing customers, that customer s data is then displayed in the Selected Business section. The Selected Business section enables you to view all relevant comparable data for the selected account. The Customer Intake Information section displays the data for the applicant organization entered on the previous screen. The side-by-side comparison allows you to review information for different existing accounts and compare them directly against the entered applicant. Click one of the three buttons, Use Selected, Create New, and Back, based on the following: If the applicant is a duplicate of a selected existing account, click Use Selected to move to the next stage. If the applicant is a new customer and not an existing account, click Create New. The system adds this account to the data and moves forward to the next stage. If there was an error in data entry and you need to correct the data before moving on, or you need to search again, click Back to return to the Customer Intake screen. Pega Underwriting for Insurance Commercial Lines User Guide 4-4

47 This example proceeds as if the Use Selected button was clicked so as not to create a duplicate account. Stage 2: Risk Evaluation The Risk Evaluation stage is where the customer application is initially vetted for appetite based on the Standard Industry Class (SIC). On the first screen-obtain SIC Code-select the Division, Group, and Industry for the applicant customer. You can indicate whether you know the SIC code already. If you need to determine the SIC code, select No. Fields appear so that you can determine the numeric SIC code. Each drop-down selection field, except for Division, is filtered based on the selection in the previous field. Once all fields are entered, the system returns the appropriate SIC code for the corresponding selections. If the customer carrier stores SIC information with existing accounts, this could be pre-loaded or it might no longer be required if the account was issued a policy previously. Pega Underwriting for Insurance Commercial Lines User Guide 4-5

48 If you know the SIC code, a field is available to enter the value. The system returns the Division, Group, and Industry Code values that match. Pega Underwriting for Insurance Commercial Lines User Guide 4-6

49 Once the SIC code is displayed, click Next. The system returns the North American Industry Classification System (NAICS) code which corresponds to the selected data on the Review Classification Details screen. When you click Finish, the Appetite Determination page appears where you can review the carrier s level of interest for the organizations in this industry. The Appetite Determination can be used by carrier customers as an initial knockout rule to then advise the user that the carrier does not wish to cover this risk. Alternatively, in PUI, the user is simply advised of the carrier s interest. Stage 3: Agent Intake The Agent Intake stage is where you can associate an agent to the submission. Select the agency from the Agency Name drop-down list. The list of agents is filtered to display only agents that are associated with the agency and have an active license to sell policies for the LOB being applied for in that jurisdiction. Pega Underwriting for Insurance Commercial Lines User Guide 4-7

50 If the logged-in user is an agent, this information is loaded automatically. You do not need to select it. Refer to the Agent Management section for information about how to manually add and configure agents and agencies. Stage 4: Account Data The Account Data stage collects account-level data that is applicable to all underlying LOBs, such as locations and business interests, so that the screen will display only LOB- specific questions for the appropriate application. On the first screen, indicate the LOBs of interest. Your selection will determine the subsequent process and screens. Pega Underwriting for Insurance Commercial Lines User Guide 4-8

51 With this release, only General Liability and Commercial Property are fully configured. Other lines have been stubbed out for ease of extension, and will appear as available products but are not configured for application data collection. The first Account Data screen collects location and building information. You can enter an unlimited number of locations and an unlimited number of buildings at each location. To add a location, click Add Location. If no locations exist, the system automatically Pega Underwriting for Insurance Commercial Lines User Guide 4-9

52 creates a location with the address of the customer from the Applicant Identification stage. If a location already exists, a blank location screen is presented. At least one location is required. Subsequently, you can click Add Building to attach a building to that location. Alternatively, the user has the option to upload a spreadsheet of locations rather than type them in manually. Click the Manage Assets button to view the menu of options. The user can select Download Template to obtain the spreadsheet into which all the location information can be entered. Upon completion, click Import Assets and browse for the file to be uploaded into the submission. The screen shown in the previous figure enables you to enter or review requested building data for the submission. Upon completion of location data entry, the next screen is General Information. Pega Underwriting for Insurance Commercial Lines User Guide 4-10

53 The General Information screen leverages the Pega Survey to ask a series of questions. If you answer Yes to any of the questions, you must enter an explanation. The General Information questions pertain to the customer s business management and general background information. The Prior Carrier Information screen collects information about insurance coverage provided to the applicant before the current submission. Pega Underwriting for Insurance Commercial Lines User Guide 4-11

54 The detail fields that appear vary, based on the LOB selected in the drop-down list. Some customers might want to modify this screen to collect underlying coverage instead. The last screen in the Account Data stage is the Loss History screen. Loss History is very important to all commercial policies. Currently, you must manually enter data for all types of relevant losses by clicking the Expand icon (+). There is a validation on the Date of Claim field to check whether the date is greater than or equal to the Date of Occurrence. Stage 5: Application The Application stage in Commercial Lines differs from Personal Lines in that the data collection screens are presented only once. However, similarly to the Personal Bundle, you need to go through the application questions one line of business at a time. First, indicate the effective date for the policy coverage. The framework is built to create annual policies, but you can adjust to 6-month, or other period policy lengths as needed. In addition, you can choose to add a second date field to select an expiration date. Pega Underwriting for Insurance Commercial Lines User Guide 4-12

55 Commercial Property Note that the case header changes to include the Commercial Property line of business name so that you know where you are. For Commercial Property the initial screen-premises Information-collects property-specific data relative to each location and building entered on the Property Details screen in the Account Data stage. You can expand and collapse each building row to add data. The Premises Information and the Additional Information screens collect building-specific data relative first to the coverage, and second to the exposure. The exposure information pertains to the building s propensity for damage primarily due to the threat of fire from within and neighboring buildings. Pega Underwriting for Insurance Commercial Lines User Guide 4-13

56 You can go back and update Account Data after leaving that stage. If something is incorrect, you need a method to go back and add or modify data at the account level for the submission. As previously stated, during the Application stage for the Commercial Property line, the Premises Information is collected for locations and buildings entered in the Account Data stage. Without this feature, there is no way to fix incorrect data without starting a new submission. From the Other Actions menu, select Add Work and Update Account Data. The system brings you back to the first screen in the Account Data stage, Property Details. From here, you can click any of the screen names in the flow, or use the Next and Back buttons to navigate to the desired screen to make changes. The last screen in the Application stage for Commercial Property is Quotes. The Quotes screen allows you to create multiple coverage quotes for a side-by-side comparison of options for each individual LOB. Pega Underwriting for Insurance Commercial Lines User Guide 4-14

57 While package policies are typically priced with all lines together upon issue, this allows you to select various coverage limits and compare the premiums for each LOB. Each coverage is listed in a row where you can select the desired level of coverage for which the system can calculate the premium for that coverage. To compare another quote, click the Expand icon (+) in the top right to create a new tab. Then select the coverage limits for that quote. To remove any tab, click the X icon next to the tab. As shown in the previous figure, you can select limits for policy level coverages, and then scroll down to review Risk information and select risk level coverage limits (see the following figure). Pega Underwriting for Insurance Commercial Lines User Guide 4-15

58 You can also add Endorsements to the quote at the Policy and Risk levels if necessary. Below each coverage section is an expandable Endorsement section that allows you to manage Endorsements. Pega Underwriting for Insurance Commercial Lines User Guide 4-16

59 To add endorsements to the Quote, expand the appropriate section and click Add/Remove Endorsements. Pega Underwriting for Insurance Commercial Lines User Guide 4-17

60 A screen appears with an autocomplete field in which you can search or select the endorsements you want include, as shown in the previous figure. After finding the endorsement name, click Add to load the endorsement and display it in the list below. To delete an endorsement from the Quote, click the Remove hyperlink in the appropriate row. This feature allows you to quickly and easily add as many endorsements as necessary. When you finish adding all endorsements, click OK. The main screen appears with the selected endorsements displayed. Pega Underwriting for Insurance Commercial Lines User Guide 4-18

61 The Data Status column indicates whether there is data outstanding on each individual endorsement. If no data is required for an endorsement, the value is empty. If data is required, the value is Outstanding. If the data has been entered, the value is Complete. To add or modify data for an endorsement, click the Outstanding or Complete hyperlink for the appropriate endorsement. A screen appears that lets you enter the necessary data for that specific endorsement. Below is an example of a Manuscript Endorsement with a box in which to enter free-form text. Note the red line indicating the spell check in that context. Once you determine which quote to submit, click the Accept Quote button. This marks the accepted quote with a green check mark in the tab, and the quote is presented to the Underwriter for evaluation. In addition, the system automatically sends an to the agent advising them of the status change of the submission and it sends an to the Underwriter to whom the submission has been assigned. Pega Underwriting for Insurance Commercial Lines User Guide 4-19

62 Pega Underwriting for Insurance Commercial Lines User Guide 4-20

63 Commercial General Liability Upon submission of the selected quote for Commercial Property, the Application stage for General Liability appears, skipping the Policy Effective Data screen. As in the Commercial Property line, the Application stage for General Liability takes you to the first screen in the flow, Schedule of Hazards. Notice that the location ID information entered in the Account Data stage has been pre-filled. The Schedule of Hazards allows you to enter various hazard code information pertaining to each individual risk location. Some carriers accept this information from the agent as part of the application process and modify it during Underwriting. Others track this information internally and only request the exposure information for rating purposes. As in Commercial Property, if you need to add or modify location data, the Update Account Data function is available from the Other Actions menu. That function returns you to the Account Data stage. Pega Underwriting for Insurance Commercial Lines User Guide 4-21

64 The next screen in the flow is Employee Benefits Liability. The Employee Benefits screen validates that the Number of Employees Covered must be less than or equal to the Number of Employees, and that the Retroactive Date must be a date in the past. The next three screens for Contractors, Products/Completed Operations, and General Information all leverage the Pega Survey for data collection. Each of the data collection fields on those screens requires either a positive (Y) or negative (N) response. If you answer Y, the Pega Survey presents a text field in which you can enter an explanation. Pega Underwriting for Insurance Commercial Lines User Guide 4-22

65 Contractors Products/Completed Operations Pega Underwriting for Insurance Commercial Lines User Guide 4-23

66 General Information Finally, you can enter remarks for the submission to be reviewed later. Pega Underwriting for Insurance Commercial Lines User Guide 4-24

67 The last screen that appears in the General Liability flow is the Quote screen. This is the same screen presented for Property but it contains Liability coverage. Pega Underwriting for Insurance Commercial Lines User Guide 4-25

68 Upon acceptance of a General Liability quote, the confirmation screen appears, including the total premium categorized by LOB. The last step in the Application stage checks for clearance. Submission Clearance checks whether the agent or broker on the submission is authorized to present this business to the carrier on the insured s behalf. The clearance process checks whether the associated agent or broker is listed as the Broker of Record on the Customer Management file, and whether another submission for the same customer and LOB is already in process. If the submission fails the clearance check, then the alternate Clearance stage is introduced to the flow. The UWClearanceSetting system setting determines what happens to the submission if it fails the clearance check. An OFF setting routes the submission to the Clearance Workbasket where back-office people can either contact the agent or broker for a Broker of Record letter authorizing submission, or review the existing submissions for duplicates. An ON Pega Underwriting for Insurance Commercial Lines User Guide 4-26

69 setting routes the submission to the Account Owner to determine if the submission should move forward in the process for evaluation. Upon confirmation and submission, the application is submitted to Underwriting for review and moves to the Underwriting stage. Pega Underwriting for Insurance Commercial Lines User Guide 4-27

70 Each line of business is assigned to an individual underwriter for review based on a decision table. Underwriter reviews are assigned many different ways by carriers, such as by line of business as shown here, or as a single submission. Other carriers may assign underwriting based on agency affiliation, premium or risk value, and so on. Stage 6: Underwriting Once the submission is assigned, the Underwriting department reviews the submission and generates a proposal if they decide to accept the risk of the submission. The submission is first reviewed by the underwriting assistant for completeness, prior to passing it on to the Underwriter. This way the Underwriter s time is better spent on more productive work, rather than finalizing data for a submission. Upon logging in, Underwriting Assistant Terry Johnson is brought to the Case Manager Portal, and his work is presented in the worklist. Pega Underwriting for Insurance Commercial Lines User Guide 4-28

71 By clicking the link for the submission, Terry is brought to the Case Contents display where he can review the submission. The tabs found in the assignment display all the relevant data entered for the submission to be reviewed. You can review the data in the entry screens using the Update Account Data function described previously. Pega Underwriting for Insurance Commercial Lines User Guide 4-29

72 The Customer tab displays Company Detail information obtained from the Contact Management area. This information was entered in the Applicant Identification stage. Pega Underwriting for Insurance Commercial Lines User Guide 4-30

73 The lower three sections of the screen, Contractors, Products/Completed Operations, and General Information, enabled you to review the General Liability data entered on those screens in the Application stage. By clicking on the small triangle to the left (>), the section expands to display the detail data for each particular section. Pega Underwriting for Insurance Commercial Lines User Guide 4-31

74 The Agency tab displays the same information related to the agent on the selected policy and displayed in the Agent Intake stage. Pega Underwriting for Insurance Commercial Lines User Guide 4-32

75 The Risk Info tab displays the Location, Hazard, and Employee Benefits data. Note the location address is a hyperlink. By clicking the hyperlink, the framework feeds Google Maps and opens a map of the location. Pega Underwriting for Insurance Commercial Lines User Guide 4-33

76 The Policies/Quotes tab displays a report of all the existing Quotes and issued Policies to the insured throughout the relationship with the carrier. Pega Underwriting for Insurance Commercial Lines User Guide 4-34

77 By clicking on the right-facing arrow ( ) to the left of any Policy ID number, the screen expands to display the detailed information for each policy for review. Pega Underwriting for Insurance Commercial Lines User Guide 4-35

78 The last tab, Notes, enables the Underwriting department to add notes to each submission. The notes roll up to the parent so that notes entered on a submission also appear at the Package level. When reviewing the notes, you can export all the notes in the display to a PDF file for sharing with external parties. Pega Underwriting for Insurance Commercial Lines User Guide 4-36

79 To add notes to a submission, click the +Add Note button at the top left of the screen. A screen opens so that you can add notes. Pega Underwriting for Insurance Commercial Lines User Guide 4-37

80 Loss Control Survey An underwriter can request that a Loss Control survey be done on the submission by creating a new subcase from the Other Actions menu. You can assign the Loss Control Survey subcase to an internal or external resource for a reivew of the company and its properties. Pega Underwriting for Insurance Commercial Lines User Guide 4-38

81 Upon Submission of the identified locations, you can enter the details for the survey. Pega Underwriting for Insurance Commercial Lines User Guide 4-39

82 With the completion of the Loss Control Survey, the Underwriter proceeds with the evaluation. Proposal On the Overview tab, when the Underwriter clicks on the Application Review (Underwriting) assignment, a screen opens that displays a list of any duplicates for review. The screen includes tabs so that the Underwriter can review the data. Pega Underwriting for Insurance Commercial Lines User Guide 4-40

83 If the Underwriter believes that this is an acceptable risk, the Underwriter proposes quotes to the customer for consideration by clicking Generate Proposal. The system creates a new subcase for the submission in which the Underwriter can create Quote options in a proposal for the customer. Pega Underwriting for Insurance Commercial Lines User Guide 4-41

84 The default quote option is what the agent or broker requested in the Application stage. The Underwriter can then modify that quote and create additional options. The Pricing Analysis section offers the underwriter information related to profitability and advice on the probability of the customer accepting the offered quote at the adjusted premium. The Target Premium is calculated by the system and it is the ideal premium that the Underwriter can use. The Underwriter can create a short description for each quote in the top left that updates the name in the tab with the first 12 characters of the short description. To create another quote option for the customer, click Copy to new quote next to the tabs. This takes an exact copy of everything on the highlighted quote and allows you to make changes. To add and remove coverages and endorsements, click the buttons for the same functionality discussed for Quotes in the Application stage. To navigate to each Location, click on the Location and expand it to display the buildings at each location. Pega Underwriting for Insurance Commercial Lines User Guide 4-42

85 An Underwriter can attach Quote-specific free-form Terms and Conditions that remain with each individual quote and is presented to the customer in the proposal. To view the list of forms that currently make up a quote, click on the View forms hyperlink to display a screen. You can sort and filter on any of the columns. Pega Underwriting for Insurance Commercial Lines User Guide 4-43

86 Pega Underwriting for Insurance Commercial Lines User Guide 4-44

87 You can perform pricing in the Quote Pricing section. Currently, the section includes some categories for Scheduled Rating as well as manual adjustments by dollar or percentage. The Underwriter can apply the change as a dollar value (+$, -$), or as a percentage (+%, - %) of the total, either up or down. When the Underwriter has completed the pricing, the Underwriter clicks Submit. The proposal is then evaluated for authority based on the total premium of each quote option in the proposal. Pega Underwriting for Insurance Commercial Lines User Guide 4-45

88 If a quote option in the proposal exceeds the user s authority, it will be routed to their supervisor for approval. Upon clicking the assignment, the approver can review all the created quote options and has the option to either Approve or Reject the proposal, as well as the ability to enter notes. If the approver rejects the proposal, notes are required. The proposal will then be sent back to the Underwriter to update the proposal. If the approver approves the proposal, it is then passed to the Account Owner for review. Pega Underwriting for Insurance Commercial Lines User Guide 4-46

89 The Account Owner is presented with a read-only view and can review all the quotes prior to delivering the proposal to the customer. If the account owner does not like the proposal, the account owner can return it to the Underwriter by selecting Return to Underwriter from the Other Actions menu. The account owner enters notes that can be reviewed by the Underwriter. The proposal is assigned to the Underwriter. Pega Underwriting for Insurance Commercial Lines User Guide 4-47

90 If the account owner accepts the proposal and submits it, the system automatically generates a proposal to the agent. However, if the submission is part of a package, the proposal waits for all submissions within the package to be completed so that a single proposal communication is delivered with all LOBs. Pega Underwriting for Insurance Commercial Lines User Guide 4-48

91 When you submit the case, an to the agent is generated and attached to the submission. It contains the formal proposal to the customer as shown. With the proposal delivered to the customer, the Proposal case updates to a status of Pending- CustomerResponse with an assignment to the account owner, and the submission status is updated to Pending-QuoteCustomerAcceptance. Pega Underwriting for Insurance Commercial Lines User Guide 4-49

92 In the case of mono-line submissions, the proposal includes directed web access to the system that allows the agent to open a special page to review the quote options and directly respond to Accept, Reject, or Negotiate the proposal. If the customer does not respond within 15 days, the assignment is then updated for the account owner to follow up with the agent on the proposal. If the customer responds to the account owner instead of responding directly, the account owner can access the proposal for each LOB and proceed. This allows a customer to accept a quote option for one LOB in a package, but negotiate options for another LOB. Pega Underwriting for Insurance Commercial Lines User Guide 4-50

93 If the customer accepts one of the quotes in the proposal as is, you continue with the submission by clicking Accept this quote to indicate which quote option the customer would like, and then click Submit. Alternatively, you can click either Proposal Reject or Proposal Negotiate from the Other Actions menu. If you click Proposal Reject, you are offered the opportunity to mark the submission to be reminded to remarket prior to the policy s anticipated expiration date with another carrier, and enter notes on the matter. Pega Underwriting for Insurance Commercial Lines User Guide 4-51

94 The remarket feature allows the carrier to try to win back the business when it comes up for renewal next year. The Proposal and Submission cases are Resolved. If you click Proposal Negotiate, a screen appears so that you can enter notes regarding the customer s response. Upon submission, the proposal case is assigned to the Underwriter with the opportunity to update quote options to try to complete the sale. The process then repeats with the Underwriter updating existing quotes or creating new quotes that are reviewed by the Account Owner and forwarded back to the customer with the new proposal. This is done within the same proposal case. Pega Underwriting for Insurance Commercial Lines User Guide 4-52

95 Once the proposal is accepted, the Proposal case is resolve, and the Submission assignment rests with the Underwriting Assistant to prepare the quote for issue. Pega Underwriting for Insurance Commercial Lines User Guide 4-53

96 At any point in the Underwriting stage, the Underwriter can decline coverage by selecting the Decline Application option from the Other Actions menu. That option resolves the case. With the acceptance of the submission, the subcase waits for the issuance of the policy as a package. Because there are multiple LOBs in this package assigned to different underwriters, one subcase may require a lengthy investigation to reach a conclusion. Pega Underwriting for Insurance Commercial Lines User Guide 4-54

97 Stage 7: Issue The system issues the policy and displays the confirmation screen for both LOBs. The framework can issue both lines as one policy or as two policies, depending on the integration with a back-office policy administration system. This resolves the case to completion. Pega Underwriting for Insurance Commercial Lines User Guide 4-55

98 ACORD Import The PUI framework supports the electronic import of data to initialize a commercial submission. The PUI framework accepts data entered into an ACORD 125 eform. It can be imported to initiate a submission. To begin the process, select +Create > Start ACORD Commercial Submission. The import screen appears. Enter an appropriate subject name for the submission and select the file to be imported by clicking the Choose File button. After the import, the first screen in the Applicant Identification stage appears for you to review the imported data and enter any required missing data. Pega Underwriting for Insurance Commercial Lines User Guide 4-56

99 Listener The system also accepts an ACORD form through and automatically creates a case for the submission. The same ACORD 125 eform can be attached to an and sent to pegaeformsubmissions@gmail.com. The listener then takes the ACORD form and generates the same case type as though the form was imported. Renewal Renewal cases are designed to be triggered automatically either from within PUI or from an external system, such as a Policy Admin System. There is a table where the number of days prior to the expiration can be adjusted by line of business. Select DesignerStudio > Framework Management >Tools > Renewal TimeLines to access the configuration rule. Pega Underwriting for Insurance Commercial Lines User Guide 4-57

100 Renewal cases can be manually generated from this screen by clicking the Generate Renewal button. The system will automatically create a Renewal Review case type (REN prefix) for each issued policy before the end of the number of days entered here, and also prior to the expiration date of the renewing policy. The case type is created for the Underwriting Assistant and Underwriter assigned to that line of business, and the Account Owner. As with the Submission process, the Account Owner is ultimately responsible for the relationship with the Agency and the customer, but the Underwriter must review the risks and create the Renewal Proposal for the customer. The Renewal Review case mimics the functionality of the Submission case for each line of business but opens in the Underwriting stage because all application data has already been received. The first party to receive the assignment and process work is the Underwriting Assistant (UWA). The UWA will complete their review of the case and then submit the assignment to push it to the Underwriter for their review. The Underwriter (UW) opens their Renewal Review assignment and can click a tab to review additional detail for each area. When the UW generates a new proposal, the system default is to display the expiring coverages and endorsements for the Underwriter to review and determine how the policy should be renewed. The UW can modify or create multiple renewal quote options, following the same process as the submission proposal. Pega Underwriting for Insurance Commercial Lines User Guide 4-58

101 Insurance Information Foundation Managing a Customer Account (MCA) The Customer account management process provides a comprehensive view of the customer and includes the capabilities to create a new customer (either individual or business), open an existing customer and view the details, or update the existing customer details. All the details such as customer profile with personal information, previous claims details, list of policies linked to the customer, and customer activities can be captured and seen in a single unified view. Navigating to the MCA Screen of a Customer: 1. Open the Case Manager Portal and click on the Customer Management tab. 2. Enter a value in the Last Name field, and then click Search. A list of matching customer records is displayed as shown in the figure below. 3. Click on the Last Name or First Name link of a customer in the list. Doing so displays the MCA of that customer for further actions. See the sample MCA screen later in this section for sample customer Natalie Song. In the Case Manager portal, shown below, click the Customer Management tab. Pega Underwriting for Insurance Commercial Lines User Guide 4-59

102 Search for a Customer: Enter song in the Last Name field, and then click Search as shown below. The MCA screen appears when you click the last name or first name link in the result list. Below is the MCA screen for sample customer Natalie Song: Pega Underwriting for Insurance Commercial Lines User Guide 4-60

103 You can see several tabs: Customer profile, Activity, Policy List, Claims, and Audit. As you can see in the figure above, the customer profile screen displays the personal information of the customer. As shown below, the Activity screen displays the recent activities performed for this customer. Pega Underwriting for Insurance Commercial Lines User Guide 4-61

104 The Policy list screen displays all the policies for this customer. Pega Underwriting for Insurance Commercial Lines User Guide 4-62

105 If the customer has any claims against his name, they are displayed under the Claims tab. The Audit tab displays the history and case-narrative details as shown below. Pega Underwriting for Insurance Commercial Lines User Guide 4-63

106 There are some other useful options that you can access from the Actions menu as shown below. You can perform several actions from the Actions menu of the MCA work object related to managing the customer s account, such as: updating customer profile, adding attachments, and so on. You can initiate new submissions such as life, personal auto, and so on, and request a policy loan using the Add work menu in Actions area. Explanation of the Actions Menu items Update Customer Profile From the Actions menu of the above MCA, select Update Custom Profile. Pega Underwriting for Insurance Commercial Lines User Guide 4-64

107 This displays a screen to update the details of this customer. Below is the update customer profile screen for a sample customer, Tom King. On this screen, you can change or update the details of the customer and click Submit. This updates the customer details in the database. When you access this customer again, the updated details are displayed on the MCA. Pega Underwriting for Insurance Commercial Lines User Guide 4-65

108 For example, change the Phone Number and ID of this customer and see the updated MCA. Click Submit and view the changes updated. Similarly, you can update the business customer profile as well. Pega Underwriting for Insurance Commercial Lines User Guide 4-66

109 Add Attachments Attachments serve an important purpose by enabling you to attach customer documents or proofs in the MCA itself. The attached documents can be identity proofs, address proofs, license documents of the customer, and so on. When you click the Add Attachments option, a screen opens so that you can upload the documents. For example, upload a test.txt file for this customer. Pega Underwriting for Insurance Commercial Lines User Guide 4-67

110 Click Choose file and then select the document from the system. Click Submit. Add Note The Add Note action adds a note to the MCA under PEGA PULSE. Click Add Note. The screen shown in the following figure opens so that you add the note text. Add the Note Test and then click Submit. Pega Underwriting for Insurance Commercial Lines User Guide 4-68

111 Now you can see the Test note under ATTACHMENTS > Advanced Link. Under Notes, you can see the Test note added. Pega Underwriting for Insurance Commercial Lines User Guide 4-69

112 You can search for a business user by selecting the Business radio button on the Customer Search screen shown earlier. The only difference is that the Add Work action under the Actions menu enables you to launch commercial submission processes instead of personal submission processes. The following is the Customer Search screen where you can search for a business customer. The following is the MCA screen of the Buten Bearings business customer: Notice that you can now see Commercial processes under the Add Work item. Pega Underwriting for Insurance Commercial Lines User Guide 4-70

113 Creating a New Customer: On the Customer Search screen, when a search (explained in the preceding paragraphs) yields no results, then you can create a new customer by clicking Create New. The following figures shows the Create New button on the Customer Search screen., Pega Underwriting for Insurance Commercial Lines User Guide 4-71

114 Click Create New to launch the Create New Customer screen to collect details about the new individual customer or business customer. Pega Underwriting for Insurance Commercial Lines User Guide 4-72

115 The following is the Create New Customer screen used to collect information for a new business customer. Complete all the details and then click Create. This creates a new customer information record. When searching for this customer, the Customer Search screen displays this newly created customer s name. Then, if you click on the customer name link, the MCA screen is displayed. Pega Underwriting for Insurance Commercial Lines User Guide 4-73

116 The following example shows the new customer creation process and how to search for the customer in the Customer Search screen. 1. Create a contact named Tom King. 2. Click Create New. This launches a screen to collect the customer details. Pega Underwriting for Insurance Commercial Lines User Guide 4-74

117 3. Click Create in this screen after completing the details. 4. Now search for this customer on the Customer Search screen. 5. Click on the last name or first name link in the search result. This opens the MCA screen of Tom King. Pega Underwriting for Insurance Commercial Lines User Guide 4-75

118 Agency and Agent Management (AAM) Landing Page This is a tool in the application that is implemented as a Landing page because it is anticipated that customers will have their own external Agency Management system with which PUI will integrate to use this data. Similar to managing a customer account (MCA), there is a process in PUI to manage agencies and agents. Using this process, agents or agencies are searched, created, linked with each other and updated. AAM is available as a landing page in the PUI Framework. Select Design Studio > Framework Management >Tools > Agent/Agency Management to access AAM. This is unlike MCA, which is managed from Case Manager Portal. This is the Landing Page screen. Pega Underwriting for Insurance Commercial Lines User Guide 4-76

119 The following is the screen that appears when you click on the Agent/Agency Management landing page. From this screen, you can search for an agency and agent, and you can create an agency or agent. Searching Agent and Agency Agent Search: The following figure shows the Agent search screen. Enter a value of a in the First Name field. When you click on the Last Name or First Name links in the search results, a screen appears on which you can update agent personal information and the linked agency. You can also update the details of the LOBs that this agent is licensed to sell. Pega Underwriting for Insurance Commercial Lines User Guide 4-77

120 The following figure shows the update agent information window. Click Update to update the details of this agent in the database. Agency Search Search by Agency Name or Carrier code when searching for an agency. The following is the Agency search screen when you search for an Agency name by entering the string a. All the Agencies that match the search criteria are displayed in the search results. Pega Underwriting for Insurance Commercial Lines User Guide 4-78

121 When you expand an Agency Name, all the agents linked to this agency are shown. The following is the expanded Agency screen with agents linked to it: You can also update an agent by double-clicking on the agent in the list shown above. This means that you can update agent data two ways: from the agent search or from the agency search as explained above. Pega Underwriting for Insurance Commercial Lines User Guide 4-79

122 The following is the Update Agent information screen that opens when you click on an agent from the Agency search results (shown in the previous figure). Pega Underwriting for Insurance Commercial Lines User Guide 4-80

123 When you click the Agency Name link in the search results, a screen opens from which you can update agency data. The following is the Update agency information screen. Create Agent and Agency Create Agent On the Agent/Agency Management screen shown in the figure below, click the Create Agent button to create a new agent. Pega Underwriting for Insurance Commercial Lines User Guide 4-81

124 When you click Create Agent, the Collect Agent Information screen opens. The Agent Intake screen collects agent details and then saves them in the database when you click Create. Agent details include personal information, the agency, and license information. Pega Underwriting for Insurance Commercial Lines User Guide 4-82

125 Create Agency From the Agent/Agency Management screen, click Create Agency to open a screen where you collect the agency details: When you complete all the details, click Create. This creates an agency record in the database. Note: While creating an agent, ensure that ID of this agent is the same as the Operator ID and ID on this agent s operator ID record. (The assumption is that this agent has the required permissions to launch a submission process). This ensures that the Agent details are prepopulated on the Agent Intake stage screen in the policy submission process. PUI is packaged with two agent operator IDs: ajones@a1insurance.com and cjohnson@a1insurance.com Circumstanced Personal Auto flow when Agent logs into the application as Operator First, create an Agent record and then create an Operator ID record for the same agent with the same ID that was used in Agent record. Pega Underwriting for Insurance Commercial Lines User Guide 4-83

126 The following is the Agent record created for Ashley Jones. Pega Underwriting for Insurance Commercial Lines User Guide 4-84

127 The following is the Agent OperatorID created in the application. Notice that the ID entered for this Agent Operator ID is same as the one in the agent record shown in the previous figure. Note: For FCM to work properly from SFAI to PUI, the operator ID for the agent must be the same in both applications. Personal Auto submission flow circumstanced for Agent Login The Agent Distribution channel is designed to be an agent-specific application submission process. The process leverages the Base Flow, but is modified for the agent to be more streamlined and to allow the agent to get through the process as quickly as possible to service the customer. To this end, the agent is automatically assigned to the submission based on their login, thereby skipping the Agent Intake and Quote stages. By going directly to the Application stage from the Effective Date, the agent can enter the data necessary for an accurate quote and necessary to bind the policy for the customer quickly. Pega Underwriting for Insurance Commercial Lines User Guide 4-85

128 Details When the Distribution Type channel is Agent, the following circumstanced case type rule is executed. The Intake Agency stage is skipped because the person who is processing this submission is the agent. The ID of the Operator ID is searched against the ID of the agent database to find out whether the person initiating the submission is the agent. If the records match, then the following circumstanced case type is triggered instead of the base Personal Auto Case Type rule. Also notice that in the Agent s circumstanced flow above, the Quote stage is not present. In the base rule, the Quote stage determines the customer s interest in the product by presenting various products or options. When the customer accepts the Quote, the system seeks additional information from the customer in the Application stage before providing an accurate offer. In the circumstanced flow, it is the agent who is processing the application submission on behalf of the customer, and the customer has already expressed his interest in the product. Therefore the Quote stage is skipped and the Application stage is directly called to speed up the process. Agent Personal Auto Demo: 1. Use the following operator ID and password to log into Pega 7 as an Agent: User ID: ajones@a1insurance.com Password: install 2. From the Case Manager Portal, select +Create > Personal Auto Submission. Pega Underwriting for Insurance Commercial Lines User Guide 4-86

129 3. Click Save to save the submission. The rest of the flow is similar to the base rule except that the information collected as part of the Quote and Application stages in the base rule is now collected as part of the Application stage. Pega Underwriting for Insurance Commercial Lines User Guide 4-87

130 Global addressing The PUI framework supports a generalized address structure that lets you support addresses from many countries by using a generic format. It can also be specialized for a specific country if needed. The framework uses the class Pagans-Data-Address- to represent any form of address used throughout the different flows. For address data capture and display, the PegaIns-Data- Address-.AddressEntry section is used throughout the framework. This section consists of multiple layouts that have visibility conditions on them. These visibility conditions are based on a dynamic system setting named ImpCountry (Implementation Country). By default, the framework ships with the value United States for this setting. In the AddressEntry section, the layout shown below is displayed when ImpCountry has the value of United States, meaning that the layout uses a US-specific address format. Pega Underwriting for Insurance Commercial Lines User Guide 4-88

131 The layout shown below is displayed for a generic implementation and is not country-specific. By distributing address elements across multiple lines, the ordering of postal codes, regions and towns can be managed without implying any specific address structure. It also helps to manage variations in name and street address by providing a single input field for each element of an address. Implications at run time From the Case Manager Portal, start a Personal Auto Submission. The first screen looks like the one shown below with the default setting of United States for ImpCountry Pega Underwriting for Insurance Commercial Lines User Guide 4-89

132 Open the ImpCountry rule, remove the default value for the property, and then save the change. Return to the Case Manager Portal and Start Personal Auto Submission. Notice that the screen now displays the generic section. The entire application will now display the generic section for address collection and display. The following are the properties used to represent these fields: PegaIns-Data-Address- Address PegaIns-Data-Address- AddressLine2 Piif-PostalAddress city PegaIns-Data-Address- State (Represents State, Province, Region, County etc.) PegaIns-Data-Address- ZipCode (Represents Zip Code or Postal Code) Piif-PostalAddress country Note that since the same section is used throughout the framework for the capture or display of addresses, any validations related to these address fields need to be handled within the particular flow action or section where it is used. No default validations are provided out-of-thebox from the framework. Pega Underwriting for Insurance Commercial Lines User Guide 4-90

133 5 Reporting PUI includes a wide variety of standard reports, graphs, and reporting tools to provide real-time information and analysis of processes, work, assignments, and historical data of quote and policy transactions over time. Most of these reports are Pega 7 out-of-the-box reports and can be found in the Case Manager Portal within the Reports section as shown below. Pega Underwriting for Insurance Commercial Lines User Guide 5-1

134 Clicking any of the categories will list the individual reports under that category as shown below. Refer to the Using the Report Browser chapter in the Application Developer Help for more details about these standard reports. To view PUI-specific reports, expand the Dashboard Reports pane in the Dashboard section of the Case Manager Portal. PUI exposes two reports: Open Submissions By LOB This report depicts the number of open submission work objects categorized by LOB. Total Premium By LOB This report depicts total premium amount categorized by LOB. Pega Underwriting for Insurance Commercial Lines User Guide 5-2

135 Clicking on the navigation menu named Chart Actions allows you to perform the following operations on that chart: Export to PDF Maximize View 2D Show Data The Show Data operation displays a report view of the chart as shown in the figure below: Pega Underwriting for Insurance Commercial Lines User Guide 5-3

136 Clicking each Line of Business results in a detailed drill down report as shown in the figure below. Pega Underwriting for Insurance Commercial Lines User Guide 5-4