Here are some sample work products from previous TPA724 client engagements…

Process Map for Enrollment Waiver Inside an Open Enrollment Period – A classic technique of visually diagramming the flow of work activities, handoffs, system components, decisions, document handling, and workflow between roles in a process internally and/or externally. There are supposed to be two versions for every functional area… an As-Is version and a To-Be version. Opportunities for improvement are identified and marked with triangles before they get logged into another relevant work product namely the OFI Catalog.
Process Map – Click to Enlarge

Wireframe Design for Employee Info Web Page

Wireframe Design for Enrollment Web Page

Employer/Employee Enrollment Web Page Screen Shot

Employer and Employee Portal – Employee Info with Coverage Enrollment Summary Screen Shot

Payment Enrollment Web Page Screen Shot

For one of our TPA/Insurance clients here is a sample architecture diagram to show how the existing software modules fit together through our integration expertise:

Implementation Roadmap

Employer Portal Experience

The Employer Portal features we have developed allow Employers to do the following:

  • Review/maintain Employer and Policy information:
    • Employer Details
    • Portal Contact information
    • Available Coverages
    • Available Coverages Rates
    • Deduction Calendar
    • Employee Classes and Special Groupings
  • Access/download Master Policy Documents
  • Access/download various Policy Forms (enrollment/evidence forms, claim forms, etc.)
  • Add new Employees
  • Review/maintain individual Employee and Coverage information:
    • Enroll Employees in available coverages
    • Waive coverages for Employees
    • Review/maintain Employee Coverage information
    • Terminate Employee coverages
    • Terminate Employees
    • Access/download Individual Coverage Certificates
    • Review/maintain Beneficiaries and Dependents
    • Search for Employees (active and terminated)
  • Access/download Policy Billing history
  • Payments
    • Make individual Policy Premium Payments (via NACHA file)
    • Enroll in monthly Auto-Pay
    • Make adjustments to Bill (terminations, skip deductions)
  • Access Employer reports
    • Census of Employees
  • a complete list of employees (active and/or terminated) and coverages (active and or terminated)
    • Age Bracket Rate Change Report
  • a listing of employees that are changing age rate brackets under attained age or anniversary age rates for a specific timeframe
    • Age Reduction Report
    • a list Employees whose coverage will be reduced because of age (within a specific date range)
    • Enrollment Tracking Report
  • a report showing the progress of all Employee enrollments
    • Payroll Deduction Report
  • a listing of all payroll deductions for a specific date range
  • Add/Delete Additional Portal Users
  • Maintain Username/Password

Employee Portal Experience

The Employee Portal features we have developed allow Employees to do the following:

  • Review/maintain their personal information:
    • Name
    • Address
    • Email Address
    • Enroll and Waive Coverages
    • Update Coverage Limits
    • Terminate Coverage
    • View/Download Coverge Certificates
  • Maintain Username/Password

Broker/Agent Portal Experience

The Broker/Agent Portal features we have developed allow Brokers access to policy information (for policies that belong to them) and information that pertain to their agency for example:

  • Review Policy information
    • Available Coverages
    • Rates
    • Deduction Calendar
    • Employee Classes and Special Groupings
  • Review/update Employee information
    • Add new Employees
    • Terminate Employees
  • Enroll in available coverages for Employees
  • Waive coverages for Employees
  • Review/update Employee Coverage information
  • Review Policy Billing history
  • Access/download Policy Forms
  • Access/download Individual Certificates
  • Track Employee Enrollments
  • Policy and Employee Reporting
  • Review Appointment Information/Access Appointment Forms
  • Review Commission Information
  • Custom Broker/Agency Reporting
  • Add/Delete Additional Portal Users
  • Maintain Username/Password

Carrier Portal Experience

The Carrier Portal features we have developed allow Carriers access to policy information (for policies they write) and specific carrier information for example:

  • Review Policy information
    • Available Coverages
    • Rates
    • Deduction Calendar
    • Employee Classes and Special Groupings
  • Review/update Employee information
    • Add new Employees
    • Terminate Employees
  • Enroll in available coverages for Employees
  • Waive coverages for Employees
  • Review/update Employee Coverage information
  • Review Policy Billing history
  • Access/download Policy Forms
  • Access/download Individual Certificates
  • Track Employee Enrollments
  • Policy and Employee Reporting
  • Review Appointment Information
  • Custom Carrier Reporting
  • Add/Delete Additional Portal Users
  • Maintain Username/Password

Employee Direct Enrollment Portal Experience

The Employee Direct Enrollment Portal features we have developed allow employees to:

  • Answer Initial Questions to Determine if Employee Qualifies for Any Available Coverages
  • Review all Available Coverages/Options
  • Enroll Selected Coverages
    • Automatically Create A Complete Policy in TPA Admin System
  • Send an Enrollment Summary Email to the Employee
  • Send a Welcome email to the Employee with link to the Employee Portal (includes initial logon credentials)
  • Capture ACH or Credit Card Payment Information
  • Automatically Enroll each Employee in Auto Pay

For one of our TPA/Insurance clients here is an outline of some of the key user pages that we have developed through our expertise in software integration, development, and usability…