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    题名: 壽險業新契約作業的演進與未來發展
    The evolution & future development in processing the new business of life insurance
    作者: 吳雲嬌
    贡献者: 蔡政憲
    吳雲嬌
    关键词: 新契約作業
    核保作業
    影像線上作業系統
    New Business Process for Life Insurance
    Underwriting Process
    Image & Workflow System
    日期: 2010
    上传时间: 2011-09-29 16:55:14 (UTC+8)
    摘要: 隨著資訊科技的日新月異與網際網路的普及應用，各企業在面臨全球化的競爭環境下，皆積極尋求應用先進的資訊技術，力求創新與躍進，以期用最有限的資源創造企業最大的效益。對以客戶服務為主的壽險業而言，隨著新契約快速成長、產品多樣化、行銷管道多元化，壽險業所面臨的挑戰與競爭亦隨之加劇，因此，保險公司除了業務推廣外，更須加快求新求變的腳步，提供更創新、更超乎預期的客戶服務，還要兼顧營運成本管控，才能在瞬息萬變的金融保險市楊，持續保有競爭優勢。

    本研究主要探討個案公司的新契約作業，在面臨業務量急速成長又要兼顧成本/利潤而無法同步大幅增加人力下，如何突破作業瓶頸，以及面臨每一階段的困難與挑戰時，如何事先評估風險與因應措施，並運用科技技術及專業團隊來大幅提升服務品質與作業效率。並且探討個案公司在完成每個階段的變革後，如何分析專案的執行成效，又如何持續提出還可再提昇改善的事項、問題以及未來可能的發展方向。個案公司的新契約作業演進過程摘要如下：

    1.由於早期的人工作業已難以負荷大幅成長的業務量，故個案公司於1992年建置了「自動化核保系統」(Underwriting Automation)。然在專案推動過程中，面臨了〝如何建置完善的自動化系統〞、〝如何在兼顧成本與流程順暢下，決定最佳的系統建置方式〞及〝如何讓人員接受作業改造〞的問題， 透過專案小組以使用者的角度規劃系統流程，並且不斷地與相關人員進行充份溝通與宣導後，終於獲得所有人員的認同與支持。透過自動核保系統，不僅解決因業務量急速成長所面臨的作業瓶頸，也大幅提昇核保效率、降低人為核保錯誤率並且節省人力成本。

    2.Underwriting Automation系統雖已提昇核保/發單效率，但仍面臨因產品的多元化以致業務員反應記不了這麼多的投保規則、以及無法在與客戶洽談保險當時即提供保戶確定的核保結果，因此，個案公司於2001年建置了「線上快速投保系統」(e-Application)。然在專案推動過程中，須克服的問題是〝如何提昇業務員使用系統的意願〞，透過專案小組不斷地與業務員進行溝通、並不斷地修正系統與持續地教育訓練及推廣，終於將e-Application系統使用率提昇到98%。透過e-Application系統，業務員不再有投保規則複雜的困擾，且不論上班/下班時間或例假日，都可隨時經由網際網路(internet)在客戶所在之處完成e受理、e核保，提供保戶即時的保障承諾，大幅提昇業務員的保險專業形象及行銷便利性。

    3.e-Application系統雖可立即獲得核保結果，惟業務員仍須將要保文件寄達分公司才能處理後續作業。再加上投資型商品熱賣且作業較傳統型商品複雜，致核保人員的作業負荷增加。為了大幅提昇作業效率且運用有限的人力資源發揮最大的效益，個案公司於2006年建置了「影像線上作業系統」（Image & Workflow）。然在專案推動過程中，面臨了〝如何改變核保人員的作業習慣 〞、〝如何將分公司人力順利移轉至簡易作業中心〞等問題，專案小組透過不斷地溝通及訓練，協助核保人員適應全程線上作業的變革；並提早一年與分公司溝通及規劃人力移轉事宜，讓人力及作業能夠順利移轉。透過Image & Workflow系統，其快速便捷的e化流程，5秒鐘即可傳遞要保文件影像，不僅有效改善新契約受理高峰量之人力及作業負荷問題，且簡易案件的分流已大幅提昇核保效率且降低行政作業成本，並使核保員可更專注於複雜案件的處理與溝通，提供保戶及業務員更優質的核保服務。

    保險是永續經營的服務事業，因此，流程變革是保險公司必須與時俱進且持續研討的重要課題。本研究藉由個案公司流程變革的過程、經驗及成效的分享，建議小型壽險公司推動核保自動化/影像化、中大型壽險公司全面e化/影像化/無紙化，並建議個案公司在邁入e化、影像化、無紙化的流程後，針對仍須仰賴人工處理的輸入作業，以及體檢核保人員養成不易的問題，可再進一步研議如何運用更精進的文字辨識技術與醫務專家系統，同時結合相關產業資源，採分階段方式逐步建置更科技化的系统平台，讓新契約作業邁向更快速、更專業的服務新里程。
    Along with the time evolution, the application of high technology and the spread of Internet are popular. The companies, currently are facing the competition environment in the era of globalization, all are looking for the modern technology aggressively to improve their service / operation in creative innovation way and to achieve the maximum benefit with limited resources. For the insurance companies, whose main focus is to provide customer service, they are facing more and more dramatic challenges and strict competition as the rapid growth of new business, variety of products, and diversity of promotion methods. Therefore, to maintain competitive advantage in the fast-changing financial-insurance market, the insurance companies need to strive for accelerated changes newly (as called re-engineering) not only to provide the innovative service which is beyond customer’s expectation, but also to manage the operation cost, besides promoting new business.

    This thesis is a case study of the new business process of the insurance company. It showed us how to break the process bottleneck, while the company faced the difficult situation that the business volume grown rapidly but no enough manpower can be added considered the cost/benefit justification. In addition, while the insurance company faced the difficulties and challenges of processing new business in each phase, how to evaluate the risks in advance and the corresponding countermeasures, adopting technology and professional team work to enhance the service quality and the operation efficiency. In these topics, we also discussed about how to evaluate the outcomes of re-engineering in each phase, included the way of reviewing the achievements / benefits of projects, continuously identifying the issues that can be improved, and the future development direction. The summary of the new business process evolution of the insurance company as below,

    1.Considered the previous manual process barely handled the loading along with the huge growth of business volume, the insurance company implemented the Underwriting Automation system in 1992 to release the work load. However, the company faced several problems as “how to implement a comprehensive automation system”, “how to decide the best implementation way to achieve the objectives of that the cost is justified and the flow is smooth”, and “how to let the user to accept the process re-engineering”. Through planed the system workflow from user’s point of view and keep fully communicating with the stakeholders by the project team, this project gained all the stakeholders’ recognition and support eventually. By using the Underwriting Automation system, not only the process bottleneck caused by the huge growth of business volume can be solved, but also can large improved the underwriting efficiency, decreased the manual underwriting error rate, and saved the manpower cost.

    2.Even though the Underwriting Automation system had improved the efficiency of underwriting and policy issuing, the agent still complained that they cannot remember so many underwriting rules and unable to provide the confirmed underwriting result timely when they sell the insurance product in front of the customer. Therefore, the company implemented e-Application system in 2001. However, the project team had to overcome the problem as “how to promote agent’s usage on this system” during the project implementation period. Through keep fully communicating with the agent, continuously enhanced the system features, training and promotion by the project team, the e-Application system usage rate finally raised up to 98%. By using the e-Application system, not only the agent’s persecution caused by the complex underwriting rule can be solved, but also can promise the protection to the customer in time as soon as the agent completed the e-submit, e-underwriting on customer site through the internet anytime. The professionalism and convenience of sales were big improved.

    3.Even though e-Application can reply with the underwriting result immediately, the agent still need to mail out the signed copy of the application documents back to branch office for further process. Furthermore, the hot sale of Investment Link Product (ILP) and more complicated process of ILP product than the traditional product that caused the underwriter work load increased. In order to improve the operation efficiency and elaborate the best effectiveness under the limited human resource, the insurance company implemented the Image & Workflow system in 2006. However, the company faced several problems as “how to change the usual practice of underwriter”, “how to smoothly transfer the manpower from branch to the simple processing center” during the project implementation period. The project team was not only keep training and fully communicating with the underwriter, helped them accommodate to the change to entire on-line process, but also well planed the transformation and communicated with the branches one year ahead to smooth out the transfer of process and manpower. By using the Image & Workflow system, the fast convenient auto-flow that enable the document image be delivered in five second, not only can effectively solve the work load problem caused by the new business peak volume., but also can separate the simple case process to improve the underwriting efficiency and lower the operation cost. So the underwriter can more focus on the complicated case handling and communication to provide the best underwriting service quality to the agent and customer.

    Since insurance is the business of providing sustainable service, the process re-engineering is important task to the insurance company and has to be examined and modified concurrently with the times. In this thesis, with sharing with the experience and the achievement of the insurance company’s re-engineering process, it is suggested to implement the underwriting automation and imagelization within the small scale of insurance company, and fully implemented the electronic, imagelizing and paperless process within the medium or large scale of insurance company. After the insurance company had done the process re-engineering in electronic, imagelizing and paperless ways, it is also suggested that for those key-in works still rely on the manual process and the difficulties of developing and training medical underwriting personnel, the company can further study how to apply more advanced handwriting identification (OCR) technology and medical specialist system to solve the problems. Through utilizing the resource from the related industries to implement the highly technological system platform by phases, so as to the new business process toward more rapid and professional service milestone.
    第一章 緒論 1
    第一節 研究背景與動機 2
    第二節 研究目的 3
    第三節 研究範圍 4
    第四節 章節架構 4

    第二章 文獻探討與研究流程 5
    第一節 壽險業新契約作業流程之相關學術研究 5
    第二節 研究流程 9

    第三章 個案公司新契約作業流程的演變 10
    第一節 個案公司介紹 10
    第二節 個案公司新契約業務量的成長與因應 13
    第三節 新契約作業流程 18
    第四節 新契約作業演進－人工作業 22
    第五節 新契約作業演進－系統化作業 26
    第六節 新契約作業演進－e化作業 37

    第四章 壽險業新契約作業的未來發展 47
    第一節 文字辨識系統(OCR) 47
    －文字辨識系統取代大量人工輸入作業之可行性
    第二節 醫務自動核保系統 56
    －醫務自動核保系統強化須專業輔助的醫務核保作業之可行性

    第五章 結論與建議 65
    第一節 結論 65
    第二節 建議 69

    參考文獻
    中文部份 73
    網站部份 74
    英文部份 75
    參考文獻: 中文部份：
    1.朱蕙君、黃國禎，「結合德懷術與凱利方格之醫療知識擷取與整合技術-以SARS疾病診斷為例」，2005年國際醫學資訊研討會，桃園。
    2.李昭河，「應用類神經網路探討人壽保險短期死亡風險之研究─以C人壽保險公司為例」，國立高雄第一科技大學風險管理與保險研究所碩士論文，2004年。
    3.周威良，「壽險業導入BPM之研究－以Ｍ人壽為例」，國立台灣科技大學資訊管理系碩士論文，2010年。
    4.曾小玲，「保險公司新契約流程改造之研究」，國立政治大學經營管理碩士學程資訊管理組碩士論文，2006年。
    5.曾元顯，「應用於資訊檢索的中文OCR錯誤詞彙自動更正」，中國圖書館學會會報第72期(2004)，頁23-31。
    6.張慶童，「壽險業IT導入BPM之研究－以個案公司系統再造為例」，國立政治大學經營管理碩士學程碩士論文，2006年。
    7.張寶源、熊雅意、沈應誠，「應用模糊理論建構眼科輔助診斷系統」，僑光技術學院和台中榮民總醫院之僑榮輔助計畫，計畫編號為OCIT-95-002和TCVGH-OCIT-958402。
    8.陳文欽、林建成、馬恆、鄭弘裕，「識別任意角度偏轉之手寫簽名」，中華大學科技管理研究所，第16屆國際資訊管理學術研討會，2005年5月。
    9.劉昆泯，「壽險醫務核保案例相關問題分析」，樹德科技大學金融保險研究所碩士論文，2005年。
    10.劉德笙，「中西醫診斷專家系統於冠狀動脈心臟病之應用」，中原大學醫學工程學系碩士論文，2003年。
    11.賴麒文，「作業策略導引保險網路服務下，進行企業流程再造之研究—以某壽險公司核保流程為例」，國立政治大學資訊管理學系碩士論文，2009年。
    12.謝明進，「企業營運作業流程管理導入之研究－以保險公司為例」，國立台灣大學資訊管理組碩士論文，2010年。
    13.龔盟鈞，「應用類神經網路建構壽險核保決策模式-以醫療日額補償金為例」，高雄第一科技大學風險管理與保險系碩士論文，2003年。
    網站部份：
    1.工業技術研究院，「通訊與光電(資訊與通訊/電子與光電)可移轉技術」，http://www.itri.org.tw/chi/tech-transfer/04.asp?RootNodeId=040&NodeId=041&id=2483。
    2.中國民國統計資訊網>關於主計處>主計故事109，取材：行政院主計處內部文案，第四局整理，2010.05，http://stud.stat.gov.tw/ct.asp?xItem=27246&ctNode=99。
    3.中國科學院自動化研究所，科普文章，「中文OCR技術的研究與應用」，2008.4.14. http://www.ia.ac.cn/kxcb/kpwz/200804/t20080414_2299214.html。
    4.徐玉梅，行政院國家科學委員會九十一年度科技行政研究發展報告，「研究文獻全文資料庫建置與檢索之規劃研究」，2003年，http://web1.nsc.gov.tw/public/Data/85718153271.pdf。
    5.李友專，「醫學診斷專家系統」，http://li.tmu.edu.tw/slide/Diag_Dec_Supp/mdss.htm,，Accessed: May 25, 1998。
    6.行政院主計處統計資訊網，主計故事，「光學字元辨識系統(OCR)應用在普查作業之由來」，2010.05，http://stud.stat.gov.tw/ct.asp?xItem=27246&ctNode=99。
    7.維基百科，自由的百科全書，專家系統，http://zh.wikipedia.org/zh-tw/%E4%B8%93%E5%AE%B6%E7%B3%BB%E7%BB%9F。
    8.Swiss Re,〝Magnum: Automated underwriting for a new decade〞，http://www.swissre.com/clients/client_tools/magnum_automated_underwriting.htm
    9.ABBYY，Success Story，〝Large Canadian Insurance Company Reduces Manual Data Entry time by 80% with 95% Accuracy〞，http://www.abbyy.com/Default.aspx?DN=c7123e6a-853a-43ff-90c5-a697b99f27f1
    英文部份：
    1.Cologne Life Reinsurance Co., 〝COMPASS-A Global Expert Underwriting System〞by RISK INSIGHTS For Life & Health Insurance Executives, Vol. 3, No. 2, May 1999。
    2.Yuen-Hsien Tseng，〝An Approach to Retrieval of OCR Degraded Text〞，台灣大學圖書館學刊第十三期，頁153~168。
    描述: 碩士
    國立政治大學
    經營管理碩士學程(EMBA)
    97932244
    99
    資料來源: http://thesis.lib.nccu.edu.tw/record/#G0097932244
    数据类型: thesis
    显示于类别:[經營管理碩士學程EMBA] 學位論文

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