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eOxegen - Software Technology & Insurance Insights

The Impact Of Core System Modernization On Policyholder Experience

20 Feb, 2024

In the ever-evolving landscape of the insurance industry, staying ahead of the curve is imperative for companies aiming to provide unparalleled service to their policyholders. One significant stride in achieving this goal is through the modernization of core systems. This transformative process doesn't just streamline internal operations for the insurance company; it has a profound impact on the policyholder experience.

Claim Adjudication

A claim is an application for payment made to a health insurance company by a member or healthcare provider for products and services that the insurer may cover. Healthcare facilities utilize these records to submit payment requests to insurance companies. The claims adjudication process checks the information and takes the member's benefits into account before deciding whether or not the insurer will pay the claim.

This is the typical workflow for claims adjudication:

  1. A brief information check is performed on the claim once it has been input into the system to ensure that it is correct, free of mistakes or omissions, and does not contain duplicate information on the patient.
  2. The claim then moves on to a comprehensive information check, which looks up diagnostic and treatment codes and checks the patient's ID and date of birth with the insurer's records.
  3. The claim is ultimately decided upon; it may be accepted (in whole or in part), postponed, or denied.

Understanding Core System Modernization

Core system modernization refers to the strategic overhaul of an insurance company's foundational systems, including policy administration, claims processing, and underwriting. The transition from legacy systems to modern, agile platforms is not merely a technological upgrade; it represents a shift in the entire operational paradigm, influencing how insurance services are delivered and experienced by policyholders.

Enhancing Policyholder Experience

Efficiency in Claims Processing

One of the most significant impacts of core system modernization is the improvement in claims processing. Swift and accurate claim adjudication is paramount for policyholders during stressful times. Modernized systems enable seamless communication and data sharing, expediting the entire claims process. This efficiency contributes to a positive policyholder experience by reducing waiting times and ensuring timely financial support when it's needed the most.

Prompt Issuance of Policies

The modernization of core systems empowers insurance companies to issue policies promptly and with increased accuracy. Automated processes, real-time data analytics, and streamlined workflows mean that policyholders can obtain coverage faster than ever before. This not only enhances the overall customer experience but also positions the insurance company as responsive and customer-centric.

Improved Customer Service

Modernized core systems enable insurance companies to provide more personalized and responsive customer service. Access to real-time data allows customer service representatives to address inquiries promptly, provide accurate information, and offer tailored solutions. This contributes to higher customer satisfaction and fosters a positive relationship between the insurance company and its policyholders.

Transparency and Communication

Communication is key in the insurance industry, especially when it comes to policyholders understanding their coverage, premiums, and claims status. Modernized systems facilitate transparent communication, allowing policyholders to access information easily through online portals or mobile apps. Clear and consistent communication builds trust and enhances the overall perception of the insurance company.

Beyond Claims

Core system modernization can also improve policyholder experience in other areas like policy issuance, account management, and customer service interactions. Modern systems facilitate quicker quotes, easier policy changes, and more efficient communication, leading to a better overall experience.

Benefits for the Insurance Company

Cost-Effective Operations

The modernization of core systems translates to cost-effective operations for the insurance company. Automated processes reduce the need for manual intervention, minimizing errors and operational costs. The efficiency gained allows the company to allocate resources more strategically, contributing to a healthier bottom line.

Increased Profitability

The prompt issuance of policies, efficient claims processing, and improved customer satisfaction collectively contribute to increased profitability. Satisfied policyholders are more likely to renew their policies and recommend the company to others, fostering a positive cycle of growth and profitability.

Agility and Adaptability

Modernized core systems make insurance companies more agile and adaptable to changes in the market. The ability to respond quickly to evolving customer needs and industry trends ensures that the company remains competitive and relevant.


The impact of core system modernization on policyholder experience is transformative. By investing in advanced technology and streamlined processes, insurance companies not only elevate the level of service provided to their customers but also position themselves for sustained growth and success in a dynamic industry. The ripple effect of a positive policyholder experience extends beyond individual transactions; it contributes to the long-term success and reputation of the insurance company in the marketplace.