The Alborada Insurance System is a full policy administration system designed to support the operation of Insurance companies that operate Property & Casualty, Life and Health products. Alborada is fully integrated offering full automation for key areas of the Insurance operation, such as accounting, agent administration, billing, claims, policy administration, reinsurance and treasury. Alborada is divided into several modules, which were designed to be configured by the end-users, thus all business rules and company policies are implemented as system controls and/or edits. The following table lists the Alborada modules, depicts sample functionality, and provides an example of business rules/functions/policy that may be automated.

Quotations; Alborada allows for manual or electronic input of quotes. Manual entry is performed via on-line user data entry onto system screens. Electronic input is done via interfaces or upload of diskettes. Quotes need to comply with pre-defined rating and underwriting criteria before they become policies. Quotes may be put in hold, and may be resumed later (unless the quote expires). Quotes may be rejected automatically by the system, requiring a senior underwriter to review or approve the quote (user configures roles and security).

Policies; Alborada allows for on-line update of policy records as quotes are converted into policies. When converting a quote, additional information may be needed to complete the process (not needed at quotation time). Billing and accounting records are created on-line, thus payments, claims or general ledger posting may be processed against the policy record instantly. Alborada supports individual, and master policies with individual certificates.

Endorsements; Alborada allows for modifications to the policy via endorsements, thus all transactions over the life of the policy are kept in the database. Endorsements include positive and negative premium endorsements, as well as no premium endorsements. The most notorious ones are cancellation, reinstatement, add/change/delete items, add/change/delete coverage, and policy renewal. Reason codes and different cancellation methods are available. Alborada provides for on-line query of all transactions as well as policy status at a given date.

Tracking; Quotes and policies may be tracked by Line of business, product, agent, client, account executive, point-of-sale (office, branch, etc.) Tracking is performed via custom table driven query/report screens.

Processing; Alborada provides for the following processing of external interfaces:

1. Credit Card / Direct Debit billing for all Insurance products
2. Generic interface file for Telemarketing operations
3. Excel Spreadsheets for mass marketing and group life products

Printing; Alborada provides for prints and re-prints of all policy documents including the declarations page, bill or invoice, and additional comments or policy clauses. Alborada uses third party form designer/merge applications to process on-line and batch print jobs.

Renewals; Alborada handles policy renewals via endorsements, thus current rates and/or any modifications in coverage, payment form, etc. are entered manually. The renewal bill and notice or letter are generated when issuing the endorsement.

Rating; Alborada provides for flat rate for most of its products, however there are custom rates for automobile and life products that include several factors such as sex, age, occupation, habits, loan term/balance, in the rate tables.

Billing Plans; Alborada allows for custom set-up of various billing plans that include number of payments, frequency, applicable interest rate and percentage for down payment. Billing plans do not include taxes or payment forms as these are configured independently.

Bill Types; Alborada handles bill types at the policy and certificate levels. A policy with multiple items may have only one bill if it is entered as an individual policy. A master policy may have as many bills as certificates are issued against it.

Billing processing; Alborada allows the user to apply bills individually (query by policy number, bill number or client identification) or in groups via the treasury module. Under and/or over payments may be applied against a policy bill, against a specifi tolerance amoutn that is defined by the end-user. Also, there are automatic billing applications via credit card interface processing. Alborada may be set to automatically cancel policies with non-paid bills via an automated process.

Payment Types; Alborada accepts both net or gross payments.

Payment Forms; Alborada allows for the definition of any payment form such as cash, check, credit card, direct debit, or credit notes that are generated as the result of cancellations with return premiums.

Billing Reports; Alborada provides for several billing reports such as the outstanding aged billing, paid, due, and past-due billing reports (bills, credit notes and debit notes). In all of these reports the breakdown can be done up to the agent/broker level. All of these reports are available on-line through a query function, thus becoming querys and reports at the same time (holds true for all Alborada reports). In most reports the ad-hoc query capability is available, as well as exporting the file to a spreadsheet.

Billing Forms; Alborada uses third party products (Jetform, Adobe) for form design, merge and printing. Alborada sends the appropriate information for every form, including control characters to set number of copies, print order, etc.; thus leaving end-users greater flexibility for form design (images, colors, barcodes, etc.), printing scheme (centralised, decentralised, or mixed), and job segregation and scheduling (print server controls all print jobs outside of Alborada).

Claim Controls; Alborada’s control environment allows end-users to specify the adjustor or supervisor limits for a wide variety of transactions including reserve movements and payments. These limits may be set by line of business, currency, and transaction type.

Claim Set-up; Alborada verifies automatically if policy coverage falls within claim accident date, if the policy is active, and if the policy doesn’t have outstanding billing before proceeding with an open claim. Alborada, also checks for previous claims on that policy . Depending on company policies, the claim may be opened against an unpaid policy or an unbooked policy (manual certificates tht have not been entered onto the system).

Claim Details; Alborada allows for detailed information about the claim to be registered into the system. This information includes claimant, third parties, claim location, claim description, adjustor’s follow-up notes, claim comments and claim services (ambulance, doctor, police, etc.).

Claim Reserves; Reserves may only be set against active coverages for the claim date. Alborada verifies fixed and aggregate limits of sum insured against claim loss on a coverage basis. Indemnity reserves and expense reserves are separated, to allow for true loss and loss expense statistics. All claim reserve movements are kept on the database, as well as the outstanding reserve balance for every coverage. Reserve movements are entered mannualy, unless specified otherwise by a custom process. The R/I distribution is performed automatically at the coverage level for every claim transaction.

Claim Documentation; Alborada allows end-users to manage administrative paperwork related to a claim (external or internal), thus incorporating claim workflows into the system. A checklist of required documents can be set against a product or coverage, thus when attempting to pay a claim the system verifies that the documents were actually received (death certificate, unemployment certificate, etc.). These documents and claim images may be kept on an electronic claims file in Alborada.

Claim Payments; Payment orders may be set from the claims modules, but checks are issued in the treasury module. Payments may be cancelled or reversed from the claims module. When setting payments, offsets may be done against deductibles, outstanding premium, and vendor’s debit notes. Payments are drawn against olicy limits, unless specified otherwise via a custom procedure . Additional controls are built-in for payments requiring users to set authorization levels. The R/I distribution is performed automatically at the coverage level for every claim payment.

Claim Salvage & Subrogation; Alborada provides for effective controls over claim losses via the salvage & recovery functions. Salvage or recovered item (via subrogation) values may be recorded and offset against the claim loss. Detail information regarding sales procedures is also available.

Claim litigation; Alborada allows end-users to record specific information regarding claims that undergo a litigation process , thus providing additional control of such claims to both the legal and claims departments.

Commissions Scheme; Alborada’s commissions may only be set at the line of business, product and coverage levels. The commissions are set by agent, thus different agents may have different commissions for the same products/coverages.

Commissions Hierachy; Only two levels of commissions may be set at the agent and sub-agent levels. The Agent receives a percentage of the defined commissions for the sub-agent, when this relationship is defined in the agent table. Also, any processing fee can be set-up at this level to pay commissions net of the fees. At the policy level, more than one agent may be included in the policy spliting the commission on a set percentage.

Commissions Processing; All alborada commissions are registered against paid premium, thus only the corresponding commission percentage of paid net premium is registered to be processed. The commissions process may be run for an individual agent or for all of them. The results may be viewed on-line, before committing payment of those commissions.

Commissions Adjustments; Alborada allows for manual transactions, they need to be pre-defined, to be credited/debited to the agent as these occur outside of the system (loans, bonuses, etc.). Once these transactions are entered, they are processed during commissions processing.

Commissions Payments; Payments to agents are set in the agent’s table allowing for multiple payment options such as cash, check, money order, transfers, etc.

Commissions Statements; Alborada produces an on-line commission statement on an individual agent basis. All commissions processing records are kept on-line, thus it is possible to view any statement, and inquire against any historical transaction. The commissions statements may be printed or exported to a spreadsheet. Tax requirements for statements are set in the agent table, thus allowing different agents to have different tax and retention schemes.