Business Requirement Document
Corporate (Group) Health
Insurance Underwriting
Business Requirement Document_______________________________________1
1. Module Overview____________________________________________________________________1
2. Use Case Details_____________________________________________________________________1
Use Case ID:_______________________________________________________________________1
Screen / UI Requirements:________________________________________________________1
Business Rules_____________________________________________________________________2
Assumptions, Dependencies & Open Points_____________________________________2
Notes for Learners:________________________________________________________________2
Business Requirement Document
1. Module Overview
Module Name: Under Writing and Decision Workflow.
Purpose: The main purpose of the underwriting is to manually
assess the proposals after automated filtration and provide
underwriting decision for the audit trail in which they will
provide the final decision whether to approve or reject the
proposal. This process will be recorded in real-time to have
transparency.
Scope: Maintains transparency across proposal assessment
and audit steps.
High-Level Objectives:
2. Use Case Details
Use Case ID: M4-01
Use Case Name: Generating Under Writing Decision
Actors: Employee.
Description: In this the employee will manually assess the
proposal to make sure the proposal matches all the eligible
criteria based on the rules applied from module 3.
Preconditions: The status of the proposal must be under
review and should contain the eligible status.
Post conditions / Expected Outcome: If approved update the
status as Approved or if rejected it will update the status as
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Business Requirement Document
Rejected else it will be referred by the employee in the
underwriting status.
Screen / UI Requirements:
Screen Name: Under Writing Dashboard
Purpose / Description: This page contains all the proposals
which are under review and contains eligible status along with
basic details of the proposals.
Fields / Elements:
Field Type Mandator Validation Comments
Name y
Proposals Drop Down Status of the The proposal
proposal is should
Box under review contain
and eligible proposal id,
status should company id,
not be null. status of
proposal, risk
status and
eligible
status.
View Button Yes It should
navigate to
proposal
details page.
Business Rules
Under Writing Dashboard contains basic details of proposals
such as proposal id, company id, risk status, status of the
proposal and eligibility status.
These basic details will be fetched from database.
When the view is pressed it will navigate to proposal details
page.
Assumptions, Dependencies & Open Points
Assumptions:
Dependencies: Proposals from the database.
Open Points / Questions:
Screen / UI Requirements:
Screen Name: Proposal Details Page
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Business Requirement Document
Purpose / Description: In this page the proposals will be
checked based on the basic proposal eligibility rules from
previous modules for a simple manual verification and send
the under writing decision to risk evaluation and audit trail.
Fields / Elements:
Field Type Mandator Validation Comments
Name y
Validation Read-only Yes It should be This document
& Review pdf present at top of is used to
Document document the page. verify the
eligible criteria
of the proposal
to provide the
under writing
decision and it
is based on
module 2 and
module 3
rules.
Proposal ID Read-only Yes Should not be
Text null
Company Read-only Yes Should not be
ID Text null
Company Read-only Yes Should not be
Name Text null
Industry Read-only Yes Should not be
Type Text null
Premium Read-only Yes Should not be
Generated Text null
based on
module 3
Risk Status Read-only Yes Should not be
Text null
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Business Requirement Document
Company Read-only Yes Should not be
Size Text null
Age Bands Read-only Yes Should not be
Text null
Dependent Read-only Yes Should not be
s Text null
Eligible Read-only Yes Should not be
Status Text null
Under Text Field Yes Should be filled It should
writing based on contain the
Review verifying the reason why
proposal details this proposal
and eligibility can be
approve or
refer or reject.
Under Selection Yes Only one option Approve or
writing Box should be Refer or Reject
decision selected out of
three.
Submit Button Yes It should When it is
automatically submitted it
close the will not be in
proposal details the current
page or table so it
navigate back to won’t be
under writing checked in a
dashboard. loop.
Business Rules
The page should contain proposal id, company id, company
name, industry type, premium generated, risk status, age
bands, dependents, eligible status under writing review and
under writing decision.
The under writing decision should be selected based on the
manual assessment of the proposal by document provided and
matching the proposal details.
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Business Requirement Document
The under writing review should be filled on why this decision
is taken for this proposal for future verification.
The submit button should close this page automatically or
navigate back to under writing dashboard and update all the
proposals.
Assumptions, Dependencies & Open Points
Assumptions:
Dependencies: It depends on the rules, document and data
provided by all the modules.
Open Points / Questions:
Use Case ID: M4-02
Use Case Name: Manual Risk Review
Actors: Employee, Company Agent (If negotiation takes place).
Description: The manual risk evaluation only the refer under
writing proposals will be shown and it will be further processed
manually by assessing the risk of the proposals by loss ratio,
premium adjustments and negotiations and these data will
store in real-time for transparency.
Preconditions: The status of the under writing must be refer.
Post conditions / Expected Outcome: Provides the remarks of
the proposal and send it for audit review.
Screen / UI Requirements:
Screen Name: Refer Proposals Dashboard
Purpose / Description: The refer proposal has only refer under
writing data which can be viewed and processed manually.
Fields / Elements:
Field Type Mandator Validation Commen
Name y ts
Proposals Drop Down Status of the The
under writing proposal
Box decision is should
refer. contain
proposal
id,
company
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Business Requirement Document
id, status
of
proposal,
risk
status
and refer
in under
writing.
View Button Yes It should
navigate to
evaluation
page.
Business Rules
Under Writing Dashboard contains basic details of proposals
such as proposal id, company id, risk status, status of the
proposal and refer in under writing.
These basic details will be fetched from database.
When the view is pressed it will navigate to evaluation page.
Assumptions, Dependencies & Open Points
Assumptions:
Dependencies: Proposals must be refer in under writing
decision.
Open Points / Questions:
Screen / UI Requirements:
Screen Name: Evaluation
Purpose / Description: In this page the employee can view the
full details of the proposal like proposal id, company id,
company name, claim history ratio, premium offered, premium
requested (if any),risk status and loss ratio along with other
data from database for risk evaluation.
Fields / Elements:
Field Type Mandator Validation Comments
Name y
Validation Read-only Yes It should be This
& Review pdf present at top document is
Document document of the page. used to verify
pg. 6
Business Requirement Document
the eligible
criteria of the
proposal to
provide the
under writing
decision and
it is based on
module 2 and
module 3
rules.
Proposal ID Read-only Yes Should not be
Text null
Company Read-only Yes Should not be
ID Text null
Company Read-only Yes Should not be
Name Text null
Industry Read-only Yes Should not be
Type Text null
Premium Read-only Yes Should not be
Generated Text null
based on
module 3
Risk Status Read-only Yes Should not be
Text null
Company Read-only Yes Should not be
Size Text null
Age Bands Read-only Yes Should not be
Text null
Dependent Read-only Yes Should not be
s Text null
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Business Requirement Document
Eligible Read-only Yes Should not be
Status Text null
Under Read-only Yes Should not be
writing Text null
Review
Under Read-only Yes Should not be
writing Text null
decision
Premium Read-only Yes Should not be
Requested Text null
Loss Ratio Read-only Yes Should not be
Text null
Claim Read-only Yes Should not be
History Text null
Total Read-only Yes Should not be
amount Text null
claimed
Negotiatio Text-box Yes (if It should only It should be
n (integer premium accept in decided
type) requested) integer manually by
format. what we can
offer and
what they
asked for.
Negotiatio Check box Yes (When Once It store in
n type premium is submitted it which way
decided) will store the the
data in real- negotiation
time took place or
finalized.
Negotiatio Text Field Yes (When Should not be They should
n review negotiation null mention what
occurs) is the final
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Business Requirement Document
negotiation
result.
Evaluation Text field Yes Should not be Final
review null evaluation
remarks of
the proposal
for audit
review.
Evaluation Read-only Yes It will show
Report Data the final
over view report of the
risk
evaluation
before
submitting.
Submit Button Yes It should
automatically
close the
evaluation
page or
navigate back
to refer
proposals
dashboard.
Business Rules
In this the employee will check the claim history, loss ratio,
risk status, premium offered and premium requested (if any).
The premiums will be adjusted by negotiations manually and
stores the actions in real-time like verified using call or In-
person or mail. [Note: They can negotiate multiple times and it
is recorded each time based on action.]
The evaluation review should be filled based on the details of
the proposal.
The submit button will send the evaluation report to the audit
review.
Assumptions, Dependencies & Open Points
Assumptions:
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Business Requirement Document
Dependencies: Proposal data fetched from database.
Open Points / Questions:
Use Case ID: M4-03
Use Case Name: Audit Review
Actors: Audit.
Description: In this page the audit will review the proposals
based on the under writing decision, evaluation review and
negotiation reports to provide the final under writing review of
the proposal.
Preconditions: Proposals must be evaluated in manual risk
evaluation.
Post conditions / Expected Outcome: Updates the status of the
proposal and stores in the database.
Screen / UI Requirements:
Screen Name: Audit Dashboard
Purpose / Description: In this page it contains the proposals
which are evaluated in manual risk evaluation.
Fields / Elements:
Field Type Mandator Validation Commen
Name y ts
Proposals Drop Down Status of the The
under writing proposal
Box decision is should
approve or contain
refer or reject proposal
and evaluated id,
review in company
manual risk id, status
evaluation. of
proposal,
risk
status
and
evaluated
review in
manual
risk
pg. 10
Business Requirement Document
evaluatio
n.
View Button Yes It should
navigate to
audit review
page.
Business Rules
The proposal should contain proposal id, company id, risk status and it
should be evaluated.
When view is pressed it should navigate to audit decision page.
Assumptions, Dependencies & Open Points
Assumptions:
Dependencies: Proposals must have evaluated review.
Open Points / Questions:
Screen / UI Requirements:
Screen Name: Audit Review
Purpose / Description: In this page the audit will decide the
status of the proposal based on the under writing decision,
evaluation review and negotiation details. This will be stored
in real-time.
Fields / Elements:
Field Type Mandator Validation Commen
Name y ts
Validation Read-only Yes It should be This
& Review pdf present at top document
Document document of the page. is used to
verify the
eligible
criteria of
the
proposal
to provide
the under
writing
decision
pg. 11
Business Requirement Document
and it is
based on
module 2
and
module 3
rules.
Proposal ID Read-only Yes Should not be
Text null
Company Read-only Yes Should not be
ID Text null
Company Read-only Yes Should not be
Name Text null
Industry Read-only Yes Should not be
Type Text null
Premium Read-only Yes Should not be
Generated Text null
based on
module 3
Risk Status Read-only Yes Should not be
Text null
Company Read-only Yes Should not be
Size Text null
Age Bands Read-only Yes Should not be
Text null
Dependent Read-only Yes Should not be
s Text null
Eligible Read-only Yes Should not be
Status Text null
Under Read-only Yes Should not be
writing Text null
pg. 12
Business Requirement Document
Review
Under Read-only Yes Should not be
writing Text null
decision
Premium Read-only Yes Should not be
Requested Text null
Loss Ratio Read-only Yes Should not be
Text null
Claim Read-only Yes Should not be
History Text null
Total Read-only Yes Should not be
amount Text null
claimed
Negotiatio Read-only Yes Should not be
n Text null
Negotiatio Read-only Yes Should not be
n type Text null
Negotiatio Read-only Yes Should not be
n review Text null
Evaluation Read-only Yes Should not be
review Text null
Audit Text Field Yes Should not be They
review null should be
filled
based on
rules,
under
writing
review
evaluatio
n review
and
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Business Requirement Document
negotiatio
n review.
Audit Selection Yes Only one Approve
Decision Box decision can or Reject
be selected.
Submit Button Yes It should
automatically
close the audit
review page or
navigate back
to audit
dashboard.
Business Rules
The proposal must contain proposal id, company id, company
name, risk status, negotiation review, evaluation review,
premium offered and premium requested along with other
details.
The decision will be based on under writing decision,
evaluation review and negotiation report.
The final decision will be update the status of the proposal to
(Approved / Rejected).
This will decision will be stored in real-time.
Assumptions, Dependencies & Open Points
Assumptions:
Dependencies: It depends on under writing decision,
evaluation report and negotiation report.
Open Points / Questions:
pg. 14