The document discusses a web-enabled claims management system called WCMS being developed by AMTPL to target the insurance market in Middle East and India. WCMS allows online claims processing and management. It has features like storing member details, policies, eligibility details, coverage details etc. on smart cards. AMTPL plans to outsource the system to insurance companies and providers to help them improve efficiency.

2. WEB ENABLED CLAIMS MANAGEMENT SYSTEM “… identifying and meeting human and social needs.” Philip Kotler

3. Today, Healthcare marketers are turning towards technology as a way to differentiate their products and services in an increasingly competitive market.”

4. EXECUTIVE SUMMARY We are pioneer in Claims Management System focused to capture the market with unique Web based Claims Management Software (WCMS). We plan to outsource business to Insurance Companies, benefit providers, Third Party Administrators, Hospital Management Organization – HMO / Managed Care Organization’s – MCO’s along with embedded Smart Card Technology in the Middle East and India.

5. The 7P’s Marketing

6. P’s of MARKETING Price Product Promotion Place Additional 3P’s Physical Evidence Process People

7. Marketing Planning Market Needs Wants Strengths of organization Weakness of organization Existing competitors Expected competitors Design for creating value

8. Strength Application and Operation divisions along with recently created online service network division. Flexible work force through contingent workers for projects. Loyal, hardworking and diverse workforce. In addition to good compensation have an opportunity to do well through bonus and with Int’l Travel and exposure all paid by the company. MNC operating through regional subsidiaries to reduce cultural differences. New product in a windows interface is an example of Smart Card Technologies. Moderate brisk product development process that allows for appropriate updating and release of products.

9. Contd… The software has numerous powerful features that are in use worldwide, thereby promoting standardization and competitive advantage through their ease of integration and cost effectiveness. WCMS is web-enabled which can be accessed online throughout the world. The major strength of it is the inter-linked Smart Card program with it. Which will also give clients of AMTPL better resource management through all the branches. Cost- effectiveness of the software makes it easy to work with and most admired. Largest software with strong repetition for innovative products.

10. Weakness Little or no significance presence in the Indian market has been disappointing. Products have a single application purpose and do not work well with other products, i.e., Linux. Downside of product launches and deadlines contributed. Dependency on Internet connectivity.

11. Opportunities Cheaper global WCMS costs open new market as people connect to the Internet. Mobile phone applications and exploitation of personal digital assistance represents growth industry so that strategic alliances could provide with Smart Card, Hand Held Devices and with opportunity in a market where it is currently little or no significant presence. Lacking of in availability of resources and shortfall of qualified manpower is compelling for the insurance companies to outsource their requirements either for software usage or claims processing. Insurance Companies by Saudi Arabian law are required to respond to an approval in 45 minutes and claims to be paid within max. 60 days to the benefit providers for which they need comprehensive online software. The demand for personal computers and global markets remains strong despite the growth and increasing popularity of personal handheld devices. The SMS alert services are being provided to the members, which is new to the industry thus enabling retention of the customers and professional customer service resulting in higher customer satisfaction.

12. Threats Waseel presently holds 23% market shares in terms of limited transferring of data between hospital and insurance companies. Companies moved into Internet space and defined it while anticipated its growth and popularity. Currency exchange rates effected demand. Rapid developments of software devices that will displace the demand in next three years. Technology life cycle is shorter and shorter

13. Marketing Mix – Price Strategy Consumer demand The product lifecycle Potential substitutes Consumer demand Driven by tastes and income Availability of products customer Pricing “ The higher the price, the higher the value.”

14. Marketing Mix – Price Strategy The product lifecycle: The newer the product the higher the price Profit margin; Recover development costs Gives a certain prestige to the product Potential substitutes: Competitors attracted by profit margin;only two “serious” competitors; unique for now; easy to imitate

15. Marketing Mix – Product Strategy Brand Personality: Pioneer in Claims Management System focused to capture the market with its unique Web based Claims Management Software Product Modification: ASPX .Net Pages and AJAX technology. Benefits of WCMS: Plans to outsource business to Insurance Companies, benefit providers, Third Party Administrators, Hospital Management Organization – HMO / Managed Care Organization’s – MCO’s along with embedded Smart Card Technology

16. Prone to product imitation: Rapid developments of software devices that will displace the demand in next five years. Learning product: Technology life cycle is shorter and shorter.

17. Marketing Mix – Promotion Strategy Objectives: To initiate strong awareness about WCMS throughout Generation Y consumers as well as their Clients. To win market shares over our top functional competitor, WaseelCo. Target Market: Generation Y only give partial attention to media and typically use more than one media at a time. Solution: Use a great variety of targeted promotional tools. Media selection: Outdoors Personal Selling Public relations Publicity

18. Marketing Mix – Place Strategy The present market is for about 10.5 Million lives. The market have 18 licensed Insurance companies. In Jeddah, Riyadh and Dammam, in addition other support Middle East, Dubai & Asia

19. CUSTOMER… CUSTOMER IS THE KING A customer is not dependent on us. We are dependent on him. A customer is not an interruption of our work, he is the purpose of it. We are not doing a favor by serving him. He is doing us a favor by giving an opportunity to do so. A customer is not some one to argue. No one has won an argument with a customer. A customer is a person who brings us his wants. It is our job to handle them profitably to him and to ourselves. CUSTOMER IS ALWAYS RIGHT

20. Product AMTPL will change the process of how Insurance Approvals, Claims and Customer services requirements are delivered and expectations of clients, hospitals and the regulators are met.

21. Aspects of Service Quality Service: it is what provided by organization to its Customers. Quality : it means “what customer wants” (a) within a given time (b) at a price (c) what he/she is willing to pay

22. CM – SG&A – Capital expenditures Profits 4.3% of revenue, based on past data Capital expenditures : Half of the O/H costs estimated, based on past data SG&A cost : Fixed Costs : Revenues - COGS C.M. Based on weighted average percentage in past data COGS Based on sales @ different channel’s price Revenues Projected Financial Performance

23. Quality The drivers of quality are: To Survive Customer is demanding Competition Profitability Strive for excellence

24. WCMS The system is designed keeping in consideration target of reducing human involvement to 5%, i.e., only to make intelligent decisions. All other decision automatically are taken by the system. Types of industries are defined in order to generate utilization pattern for the Underwriters It allows the user to enter discounts that are applicable on Medicines for outpatient, Inpatient and on day case basis It allows the user to directly import Consultation price list Service Price List, Supplies Price List and Package Price List

25. WCMS Multiple contracts dates can be applied Eligibility details, Premiums and Outside territory details, benefits, Deductibles, Class territory, providers and doctor, room and board and coverage details for Dental, Optical & Maternity System is designed using ASPX .Net Pages and AJAX technology.

26. WCMS The charge on every transaction Insurance companies and hospitals are not willing to use the portal. AMTPL doesn’t charge the hospitals at all. AMTPL charges only the Insurance company and that also not on each transaction but on each member insured a flat amount, which is very attractive for both the Insurance companies and the hospitals to use our WCMS. AMTPL also personalizes WCMS so it enables building of a brand for the Insurance companies in the market of being a leader and innovator

27. WCMS WCMS is highly secured by SSL Certification with 128bit encryption by that and at the user level. Our SMS model immediately notifies the member whenever their approval has been processed along with the approval details

28. Principles of Quality Focus on Customer Do it Right Communicate & Educate Measure & Record Do it together

29. Customer satisfaction with service quality can be measured by comparing the perceptions of service received, with service expected. Service Expected – Service Received = Customer Satisfaction When, S.R > S.E = Service is of excellent quality S.R = S.E = Service is satisfactory S.R < S.E = Service is unsatisfactory

30. Quality is an attitude….. Attitude is based on values and belief about people, life and work, that leads a person to willingly serve others and take pride in his or her work. what differentiates between excellence and mediocrity. Positive attitude leads to high quality and vice-versa.

31. Product Quality Experience Personal Needs Past Needs Expected Service Perceived Service Reliability Assurance Empathy Responsiveness Tangible Quality Dimension Perceived Service Quality E.S >P.S ( Surprise ) E.S = P.S ( Satisfactory ) E.S<P.S (Poor Quality)

32. AMTPL refers to the ability to perform the promised service independently and accurately without errors for Client Willingness to help customized work to provide prompt service, without keeping the client waiting for approvals. Competence to perform the service asked by the customer, with politeness and respect for the Client with effective communication Approachability, sense of security and efforts to understand Client needs for their customers Complete attention given to the Client

33. Market Research No MR is done MR is done but not made use of Concentrating on Day to Day Operations In MR Data regarding customer expectations collected Data regarding customer perceptions collected Complaint made by customer neglected thought off. Even if findings are available Research are very complex Research is too technical

34. The present market is for about 10.5 Million lives. The market have 18 licensed Insurance companies. Assumed Average Premium Per Person Per year as per CCHI coverage is SR.800 x 10.5 Million = SR 8.40 Billion. NCCI is at No. 1 position in the market followed by Medgulf, BUPA & ACIG. ACIG share 168,000 =SR. 134 Million (almost 1.6%). ACIG have to grow, make profits and increase its market share from 1.6% to at least 2.5% for the year 2008 = 262,500 lives = SR.210 Million premiums and generate profits.

35. Goal Will be the first Insurance company in the Middle East and Asia to introduce SMARTCARD Technology. It works both as a plastic card and a card that can store all the required information, information can be read using card readers:- Member details. Policy details. General & Eligibility details. Coverage Details. Coverage sub-details such as: Dental, Optical & Maternity. All update information can be stored in the card till the last claims, which is automatically updated from the server every time the member uses the card. Can store information for upto 10 years. Allows read and write cycle for upto 100,000 times. Fully secure and safe, can’t be tampered or copied like the plastic card & other cards. Will allow ACIG to establish its Brand and be recognized as a leader and innovator in the Saudi Market.

36. Goal YOU as a client is doing all the remaining work, this means, to process the claims, except data entry, all claims review, claims adjudication, claims notification, claims rejection, claims deductions etc.. You will need to hire staff. To service a portfolio of 250,000 members, you will need atleast 150 staff, at an average salary of SR.4,500 Per month = 8.1 Million yearly. Cost of Iqama yearly = SR.150,000. Yearly ESB = SR.337,500. Investment in computers = SR.300,000. Office Space yearly = SR.500,000. Cost of software purchase = SR.1 Million (minimum) – SR.12,681,250 Cost of software maintenance and modification – SR.150,000. Cost of telephones, fax etc. yearly SR.200,000. Yearly vacation Emp. Wife & 2 kids= Medical Insurance for Emp. Wife & 2 kids= 5,000 x 150 Plus savings on the volume discounts from the hospitals Additional 15 – 20% minimum savings are guaranteed.

37. CM – SG&A – Capital expenditures Profits 4.3% of revenue, based on past data Capital expenditures : Half of the O/H costs estimated, based on past data SG&A cost : Fixed Costs : Revenues - COGS C.M. Based on weighted average percentage in past data COGS Based on sales @ different channel’s price Revenues Projected Financial Performance

38. Implementation Plan Pre-launch preparation: Focus on organising resources to implement. Stage: should we continue product implementation ? Launch: Date……is freshly on the shelves ! Advertising campaign through promotion schedule. Post-launch (monitor and control): Assess feedback from sales revenue, and customers. Maintain positive dynamic by training managers & staff, and by upgrading the web site.

39. Challenges Ahead Designing quality into service Service blue-printing Hard but worthwhile work Making technology as a servant Combining high tech with high touch Use technology to support the service strategy Focus technology on the customer Attacking the labor shortfall Mismatch Need for innovative approaches Raising our service aspirations