Insurance Industry Knowledge Document

1. Industry Overview

Market Landscape

• Global insurance market: $7+ trillion in premiums
• Key segments: Life, Property & Casualty (P&C), Health Insurance, Reinsurance
• Major players: Traditional insurers (Allianz, AXA), InsurTechs (Lemonade, Root)
• Rise of digital insurance and embedded insurance models
• Platform-based insurance and Insurance-as-a-Service trends

Regulatory Environment

• Solvency II requirements for capital adequacy
• Regional regulations (NAIC in US, IDD in EU)
• Data protection requirements (GDPR, HIPAA)
• Consumer protection and market conduct regulations
• Risk-based capital requirements

Industry Challenges

• Digital transformation pressure
• InsurTech disruption
• Climate change risk
• Legacy system modernization
• Changing customer expectations
• New risk landscapes

2. Business Architecture

Value Chain

Primary Activities:

• Product Development & Actuarial
• Distribution & Sales
• Underwriting & Risk Assessment
• Policy Administration
• Claims Management
• Reinsurance Management

Support Activities:

• Investment Management
• Actuarial Services
• Technology Infrastructure
• Risk & Compliance
• Asset-Liability Management

Business Capabilities

L1 Capabilities:

1. Product Management

   • Design & Development
   • Pricing & Actuarial
   • Portfolio Management

2. Distribution Management

   • Agency Management
   • Broker Relations
   • Direct Channel
   • Bancassurance

3. Operations Management

   • Underwriting
   • Policy Administration
   • Claims Processing
   • Reinsurance

4. Risk & Compliance

   • Underwriting Risk
   • Investment Risk
   • Operational Risk
   • Regulatory Compliance

Operating Model

Typical Structures:

• Line of Business-based (Life, P&C, Health)
• Geography-based
• Distribution channel-based
• Customer segment-based
• Matrix combinations

3. Technology Landscape

Core Systems

1. Core Insurance Systems

   • Policy Administration
   • Claims Management
   • Billing & Collection

2. Distribution Systems

   • Agency Management
   • Broker Portals
   • Digital Sales Platform
   • CRM Systems

3. Common Platforms

   • Core Insurance: Guidewire, Duck Creek
   • CRM: Salesforce Insurance Cloud
   • Claims: Snapsheet, Mitchell
   • Analytics: SAS, RMS

Technology Trends

• Cloud adoption (Private/Hybrid)
• AI/ML for underwriting
• IoT and telematics
• Blockchain for claims
• API-first architecture
• Low-code/no-code platforms

IT Operating Model

Structure:

• Business-aligned IT teams
• Digital platform teams
• Data & Analytics
• Security & Compliance
• Innovation Labs

4. Value Streams & Processes

Core Value Streams

1. New Business

   • Lead generation
   • Quote & Bind
   • Risk assessment
   • Policy issuance

2. Claims Operations

   • First Notice of Loss
   • Assessment
   • Investigation
   • Settlement
   • Recovery

3. Policy Administration

   • Renewals
   • Endorsements
   • Cancellations
   • Premium collection

Support Value Streams

1. Actuarial Services

   • Product pricing
   • Reserve calculation
   • Experience analysis
   • Risk modeling

2. Risk Management

   • Portfolio analysis
   • Exposure management
   • Capital modeling
   • Reinsurance optimization

5. Agile Transformation Context

Transformation Drivers

• Speed to market
• Customer experience
• InsurTech competition
• Cost optimization
• Risk agility
• Legacy modernization

Common Patterns

1. Transformation Approach

   • Digital-first initiatives
   • Product-oriented teams
   • Customer journey focus
   • DevSecOps adoption

2. Organization Structure

   • Product-aligned teams
   • Feature teams
   • Platform teams
   • Centers of Excellence

6. Change Management Considerations

Cultural Aspects

• Risk-averse mindset
• Traditional distribution relationships
• Actuarial-driven decisions
• Technology resistance
• Siloed operations

Stakeholder Management

Key Groups:

1. Internal

   • Board/Executive Leadership
   • Business Unit Leaders
   • Distribution Partners
   • Operations Teams
   • Actuarial Teams

2. External

   • Regulators
   • Customers
   • Agents/Brokers
   • Reinsurers

7. Reference Information

Industry Standards

• ACORD (Insurance Industry Standards)
• ISO Insurance Standards
• NAIC Model Laws
• IFRS 17/9

Key Frameworks

• TOGAF for Insurance
• ITIL in Insurance
• Insurance Data Models
• Risk Management (COSO, Solvency II)

Metrics & KPIs

1. Business

   • Combined Ratio
   • Loss Ratio
   • Expense Ratio
   • Premium Growth

2. Operations

   • Quote-to-Bind Ratio
   • Claims Settlement Time
   • First Call Resolution
   • Renewal Rate

3. Digital

   • Digital Sales %
   • Self-Service Usage
   • Straight-Through Processing
   • Digital Claims %