A. Data Storage, Security, and Management: 1. Centralized Data Storage: Collect and store comprehensive insurance-related data, including claims, premiums, actuarial reports, and policy details, in a structured and accessible manner. 2. Enhanced Risk Analysis: Utilize historical data to identify trends, predict risks, and refine underwriting processes for better coverage decisions. 3. Improved Claims Management: Track claim histories, detect patterns in fraudulent activities, and optimize claim processing efficiency. 4. Regulatory Compliance & Reporting: Ensure accurate and timely reporting for regulatory requirements, audits, and stakeholder transparency. 5. Cost Control & Financial Insights: Monitor expenses, forecast liabilities, and assess funding adequacy to maintain financial stability. 6. Integration with Other Systems: Enable seamless data flow with plan administrator, consultants, HR, and other enterprise systems to support cross-functional decision-making. 7. Data Security & Privacy: Safeguard sensitive information through robust access controls and encryption to comply with legal and ethical standards. Users will have NO access to HIPAA protected information, all data will be de-identified and inaccessible to users. B. Continuous Improvement, Auditing, & Optimization 1. AI & Machine Learning Integration: Incorporate predictive analytics for more advanced risk forecasting and claims cost optimization. Drill down capabilities that maintain privacy to the individual. 2. Data Warehouse Scalability: Plan for future growth by ensuring the system can handle increasing data volumes and complexity. 3. County’s ability to own all claims data. 4. Automated Auditing Tools: Build tools that continuously monitor data quality, compliance, and reporting accuracy. C. User Experience & Stakeholder Engagement 1. Customization for Different Users: Develop role-specific dashboards for finance, risk management, and actuaries. 2. Mobile Access & Remote Capabilities: Ensure stakeholders can securely access reports and insights from anywhere. 3. Collaboration Features: Implement data-sharing protocols and reporting templates for interdepartmental coordination. D. Governance & Compliance Enhancements 1. Data Lifecycle Management: Define retention policies and archival strategies to ensure efficient historical tracking. 2. Advanced Security Protocols: Implement multi-factor authentication, real-time threat detection, and compliance tracking to prevent breaches. 3. Legal & Ethical Considerations: Ensure alignment with regulations beyond standard insurance laws, such as data privacy mandates.
