Rules Manager

Business process and operational and product agility has become a competitive issue and key business differentiator for organizations in almost every industry worldwide. The global and real-time nature of business no longer allows institutions to be slow to respond to competitive or regulatory demands.

FINEOS solutions have been engineered to provide the business agility required for success in today’s marketplace.  FINEOS delivers powerful rules management capability, designed to enable flexibility and shorten change cycles by giving the business more control over their systems.   

Rules Manager removes the complex IT coding that powered yesterday’s legacy systems and replaces it with external business rules that can be modified and changed quickly and easily by business users.  Additionally, business rules and system rules are separated out, ensuring that system changes can be tightly controlled.

Rules Manager provides the capability to define business rules to implement automatic decision making, decision support advice for manual decision making, automation of calculations, implementation and other institutional-specific modifications of FINEOS solutions. Through a tight integration with Workflow Manager, Rules Manager supports auto-adjudication and straight-through processing. 

Business rules, which can be defined based on any information available to the system, can then be tested in a controlled environment without generating code which requires software development skills.

Rules can be of many types, including:

  • Fact or Look-up Rules e.g. the payment period begins 4 weeks after the incident; the premium rate depends on age and gender, etc.
  • Computation Rules e.g. the premium amount = coverage amount * premium rate
  • Inferred Knowledge Rules e.g. If payment type = regular Then payment frequency = monthly Else payment frequency = once off
  • Decision Making Rules e.g. If age > 65 and smoker Then decline application,
  • Guidance Rules e.g. If claim illness code is ‘pregnancy’ and age is >50 then send to claim specialist for review
  • Edits and Validation Rules e.g. If claim illness code is 'pregnancy' and gender = male then prompt for data review

 

Rules Manager works in conjunction with FINEOS workflow management to enable users to establish workflow based on business events. 

Rules Manager is built within the FINEOS Enterprise Platform, a customer and case centric, rules-driven, component-based product platform that delivers powerful core processing against an enterprise business model.