Health Insurance: Group and Individual

Health insurance is complicated. Products filed must match the plans that are sold while matching the claims that are serviced. Add in complying with regulations and mandates and cutting costs while responding to increasing customer needs.

Capitalize on emerging market opportunities with streamlined workflows, engaging consumer experiences, and enhanced visibility into your data.  FJA’s flexible, tailored solutions can speed up and simplify your processes so you can capture customer loyalty, ensure operational efficiency and increase profitability.

Profitably Build

Build customized solutions and launch insurance products quickly to keep pace with the market.

Product Machine allows health carriers to launch new insurance products quickly, reduce development timelines, minimize overhead, and build customized solutions to meet market requirements and strategic goals. 

Product Machine includes:

Product Modeler allows health insurers to model products based on compliance approved options. It’s the single source of truth for product rules and structure to accommodate new product features, benefits, riders and statutory mandates.


  • Launch products quickly
  • Reduce development timelines
  • Minimize overhead
  • Build customized solutions to meet customer needs and strategic goals

Product Builder allows carriers to quickly commercialize competitive products and services.


  • Build plans guided by product modeler that meet market requirements
  • Health: Associate health plans to packages that include prescription drug plans, dental and / or vision plans, or health and wellness programs

Product Profitability Planner allows the product department to make all decisions affecting product price including regulation changes, risk scoring routines and rate refusals.


  • Configure product pricing, and underwriting rules 
  • Standard and customized rate exhibits, proposals, EOI forms, requirement letters, etc. 
  • Support different user profiles and authority levels 
  • Expose sophisticated calculation engine used by sales, underwriting, and reserving

Profitably Sell

Automate consistent underwriting decisions leading to improved mortality and profit margins.

Underwriting Machine facilitates both financial and medical underwriting. This allows carriers to price and rate new cases or design plans from historical runs. Health insurers can experiment successfully with different risk management approaches and can link underwriting to claims and health management and then back to underwriting and product design.

Health insurers can easily configure rules and rates specific to business needs and update them as circumstances change.

Underwriting Machine can be bundled with our other applications to create an unmatched end-to-end solution or deployed separately:

Underwriting Workbench (UWB) Base

  • Rating and Quoting (including endorsement / renewals)
  • Automated workflow rapidly routes cases to auto approval or the appropriate underwriter or resource
  • Easily configure unique business rules
  • Multi-channel support through open APIs streamlines the sales process to improve quote turn-around-time and transfer reliable data
  • Facilitates collection of collaterals & attachments
  • Easily import census and experience Data
  • Large Claim Tracking
  • Manual & Experience Rating
  • Manage rate adjustments and concessions
  • Integration with external data providers obtains additional information about the group

Evidence of Insurability (EOI)

  • Automate and simplify approvals
  • Integration to third party data sources and service bureaus

Profitably Manage

Automate and accelerate policy issuance and facilitate an improved customer experience.

Install Machine facilitates policy lifecycle management. Don’t spend up to 60 days on a case installation. Install Machine automates and accelerates binding of coverage and issuing of policies leading to significantly improved customer satisfaction scores.

With Install Machine users can:
  • Create employee groups
  • Create billing groups
  • Create employee benefit options
  • Create policy documents
    • Policy output
    • Customer notifications
    • Invoices
  • Manage policy renewals

Customize Medicare Advantage plans and automate CMS PBP submissions.

Medicare Machine allows carriers to streamline PBP submissions and the Medicare document generation process, saving time and freeing up resources, so you can focus on growing your business and expanding membership.

With Medicare Machine carriers can:
  • Customize Medicare Advantage plans and automate the CMS PBP submission process
  • Reduce data entry and the potential for human error and ensure collaboration with stakeholders
  • Automate the Annual Notice of Change and Evidence of Coverage process compliant with all federal requirements

Profitably Distribute

Distribute products and services online with decision support that provides personalized recommendations and self-service.

Engagement Machine delivers superior customer experiences.

Quickly and easily provide personalized, highly engaging customer experiences with Engagement Machine.  Engagement Machine is an intuitive decision support application that educates users and guides them through their options with animated stories, data visualization, decision support algorithms and benefit calculators.

Engagement Machine helps improve top-line growth by expanding your reach, simplifying complex concepts for any audience while enhancing the self-service customer experience – at a much lower cost-of-acquisition and support compared with prevailing methods.

With Engagement Machine you can:
  • Assist customers in making better decisions about their insurance needs utilizing world-class cognitive / behavioral science techniques
  • Personalize the experience with data from user profiles and other inputs
  • Use content authoring tools and calculator builders to provide highly personalized customer experiences
  • Secure customer profile, usage and satisfaction data to improve product development
  • Improve data gathering such as securing health history with a more user friendly interface designed to remove barriers to communication
  • Allow users year round self-service such as deductible / co-pay lookups and co-insurance accumulators