General Insurance Provider — Policy Lifecycle Orchestration (AML/KYC)

Summary

Designed and implemented end-to-end policy lifecycle orchestration across issuance, endorsements, renewals, and cancellations, embedding maker–checker approvals, dynamic serial/parallel routing, and AML/KYC branches. The platform unified CRM, finance, and document management, yielding faster turnaround, cleaner audits, and predictable customer updates.

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Problem

• Fragmented steps across CRM, policy admin, finance, and document systems created handoff latency and lost context.
• Approvals lacked consistency: maker–checker enforcement varied by product and channel.
• AML/KYC checks were bolt-ons; required documents and status flags were not consistently propagated, raising compliance risk.
• Customers lacked transparency during endorsements and issuance, hurting CX and rework rates.

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Solution Mechanics

Primary pattern: API-led orchestration (request/response workflows with SLAs, human approvals, and partner callbacks).
Secondary pattern: Rules/validation (maker–checker & KYC gating, product-driven serial/parallel routing).

• Orchestration Layer (SOA services)

  • Routes lifecycle requests from Portal/CRM to the Policy Administration System (COTS) via SOAP/XML adapters; all calls carry correlation IDs and idempotency keys.
  • Implements GetFlowMode/GetNextStep decisions to choose serial vs parallel branches and whether to spawn Maker and/or Checker tasks.
  • Exposes status & progress APIs for channels; enforces SLAs and timeout/retry budgets.

• Maker–Checker & Human Tasks

  • Creates Maker and Checker work items per product rules; supports UW referral paths.
  • Custom task forms with consistent metadata (policy, party, amounts, evidence links).
  • Role-based access and audit trails (who/what/when, before/after snapshots).

• AML/KYC Branching

  • KYC Status Update APIs to the policy system; KYC RFI Inwarding tasks when documents are missing.
  • Inwarding Document Checklist service to fetch product-specific doc lists (including KYC categories) for Scanning & Indexing; drives RFI subflows.
  • Parallel path supports Receipting while KYC evidence is gathered; serial path enforces strict sequence for products that require it.

• Endorsements & Issuance

  • Premium computation → Customer confirmation (endorsement) with negative path to exit if declined.
  • Receipting integration; Printing/document generation; policy document storage in ECM with links persisted, not binaries.
  • CRM updates at key milestones to keep customer-facing status accurate.

• Integration & Data

  • JMS topics/queues for work events, exceptions, and notification fan-out.
  • ECM for artifact capture (scans, receipts, printed policy PDFs).
  • Finance request/response for receipting and reversals; CRM for unified status.
  • Append-only audit tables for decisions, approvals, KYC flags, and checklist versions.

• Observability & Operations

  • Progress service (policy number → current step, owner, ETA).
  • DLQ/replay for failed calls; notification service for customer/ops comms.
  • Runbooks for parallel branch hazards (e.g., receipting vs RFI), including async sub-process patterns to remove inter-branch locks.

Diagram 1 - Context Diagram — Policy lifecycle with AML/KYC, maker–checker, and channel updates

Diagram 2 - Sequence — New policy issuance with dynamic serial/parallel and KYC branches

Diagram 3 - Ops & Rules — Maker–checker policy, KYC checklist, DLQ/replay, and audit views

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Process Flow

1. Initiate: Portal/CRM requests Issuance or Endorsement → Orchestration resolves flow mode (serial vs parallel) and maker/checker needs for the product.
2. Inwarding & Evidence: Create Inwarding task; fetch Document Checklist (incl. KYC categories) → Scanning & Indexing; open RFI subflow if items missing.
3. Receipting: In parallel (if allowed) or serially per rule, perform receipting; post KYC status flags to policy system.
4. Approvals: Spawn Maker (prepare/validate) and Checker (approve) tasks as configured; allow UW referral when risk thresholds hit.
5. Issuance/Update: Commit issuance/endorsement in policy system; Print and store documents in ECM; update Finance/CRM.
6. Notifications & Progress: Publish events; customers and ops see live status via Progress API; exceptions routed to DLQ with replay.
7. Close & Audit: Persist approval trail, KYC artifacts, and checklist versions; emit audit events for compliance reporting.

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Outcomes

• Faster issuance and endorsements through governed parallelization and consistent maker–checker.
• Audit-clean traceability of approvals, KYC flags, and document checklists by product.
• Improved CX via reliable status updates and fewer back-and-forth RFIs.

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Strategic Business Impact

• Issuance/endorsement turnaround –15–30% (Proxy): driven by parallel receipting and pre-validated checklists.
• Compliance posture uplift (Proxy): standardized maker–checker and KYC updates reduce audit findings.
• First-time-right rate +10–20% (Modeled): fewer missing docs and misrouted cases due to product-aware routing.

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Role & Scope

Led orchestration design and rollout: routing rules, maker–checker task model, KYC flows (status update + RFI inwarding + checklist), receipting & printing integration, CRM/Finance updates, and audit/observability (progress, DLQ/replay, notifications).

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Key Decisions & Trade-offs

• Dynamic serial/parallel routing by product → higher throughput; required explicit async sub-processes to avoid branch locks.
• Maker–checker as policy (not app logic) → easier to evolve across products; needs versioned governance.
• KYC gating before issuance vs post-issuance remediation → better compliance; occasional longer path for strict products.
• ECM links vs binary in DB → performance and portability; mandates link governance and retention policy.
• Strict idempotency on policy/receipting calls → safe retries; added key management and conflict handling.

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Risks & Mitigations

• Parallel branch contention (receipting waiting on RFI) → move one branch into async sub-process; set correlation gates.
• Checklist drift across products → central checklist service with versioned templates; nightly diffs.
• KYC false negatives → second-factor doc categories + manual override with audit reason.
• Callback timeouts → retries with backoff; circuit breakers and DLQ; operator prompts.
• Rework loops in endorsements → customer confirmation gate; auto-close on decline with full rationale logged.

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Suggested Metrics (run-time SLOs)

• Issuance p95 and endorsement p95 (request → commit).
• Maker–checker rework rate and UW referral ratio.
• KYC exception rate and RFI closure time.
• Parallel branch success rate (no deadlocks) and DLQ depth/age.
• Audit event latency (action → audit record available).

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Closing principle

Codify governance into the flow—let routing, maker–checker, and KYC rules decide pace and path, not handoffs.

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