Generally speaking, business processes describe end-to-end processing paths including tasks and information flows. Often crossing departmental and even organizational boundaries, business process usually starts with a customer request/need and ends with an outcome for the customer and the organization. In turn, a Business Process Model specifies several related business processes and defines the ways in which operations are carried out to accomplish the intended organizational objectives.
A process-based approach in social security administration relies on best practices to provide a common way of describing the activities of a social security institution. The overall management of social security business processes involves its business areas, notably: registration, contribution collection, accounting and finance, payment, appeals and complaints management, planning and evaluation areas, and cash benefits administration for pensions, sickness, health insurance, unemployment, maternity, and family benefits.
This section addresses these issues and provides recommendations on implementing a process-based approach in social security institutions. The key advantage of this approach is that it facilitates the identification of business process similarities across various programmes which allows for economies of scale in the development and maintenance of systems as well as simplifying operations both for the user/customer and for the staff responsible for the various functions through standardization.
The core operational business processes are:
- Registration of all categories of contributors and beneficiaries;
- Contribution collection for all categories of contributors, which includes collecting declarations/payroll, collecting contributions and apportioninf contributions/premiums;
- Management of cash benefits:
- Receiving benefit applications for all the schemes;
- Control and adjudication, including eligibility and other controls as well as decisions on entitlement and computation of payment amounts;
- Payment of cash benefits;
- Managing appeals, complaints and redress;
- Permanent evaluation of the operational processes by computing key performance indicators.
The main goals of this section are to:
- Provide recommendations on implementing core social security business processes taking into account schemes’ specificities and, at the same time, preventing fragmented implementations by promoting common processes when appropriate;
- Promote a standardized business process framework for the ICT developments as well as for other functions (e.g. service delivery) to address the business requirements of the schemes;
- Promote good practices on the design and implementation of social security processes in particular for strengthening security and data quality assurance mechanisms.
The section takes into account specificities of the targeted core processes in the different social security schemes and programmes, which are grouped as follows:
- Short term income replacement benefits providing an income replacement for a limited time period during which the insured person is not able to work due to sickness, maternity and unemployment;
- Long-term benefits payable for life or for a considerable number of years, such as old-age, disability and survivors pensions;
- Hybrid benefits such as family allowances and health insurance. The former provides additional income for families with young children, often with conditionalities such as means-testing and/or school attendance and receiving medical care. The latter covers health services to workers and their dependants. The benefits may consist of covering beneficiaries’ enrolment to medical services provided by external health providers and/or, reimbursement-based cash benefit for medical expenses incurred.
Table C.4.1 summarizes the business process considered in this section as well as the ICT-implementation approach.
These guidelines are primarily intended to provide orientations to the ICT unit on implementing software systems responding to requirements of business areas. They also aim at providing guidance to the institution’s management and business areas on the main social security business processes.
In addition, these guidelines may mean that operational and technical development will have to adapt their skills and/or new skills requirements.