K07155 - Health Insurance Payor - 721 - 021319 - April 2023

HE ALT H INSUR ANCE PAYOR
PROCE S S CL A S SIFIC AT ION FR AME WORK®

Version 7.2.1
HEALTH INSURANCE PAYOR PCF

OVERVIEW OPERATING PROCESSES
Based on the renowned Process Classification 1.0 >>> 2.0 >>> 3.0 >>> 4.0 >>> 5.0 >>> 6.0
Framework® (PCF), The Health Insurance Develop
Vision
Develop and
Manage Products
Market
and Sell
Deliver
Physical Products
Deliver
Services
Manage
Customer
Payor PCF® is customized to define processes and
Strategy
and Services Products and
Services
Service
used within organizations around the world.

Version 7.2.1 of The Health Insurance Payor
PCF® includes changes to make it compliant MANAGEMENT AND SUPPORT SERVICES
with the most recent information in Cross 7.0 Develop and Manage Human Capital
Industry PCF® v7.2.1. This version of the PCF

8.0 Manage Information Technology
was developed in conjunction with KPMG and
contains feedback from a variety of individuals 9.0 Manage Financial Resources
within the industry. APQC provided much

10.0 Acquire, Construct, and Manage Assets
of the subject matter expertise to create
this industry specific process classification 11.0 Manage Enterprise Risk, Compliance, Remediation, and Resiliency
framework.
12.0 Manage External Relationships
THE FRAMEWORK FOR

13.0 Develop and Manage Business Capabilities
PROCESS IMPROVEMENT
Experience shows that the potential of
benchmarking to drive dramatic improvement lies squarely in making out-of-the-box comparisons and searching for insights not
typically found within intra-industry paradigms. To enable this beneficial benchmarking, the APQC Process Classification Framework
(PCF)® serves as a high-level, industry-neutral enterprise process model that allows organizations to see their business processes
from a cross-industry viewpoint. The cross-industry framework has experienced more than 20 years of creative use by thousands
of organizations worldwide. The PCF provides the foundation for APQC’s Open Standards Benchmarking® (OSB) database and the
work of its advisory council of global industry leaders. Each version of the PCF will continue to be enhanced as the OSB database
further develops definitions, processes, and measures. The PCF and associated measures and benchmarking surveys are available for
download from the Open Standards Benchmarking web site at www.apqc.org/osb.
HISTORY
The cross-industry Process Classification Framework® was originally envisioned as a taxonomy of business processes and a common
language through which APQC member organizations could benchmark their processes. The initial design involved APQC and more
than 80 organizations with a strong interest in advancing the use of benchmarking in the United States and worldwide. Since its
inception in 1992, the PCF has seen updates to most of its content. These updates keep the framework current with the ways that
organizations do business around the world. In 2014, APQC worked to enhance the cross-industry PCF and updated a number of
industry-specific process classification frameworks.
The PCF is written in United States English language format.
Version 7.2.1-en-XI • January 2019 1

PROCESS CLASSIFICATION FRAMEWORK® TABLE OF CONTENTS
LOOKING FORWARD work, and succeed in a competitive marketplace. With a focus

The cross-industry and industry Process Classification on productivity, knowledge management, benchmarking, and
Frameworks are evolving models, which APQC will continue quality improvement initiatives, APQC works with its member
to enhance and improve regularly. Thus, APQC encourages organizations to identify best practices; discover effective
comments, suggestions, and more importantly, the sharing of methods of improvement; broadly disseminate findings; and
insights from having applied the PCF within your organization. connect individuals with one another and the knowledge,
Share your suggestions and experiences with the PCF by training, and tools they need to succeed. Founded in 1977, APQC
e-mailing pcf_feedback@apqc.org. is a member-based non profit serving organizations around the
world in all sectors of business, education, and government.
APQC is also a proud winner of the 2003, 2004, 2008, 2012, and
ABOUT APQC 2013 North American Most Admired Knowledge Enterprises
An internationally recognized resource for process and (MAKE) awards. This award is based on a study by Teleos, a
performance improvement, APQC helps organizations adapt to European-based research firm, and the KNOW network.
rapidly changing environments, build new and better ways to
PROCESS CLASSIFICATION FRAMEWORK® TABLE OF CONTENTS

Content Organization 3
PCF Levels Explained/Number Scheming 3
1.0 Develop Vision and Strategy 4
2.0 Develop and Manage Products and Services 6
3.0 Market and Sell Products and Services 8
4.0 Deliver Physical Products 11
5.0 Deliver Services 13
6.0 Manage Customer Service 15
7.0 Develop and Manage Human Capital 17
8.0 Manage Information Technology (IT) 19
9.0 Manage Financial Resources 24
10.0 Acquire, Construct, and Manage Assets 29
11.0 Manage Enterprise Risk, Compliance, Remediation, and Resiliency 30
12.0 Manage External Relationships 31
13.0 Develop and Manage Business Capabilities 32
COPYRIGHT AND ATTRIBUTION

©2022 APQC. ALL RIGHTS RESERVED. This Process Classification Framework® ("PCF") is the copyrighted intellectual property of APQC. APQC
encourages the wide distribution, discussion, and use of the PCF for classifying and defining organizational processes. Accordingly, APQC hereby
grants you a perpetual, worldwide, royalty-free license to use, copy, publish, modify, and create derivative works of the PCF, provided that all
copies of the PCF and any derivative works contain a copy of this notice.
2 Permission granted to photocopy for personal use. ©2019 APQC. ALL RIGHTS RESERVED.
PCF LEVELS EXPLAINED
PROCESS ELEMENT NUMBERING SCHEME

The PCF identifies each process element using a unique 5-digit reference number following the name of the process element.[i.e., (16437),
(17060), (17061) (16458), (18129), shown in the above graphic]. This number will always refer to the conceptual definition of the process
element. The actual process elements and actual definition may change, but conceptually the decomposition will remain consistent
considering the entire scope of the PCF. A new 5-digit number will be assigned to a process element if its definition substantially changes.

1.0 Develop Vision and Strategy (10002)
1.1 Define the business concept and long-term vision (17040) 1.2.2.3 Develop B2B strategy (16800)
1.1.1 Assess the external environment (10017) 1.2.2.3.1 Develop service as a product strategy
1.1.1.1 Identify competitors (19945) (16801)
1.1.1.2 Analyze and evaluate competition (10021) 1.2.2.4 Develop B2C strategy (16802)
1.1.1.3 Identify economic trends (10022) 1.2.2.5 Develop partner/alliance strategy (16803)
1.1.1.4 Identify political and regulatory issues (10023) 1.2.2.6 Develop merger/demerger/acquisition/exit
strategy (16805)
1.1.1.5 Assess new technology innovations (10024)
1.2.2.7 Develop innovation strategy (16806)
1.1.1.6 Analyze demographics (10025)
1.2.2.8 Develop sustainability strategy (14189)
1.1.1.7 Identify social and cultural changes (10026)
1.2.2.9 Develop global support strategy (19950)
1.1.1.8 Identify ecological concerns (10027)
1.2.2.10 Develop shared services strategy (19951)
1.1.1.9 Identify intellectual property concerns (16790)
1.2.2.11 Develop lean/continuous improvement strategy
1.1.1.10 Evaluate IP acquisition options (16791) (14197)
1.1.2 Survey market and determine customer needs and wants 1.2.2.12 Develop innovation strategy and framework
(10018) (19952)
1.1.2.1 Conduct qualitative/quantitative research and 1.2.3 Select long-term business strategy (10039)
assessments (10028)
1.2.4 Coordinate and align functional and process strategies
1.1.2.2 Capture customer needs and wants (19946) (10040)
1.1.2.3 Assess customer needs and wants (19947) 1.2.5 Create organizational design (10041)
1.1.3 Assess the internal environment (10019) 1.2.5.1 Evaluate breadth and depth of organizational
1.1.3.1 Analyze organizational characteristics (10030) structure (10049)
1.1.3.2 Analyze internal operations (19948) 1.2.5.2 Perform job-specific roles mapping and value-
1.1.3.3 Create baselines for current processes (10031) added analyses (10050)
1.1.3.4 Analyze systems and technology (10032) 1.2.5.3 Develop role activity diagrams to assess hand-
1.1.3.5 Analyze financial health (10033) off activity (10051)
1.1.3.6 Identify core competencies (10034) 1.2.5.4 Perform organization redesign workshops (10052)
1.1.4 Establish strategic vision (10020) 1.2.5.5 Design the relationships between
1.1.4.1 Define the strategic vision (19949) organizational units (10053)
1.1.4.2 Align stakeholders around strategic vision (10035) 1.2.5.6 Develop role analysis and activity diagrams for
key processes (10054)
1.1.4.3 Communicate strategic vision to stakeholders
(10036) 1.2.5.7 Assess organizational implication of feasible
alternatives (10055)
1.1.5 Conduct organization restructuring opportunities (16792)
1.2.5.8 Migrate to new organization (10056)
1.1.5.1 Identify restructuring opportunities (16793)
1.2.6 Develop and set organizational goals (10042)
1.1.5.2 Perform due-diligence (16794)
1.1.5.3 Analyze deal options (16795) 1.2.6.1 Identify organizational goals (19953)
1.1.5.3.1 Evaluate acquisition options (16796) 1.2.6.2 Establish baseline metrics (19954)
1.1.5.3.2 Evaluate merger options (16797) 1.2.6.3 Monitor performance against goals (19955)
1.1.5.3.3 Evaluate de-merger options (16798) 1.2.7 Formulate business unit strategies (10043)
1.1.5.3.4 Evaluate divesture options (16799) 1.2.7.1 Analyze business unit strategies (19956)
1.2.7.2 Identify core competency for each business unit
1.2 Develop business strategy (10015) (19957)
1.2.1 Develop overall mission statement (10037) 1.2.7.3 Refine business unit strategies in support of
1.2.1.1 Define current business (10044) company strategy (19958)
1.2.1.2 Formulate mission (10045) 1.2.8 Develop customer experience strategy (19959)
1.2.1.3 Communicate mission (10046) 1.2.8.1 Assess customer experience (19960)
1.2.2 Define and evaluate strategic options to achieve the 1.2.8.1.1 Identify and review customer
objectives (10038) touchpoints (19961)
1.2.2.1 Define strategic options (10047) 1.2.8.1.2 Assess customer experience across
1.2.2.2 Assess and analyze impact of each option (10048) touchpoints (19962)
1.2.2.2.1 Identify implications for key 1.2.8.1.3 Perform root cause analysis of
operating model business elements problematic customer experiences
that require change (13289) (19963)
1.2.2.2.2 Identify implications for key 1.2.8.2 Design customer experience (19964)
technology aspects (13290) 1.2.8.2.1 Define and manage personas (16612)
1.2.8.2.2 Create customer journey maps (19965) 1.3.3 Select strategic initiatives (10059)
1.2.8.2.3 Define single view of the customer 1.3.3.1 Prioritize strategic initiatives (19980)
for the organization (19966) 1.3.3.2 Communicate strategic initiatives to business
1.2.8.2.4 Define a vision for the customer units and stakeholders (19981)
experience (19967)
1.3.4 Establish high-level measures (10060)
1.2.8.2.5 Validate with customers (19968)
1.2.8.2.6 Align experience with brand values 1.3.4.1 Identify business value drivers (19982)
and business strategies (19969) 1.3.4.2 Establish baselines for business value drivers
1.2.8.2.7 Develop content strategy (19970) (19983)
1.2.8.3 Design customer experience support structure 1.3.4.3 Monitor performance against baselines (19984)
(19971) 1.3.5 Execute strategic initiatives (19507)
1.2.8.3.1 Identify required capabilities (19972)
1.4 Develop and maintain business models (20944)
1.2.8.3.2 Identify impact on functional
processes (19973) 1.4.1 Develop business models (20945)
1.2.8.4 Develop customer experience roadmap to develop 1.4.1.1 Assemble business model information (20946)
and implement defined capabilities (19974)
1.4.1.2 Secure appropriate approvals (20947)
1.2.9 Communicate strategies internally and externally (18916)
1.4.1.3 Identify integration points with existing models
1.3 Execute and measure strategic initiatives (10016) (20948)
1.3.1 Develop strategic initiatives (10057) 1.4.1.4 Adopt the business model (20949)
1.3.1.1 Identify strategic priorities (19975) 1.4.2 Maintain business models (20950)
1.3.1.2 Develop strategic initiatives based on business/
1.4.2.1 Establish business model maintenance
customer value (19976)
parameters (20951)
1.3.1.3 Review with stakeholders (19977)
1.4.2.2 Accept business model feedback parameters
1.3.2 Evaluate strategic initiatives (10058)
(20952)
1.3.2.1 Determine business value for each strategic
priority (19978) 1.4.2.3 Prioritize and manage incoming feedback (20953)
1.3.2.2 Determine the customer value for each strategic 1.4.2.4 Update existing models (20954)
priority (19979) 1.4.3 Establish business model governance (20955)

2.0 Develop and Manage Products and Services (10003)
2.1 Govern and manage product/service development program 2.1.1.4.2 Review infringement of patents and
(19696) copyrights (16826)
2.1.1 Manage product and service portfolio (10061) 2.1.1.4.3 Determine patent and copyright
needs (16827)
2.1.1.1 Evaluate performance of existing products/
services against market opportunities (10063) 2.1.1.4.4 Define product technical documentation
management requirements (19697)
2.1.1.2 Confirm alignment of product/service concepts
with business strategy (10066) 2.1.1.4.5 Manage regulatory requirements
(12771)
2.1.1.2.1 Plan and develop cost and quality
targets (10073) 2.1.1.4.5.1 Train employees on
appropriate regulatory
2.1.1.2.2 Prioritize and select new product/
requirements (12772)
service concepts (10074)
2.1.1.4.5.2 Maintain records for
2.1.1.2.3 Specify development timing targets
regulatory agencies
(10075)
(12773)
2.1.1.2.4 Plan for product/service offering
2.1.1.4.5.3 Manage regulatory
modifications (10076)
submission life cycle
2.1.1.3 Manage product and service life cycle (10067) (12776)
2.1.1.3.1 Develop plan for new product/ 2.1.1.5 Manage product and service master data (11740)
service development and
2.1.1.5.1 Manage materials master lists (11741)
introduction/launch (16824)
2.1.1.5.2 Manage bills of material (11742)
2.1.1.3.2 Introduce new products/services
(10077) 2.1.1.5.3 Manage routings (11743)
2.1.1.3.3 Retire outdated products/services 2.1.1.5.4 Manage specifications (11744)
(10078) 2.1.1.5.5 Manage drawings (11745)
2.1.1.3.4 Identify and refine performance 2.1.1.5.6 Manage product/material
indicators (10079) classification (11746)
2.1.1.3.5 Conduct post launch review (11423) 2.1.1.5.7 Develop and maintain quality/
2.1.1.3.5.1 Carry out post launch inspection documents (11747)
analytics to test the 2.1.1.5.8 Maintain process specification data
acceptability in the (11748)
market (19646) 2.1.1.5.9 Manage traceability data (11749)
2.1.1.3.5.2 Review market 2.1.1.5.10 Review and approve data access
performance (11424) requests (11750)
2.1.1.3.5.3 Review effectiveness 2.2 Generate and define new product/service ideas (19698)
of supply chain and
distribution network 2.2.1 Perform discovery research (10065)
(11425) 2.2.1.1 Identify new technologies (10070)
2.1.1.3.5.4 Apply data and analytics 2.2.1.2 Develop new technologies (10071)
to review supply chain 2.2.1.3 Assess feasibility of integrating new leading
methodologies (19647) technologies into product/service concepts
2.1.1.3.5.5 Review quality and (10072)
performance of the 2.2.2 Generate new product/service concepts (19669)
product/service (11426) 2.2.2.1 Gather new product/service ideas and
2.1.1.3.5.6 Conduct financial requirements (19986)
review (11427) 2.2.2.2 Analyze new product/service ideas and
2.1.1.3.5.7 Conduct new product requirements (19987)
development process 2.2.2.3 Evaluate new product/service inputs and
assessment (11428) requirements (19988)
2.1.1.4 Manage patents, copyrights, and regulatory 2.2.2.4 Formulate new product/service concepts (19989)
requirements (19985) 2.2.2.5 Identify potential improvements to existing
2.1.1.4.1 Conduct mandatory and elective products and services (10068)
reviews (19941) 2.2.3 Define product/service development requirements (19990)
2.2.3.1 Define product/service requirements (11331) 2.3.1.8.1 Design for manufacturing (16819)
2.2.3.1.1 Define basic functional requirements 2.3.1.8.2 Design for product servicing (16820)
(19991)
2.3.1.8.3 Design for re-manufacturing (16821)
2.2.3.1.2 Derive interoperability requirements
for products and services (16808) 2.3.1.8.4 Review product troubleshooting
2.2.3.1.3 Derive safety requirements for methodology (16822)
products and services (16809) 2.3.1.8.5 Design and manage product data,
2.2.3.1.4 Derive security requirements for design, and bill of materials (16818)
products and services (16810) 2.3.1.8.6 Design for product upgrades (16823)
2.2.3.1.5 Derive regulatory compliance
2.3.1.9 Build prototypes/proof of concepts (10088)
2.2.3.1.6 Derive requirements from industry 2.3.1.10 Develop and test prototype production and/or
standards (16812) service delivery process (10098)
2.2.3.1.7 Develop user experience requirements 2.3.1.11 Eliminate quality and reliability problems (10089)
(19992) 2.3.1.12 Conduct in-house product/service testing and
2.2.3.1.8 Derive ‘services-as-a-product’ offering evaluate feasibility (10090)
(16814)
2.3.1.13 Identify design/development performance
2.2.3.2 Define post launch support model (16815)
indicators (10091)
2.2.3.3 Identify product/service bundling opportunities
(17389) 2.3.1.14 Collaborate on design with suppliers and
external partners (10092)
2.3 Develop products and services (10062)
2.3.2 Test market for new or revised products and services (19996)
2.3.1 Design and prototype products and services (19993)
2.3.1.1 Assign resources to product/service project 2.3.2.1 Prepare detailed market study (10093)
(10083) 2.3.2.2 Conduct customer tests and interviews (10094)
2.3.1.1.1 Identify requirements for product/ 2.3.2.3 Finalize product/service characteristics and
service design/development partners business cases (10095)
(19994)
2.3.2.4 Finalize technical requirements (10096)
2.3.1.2 Prepare high-level business case and technical
assessment (10084) 2.3.3 Prepare for production/service delivery (19997)
2.3.1.3 Develop product/service design specifications 2.3.3.1 Design and obtain necessary capabilities/
(10085) materials and equipment (10099)
2.3.1.4 Develop user experience design specifications 2.3.3.2 Identify requirements for changes to
(16813) manufacturing/delivery processes (10097)
2.3.1.5 Provide warranty-related recommendations
2.3.3.3 Request engineering/process change (11418)
(16817)
2.3.3.4 Install and validate production/service delivery
2.3.1.6 Document design specifications (10086)
process (10100)
2.3.1.7 Conduct mandatory and elective external
reviews (10087) 2.3.3.4.1 Monitor initial production runs (11417)
2.3.1.8 Design products/services (19995) 2.3.3.5 Validate launch procedures (19998)

3.0 Market and Sell Products and Services (10004)
3.1 Understand markets, customers, and capabilities (10101) 3.2.4.2 Monitor and report performance (16574)
3.1.1 Perform customer and market intelligence analysis (10106) 3.2.4.3 Monitor and report events influencing factors
(16575)
3.1.1.1 Conduct customer and market research (10108)
3.2.4.4 Analyze performance (16500)
3.1.1.2 Identify market segments (10109)
3.2.4.5 Develop plan for improvements (16501)
3.1.1.3 Analyze market and industry trends (10110)
3.2.5 Develop marketing communication strategy (16848)
3.1.1.4 Analyze competing organizations, competitive/
substitute products/services (10111) 3.2.5.1 Develop customer communication calendar
(16849)
3.1.1.5 Evaluate existing products/services (10112)
3.2.5.2 Define public relations (PR) strategy (16850)
3.1.1.6 Assess internal and external business
environment (10113) 3.2.5.3 Define direct marketing strategy (16851)
3.1.2 Evaluate and prioritize market opportunities (10107) 3.2.5.4 Define internal marketing communication
strategy (16852)
3.1.2.1 Quantify market opportunities (10116)
3.2.5.5 Identify new media for marketing
3.1.2.2 Determine target segments (10117)
communication (16853)
3.1.2.2.1 Identify under-served and saturated
3.2.5.6 Define new media communication strategy
market segments (18941)
(16854)
3.1.2.3 Prioritize opportunities consistent with
3.2.5.7 Define point of sale (POS) communication
capabilities and overall business strategy (10118)
strategy (16855)
3.1.2.4 Validate opportunities (10119)
3.2.5.8 Define communication guidelines and
3.2 Develop marketing strategy (10102) mechanisms (18627)
3.2.1 Define offering and customer value proposition (11168) 3.2.6 Design and manage customer loyalty program (18924)
3.2.1.1 Define offering and positioning (11169) 3.2.6.1 Define customer loyalty program (20007)
3.2.1.2 Develop value proposition including brand 3.2.6.2 Acquire members to customer loyalty program
positioning for target segments (11170) (18925)
3.2.1.3 Validate value proposition with target segments 3.2.6.3 Build engagement and relationship with
(11171) members (18926)
3.2.1.4 Develop new branding (11172) 3.2.6.4 Monitor customer loyalty program benefits to
3.2.2 Define pricing strategy (10123) the enterprise and the customer (16633)
3.2.2.1 Conduct pricing analysis (13169) 3.2.6.5 Optimize loyalty program value to both the
enterprise and the customer (18927)
3.2.2.2 Establish guidelines for applying pricing and
discounting of products/services (10124) 3.2.7 Design brochures/collateral (17064)
3.2.2.3 Establish pricing targets (19999) 3.3 Develop and manage marketing plans (20008)
3.2.2.4 Approve pricing strategies/policies and targets 3.3.1 Establish goals, objectives, and metrics for products/
(10125) services by channel/segment (10148)
3.2.3 Define and manage channel strategy (20000) 3.3.2 Establish marketing budgets (10149)
3.2.3.1 Determine channels to be supported (20001) 3.3.2.1 Confirm marketing alignment to business
3.2.3.2 Establish channel objectives (20002) strategy (10155)
3.2.3.3 Determine channel role and fit with target 3.3.2.2 Determine costs of marketing (10156)
segments (10127) 3.3.2.3 Create marketing budget (10157)
3.2.3.4 Select channels for target segments (10128) 3.3.2.4 Determine projected ROI for marketing
3.2.3.5 Identify required channel capabilities (20003) investment (17683)
3.2.3.6 Evaluate channel attributes and potential 3.3.3 Develop and manage pricing (20593)
partners (10126) 3.3.3.1 Understand resource requirements for each
3.2.3.7 Orchestrate seamless customer experience product/service and delivery channel/method
across supported channels (20004) (20009)
3.2.3.7.1 Define omni-channel strategy (16590) 3.3.3.2 Determine corporate incentives (18948)
3.2.3.7.2 Define omni-channel requirements 3.3.3.3 Determine pricing based on volume/unit
(16591) forecast (10163)
3.2.3.7.3 Develop omni-channel policies and 3.3.3.4 Execute pricing plan (10164)
procedures (16592) 3.3.3.5 Evaluate pricing performance (10165)
3.2.3.8 Develop and manage execution roadmap (20005) 3.3.3.6 Refine pricing as needed (10166)
3.2.4 Analyze and manage channel performance (20006) 3.3.3.7 Implement promotional pricing programs (11495)
3.2.4.1 Establish channel-specific metrics and targets 3.3.3.8 Implement other retail pricing programs (11496)
(16573)
3.3.3.9
Communicate and implement price changes 3.4.2.4
Develop customer trade strategy and customer
(11497) objectives/targets (11465)
3.3.3.10 Achieve regulatory approval for pricing (17684) 3.4.2.5 Define trade programs and funding options
3.3.4 Develop and manage promotional activities (20010) (11521)
3.3.4.1 Define promotional concepts and objectives 3.4.2.6 Conduct planning activities for major trade
(10167) customers (11466)
3.3.4.2 Develop marketing messages (10159) 3.4.2.7 Develop partner and alliance management
strategies (10141)
3.3.4.3 Define target audience (10160)
3.4.2.8 Establish partner and alliance management
3.3.4.4 Plan and test promotional activities (10168)
goals (10142)
3.3.4.5 Execute promotional activities (10169)
3.4.3 Perform broker channel management (17065)
3.3.4.6 Evaluate promotional performance metrics (10170)
3.4.3.1 Profile brokers and agents (17066)
3.3.4.7 Refine promotional performance metrics (10171)
3.4.3.2 Contract with brokers and agents (17067)
3.3.4.8 Incorporate learning into future/planned
3.4.3.3 Establish partner and alliance agreements (18629)
consumer promotions (10172)
3.4.3.4 Develop promotional and category
3.3.4.9 Analyze purchasing behavior (17072)
management calendars (trade marketing
3.3.4.10 Analyze customer campaigns (17073) calendars) (11522)
3.3.4.11 Analyze customer market research (17074) 3.4.3.5 Create strategic and tactical sales plans by
3.3.5 Track customer management measures (10153) customer (11523)
3.3.5.1 Determine customer loyalty/lifetime value (10173) 3.4.3.6 Communicate planning information to customer
3.3.5.2 Analyze customer revenue trend (10174) teams (11468)
3.3.5.3 Analyze customer attrition and retention rates 3.4.4 Establish overall sales budgets (10131)
(10175) 3.4.4.1 Calculate product market share (17682)
3.3.5.4 Analyze customer metrics (10176) 3.4.4.2 Calculate product revenue (10143)
3.3.5.5 Revise customer strategies, objectives, and 3.4.4.3 Determine variable costs (10144)
plans based on metrics (10177) 3.4.4.4 Determine overhead and fixed costs (10145)
3.3.6 Analyze and respond to customer insight (16613) 3.4.4.5 Calculate net profit (10146)
3.3.6.1 Monitor and respond to social media activity 3.4.4.6 Create budget (10147)
(16627) 3.4.5 Establish sales goals and measures (10132)
3.3.6.2 Analyze customer website activity (16614) 3.4.6 Establish customer management measures (10133)
3.3.6.3 Analyze customer purchase patterns (16615)
3.5 Develop and manage sales plans (17069)
3.3.6.4 Develop business rules to provide personalized
offers (16616) 3.5.1 Manage sales collateral (17070)
3.3.6.5 Monitor effectiveness of personalized offers 3.5.1.1 Manage proposal templates (17071)
and adjust offers accordingly (16617) 3.5.1.2 Manage Campaigns (17075)
3.3.7 Develop and manage packaging strategy (10154) 3.5.2 Manage leads/opportunities (10182)
3.3.7.1 Plan packaging strategy (10178) 3.5.2.1 Identify potential customers (10188)
3.3.7.2 Test packaging options (10179) 3.5.2.2 Identify/receive leads/opportunities (10189)
3.3.7.3 Execute packaging strategy (10180) 3.5.2.3 Validate and qualify leads/opportunities (18115)
3.3.7.4 Refine packaging (10181) 3.5.2.4 Match opportunities to business strategy (11773)
3.3.8 Manage product marketing content (16629) 3.5.2.5 Develop opportunity win plans (18116)
3.3.8.1 Manage product images (16630) 3.5.2.6 Manage opportunity pipeline (20011)
3.3.8.2 Manage product copy (18130) 3.5.2.7 Determine sales resource allocation (10209)
3.4 Develop sales strategy (10103) 3.5.2.8 Manage customer sales calls (10184)
3.5.2.8.1 Conduct direct sales to groups (17081)
3.4.1 Develop sales forecast (10129)
3.5.2.8.2 Perform pre-sales activities (10191)
3.4.1.1 Gather current and historic order information
3.5.2.8.2.1 Produce proposal
(10134)
(17082)
3.4.1.2 Analyze sales trends and patterns (10135)
3.5.2.8.2.2 Produce renewals
3.4.1.3 Generate sales forecast (10136) (17083)
3.4.1.4 Analyze historical and planned promotions and 3.5.2.8.2.3 Negotiate contracts
events (10137) (17084)
3.4.2 Develop sales partner/alliance relationships (10130) 3.5.2.8.3 Manage customer meetings/
3.4.2.1 Identify alliance opportunities (10138) workshops (20012)
3.4.2.2 Design alliance programs and methods for 3.5.2.8.4 Close the sale (10192)
selecting and managing relationships (10139) 3.5.2.8.5 Record outcome of sales process
3.4.2.3 Select alliances (10140) (10193)

3.5.3 Manage customers and accounts (10183) 3.5.5.7 Process back orders and updates (10199)
3.5.3.1 Select key customers/accounts (20013) 3.5.5.8 Handle order inquiries including post-order
3.5.3.2 Develop sales/key account plan (11173) fulfillment transactions (10200)
3.5.3.3 Manage sales/key account plan (20014) 3.5.6 Manage sales partners and alliances (10187)
3.5.3.4 Manage customer relationships (11174) 3.5.6.1 Provide sales and product/service training to
3.5.3.5 Manage customer master data (14208) sales partners/alliances (10211)
3.5.3.5.1 Collect and merge internal and third- 3.5.6.1.1 Provide certification enablement
party customer information (16598) training (20019)
3.5.3.5.2 De-duplicate customer data (16599) 3.5.6.1.2 Manage certifications and skills
(20020)
3.5.3.6 Premium payment profile administration (17076)
3.5.6.1.3 Provide support to partners/alliances
3.5.3.6.1 Set payment allocation (17077) (20021)
3.5.3.6.2 Manage responsible party (17078) 3.5.6.2 Provide marketing materials to sales partners/
3.5.3.6.3 Assign billing attributes (17079) alliances (18641)
3.5.3.6.4 Manage billing preferences (17080) 3.5.6.3 Evaluate partner/alliance results (10214)
3.5.4 Develop and manage sales proposals, bids, and quotes 3.5.6.4 Manage channel partner master data (14209)
(11779) 3.5.6.5 Manage distribution channels (14180)
3.5.4.1 Receive Request For Proposal (RFP)/Request For
Quote (RFQ) (11781) 3.6 Enroll and onboard membership (17085)
3.5.4.2 Refine customer requirements (11780) 3.6.1 Validate members (17086)
3.5.4.3 Review RFP/RFQ request (11782) 3.6.1.1 Conduct CMS authorization (17087)
3.5.4.4 Perform competitive analysis (11783) 3.6.1.2 Verify member information (17088)
3.5.4.5 Validate with strategy/business plans (11784) 3.6.1.3 Determine enrollment eligibility (17089)
3.5.4.6 Understand customer business and requirements 3.6.2 Profile members (17090)
(11785) 3.6.2.1 Create and/or modify manage member identifier
3.5.4.7 Develop solution and delivery approach (20015) number (17091)
3.5.4.8 Identify staffing requirements (11787) 3.6.2.2 Input or update member demographics (17092)
3.5.4.9 Develop pricing and scheduling estimates (11788) 3.6.2.3 Input or update confidential communication
3.5.4.10 Conduct profitability analysis (11789) profile (17093)
3.5.4.11 Manage internal reviews (20016) 3.6.2.4 Input or update ember provider panel/PCP (17094)
3.5.4.12 Manage internal approvals (20017) 3.6.2.5 Manage coverage enrollments (17095)
3.5.4.13 Submit/present bid/proposal/quote to customer 3.6.2.6 Collect associate member healthcare information
(11790) (17096)
3.5.4.14 Revise bid/proposal/quote (20018) 3.6.2.7 Coordinate benefits (17097)
3.5.4.15 Manage notification outcome (11793) 3.6.3 Conduct fulfillment administration (17098)
3.5.5 Manage sales orders (10185) 3.6.3.1 Specify appropriate member welcome Letters
(17099)
3.5.5.1 Accept and validate sales orders (10194)
3.6.3.2 Specify ID Card Template (17100)
3.5.5.2 Collect and maintain account information (10195)
3.6.3.3 Specify Benefit Booklet (17101)
3.5.5.2.1 Administer key account details (10201)
3.6.4 Install and maintain account/case (17102)
3.5.5.2.2 Retrieve full customer details (10202)
3.6.4.1 Set up account structure and maintenance (17103)
3.5.5.2.3 Modify involved party details (10203)
3.6.4.2 Manage group demographics (17104)
3.5.5.2.4 Record address details (10204)
3.6.4.3 Manage group contacts (17105)
3.5.5.2.5 Record contact details (10205)
3.6.4.4 Verify group information (17106)
3.5.5.2.6 Record key customer communication
profile details (10206) 3.6.4.5 Verify group participation requirements (17107)
3.5.5.2.7 Review involved party information 3.6.4.6 Manage rate schedules (17108)
(10207) 3.7 Perform policy renewal and maintenance (17109)
3.5.5.2.8 Terminate involved party information 3.7.1 Generate pre-renewal material (advance notice of change)
(10208) (17110)
3.5.5.3 Determine availability (10196) 3.7.2 Conduct early renewal process (17111)
3.5.5.4 Determine fulfillment process (10197) 3.7.3 Conduct annual renewal process (17112)
3.5.5.5 Enter orders into system (10198) 3.7.4 Conduct late renewal process (17113)
3.5.5.6 Identify/perform cross-sell/up-sell activity (17404)
4.0 Deliver Physical Products (20022)
4.1 Plan for and align supply chain resources (10215) 4.1.5.8 Manage dispatch plan attainment (10259)
4.1.1 Develop production and materials strategies (10221) 4.1.5.9 Calculate and optimize destination load plans
4.1.1.1 Define manufacturing goals (10229) (10260)
4.1.1.2 Define labor and materials policies (10230) 4.1.5.10 Manage partner load plan (10261)
4.1.1.3 Define outsourcing policies (10231) 4.1.5.11 Manage cost of supply (10262)
4.1.1.4 Define capital expense policies (10232) 4.1.5.12 Manage capacity utilization (10263)
4.1.1.5 Define capacities (10233) 4.1.6 Establish distribution planning constraints (10226)
4.1.1.6 Define production network and supply 4.1.6.1 Establish distribution center layout constraints
constraints (10234) (10267)
4.1.1.7 Define production process (14193) 4.1.6.2 Establish inventory management constraints
(10268)
4.1.1.8 Define standard operating procedures (19551)
4.1.6.3 Establish transportation management constraints
4.1.1.9 Define production workplace layout and
(10269)
infrastructure (14194)
4.1.6.4 Establish storage management constraints (19558)
4.1.2 Manage demand for products (10222)
4.1.7 Review distribution planning policies (10227)
4.1.2.1 Develop baseline demand forecasts (10235)
4.1.7.1 Review distribution network (10264)
4.1.2.2 Collaborate demand with customers (10236)
4.1.7.2 Establish sourcing relationships (10265)
4.1.2.3 Develop demand consensus forecast (10237)
4.1.7.3 Establish dynamic deployment policies (10266)
4.1.2.4 Determine available to promise (10238)
4.1.8 Develop quality standards and procedures (10368)
4.1.2.5 Monitor activity against demand forecast and
revise forecast (10239) 4.1.8.1 Establish quality targets (10371)
4.1.2.6 Evaluate and revise demand forecasting approach 4.1.8.2 Develop standard testing procedures (10372)
(10240) 4.1.8.3 Communicate quality specifications (10373)
4.1.2.7 Measure demand forecast accuracy (10241) 4.2 Procure materials and services (10216)
4.1.3 Create materials plan (10223) 4.2.1
Provide sourcing governance and perform category
4.1.3.1 Create unconstrained plan (10242) management (10277)
4.1.3.2 Collaborate with supplier and contract 4.2.1.1 Develop procurement plan (10281)
manufacturers (10243)
4.2.1.2 Clarify purchasing requirements (10282)
4.1.3.3 Identify critical materials and supplier capacity
4.2.1.3 Establish materials management contingency
(10244)
plans (10283)
4.1.3.4 Monitor material specifications (10245)
4.2.1.4 Match needs to supply capabilities (10284)
4.1.3.5 Generate constrained plan (10246)
4.2.1.5 Analyze organization’s spend profile (10285)
4.1.3.6 Define production balance and control (14196)
4.2.1.6 Seek opportunities to improve efficiency and
4.1.4 Create and manage master production schedule (10224) value (10286)
4.1.4.1 Model production network to enable simulation 4.2.1.7 Collaborate with suppliers to identify sourcing
and optimization (20023) opportunities (10287)
4.1.4.2 Create master production schedule (20024) 4.2.2 Develop sourcing and category management strategies
4.1.4.3 Maintain master production schedule (17041) (20973)
4.1.5 Plan distribution requirements (17042) 4.2.3 Select suppliers and develop/maintain contracts (10278)
4.1.5.1 Maintain master data (10252) 4.2.3.1 Select suppliers (10288)
4.1.5.2 Determine finished goods inventory 4.2.3.2 Certify and validate suppliers (10289)
requirements at destination (10253)
4.2.3.3 Negotiate and establish contracts (10290)
4.1.5.3 Determine product storage facility requirements
4.2.3.4 Manage contracts (10291)
(19555)
4.1.5.4 Calculate requirements at destination (10254) 4.2.4 Order materials and services (10279)
4.1.5.5 Calculate consolidation at source (10255) 4.2.4.1 Process/Review requisitions (10292)
4.1.5.6 Manage collaborative replenishment planning 4.2.4.2 Approve requisitions (10293)
(10256) 4.2.4.3 Solicit/Track vendor quotes (10294)
4.1.5.7 Calculate and optimize destination dispatch plan 4.2.4.4 Create/Distribute purchase orders (10295)
(10258) 4.2.4.5 Expedite orders and satisfy inquiries (10296)

4.2.4.6 Reconcile purchase orders (10297) 4.3.4.1 Determine lot numbering system (10376)
4.2.4.7 Research/Resolve order exceptions (10298) 4.3.4.2 Determine lot use (10377)
4.2.5 Manage suppliers (10280) 4.4 Manage logistics and warehousing (10219)
4.2.5.1 Monitor/Manage supplier information (10299)
4.4.1
Provide logistics governance (10338)
4.2.5.2 Prepare/Analyze procurement and vendor
4.4.1.1 Translate customer service requirements into
performance (10300)
logistics requirements (10343)
4.2.5.3 Support inventory and production processes
(10301) 4.4.1.2 Design logistics network (10344)
4.2.5.4 Monitor quality of product delivered (10302) 4.4.1.3 Communicate outsourcing needs (10345)
4.4.1.4 Develop and maintain delivery service policy
4.3 Produce/Assemble/Test product (10217)
(10346)
4.3.1 Schedule production (10303) 4.4.1.5 Optimize transportation schedules and costs
4.3.1.1 Model and simulate plant (19563) (10347)
4.3.1.2 Generate line level plan (10306) 4.4.1.6 Define key performance measures (10348)
4.3.1.3 Generate detailed schedule (10307) 4.4.1.7 Define reverse logistics strategy (16905)
4.3.1.4 Schedule production orders and create lots (10308) 4.4.2 Plan and manage inbound material flow (20936)
4.3.1.5 Schedule preventive (planned) maintenance 4.4.2.1 Plan inbound material receipts (10349)
(preventive maintenance orders) (10315)
4.4.2.2 Manage inbound material flow (10350)
4.3.1.6 Schedule requested (unplanned) maintenance
4.4.2.3 Monitor inbound delivery performance (10351)
(work order cycle) (10316)
4.3.1.7 Release production orders and create lots (10309) 4.4.2.4 Manage flow of returned products (10352)
4.3.2 Produce/Assemble product (10304) 4.4.2.5 Control quality of returned parts (12708)
4.3.2.1 Manage raw material inventory (10310) 4.4.2.6 Salvage or repair returned products (20109)
4.3.2.2 Execute detailed line schedule (10311) 4.4.2.6.1 Perform salvage activities (10366)
4.3.2.3 Report maintenance issues (10319) 4.4.2.6.2 Manage repair/refurbishment and
4.3.2.4 Rerun defective items (10313) return to customer/stock (14195)
4.3.2.5 Monitor and optimize production process (19566) 4.4.3 Operate warehousing (10340)
4.3.2.5.1 Automate and control plant (19567) 4.4.3.1 Track inventory deployment (10353)
4.3.2.5.2 Perform advanced process control 4.4.3.2 Receive, inspect, and store inbound deliveries
(19568) (10354)
4.3.2.5.3 Perform real-time optimization (19569) 4.4.3.3 Track product availability (10355)
4.3.2.5.4 Manage plant alarms and alerts 4.4.3.4 Pick, pack, and ship product for delivery (10356)
(19570) 4.4.3.5 Track inventory accuracy (10357)
4.3.2.6 Assess production performance (10314) 4.4.3.6 Track third-party logistics storage and shipping
4.3.3 Perform quality testing (10369) performance (10358)
4.3.3.1 Calibrate test equipment (10318) 4.4.3.7 Manage physical finished goods inventory (10359)
4.3.3.2 Perform testing using the standard testing 4.4.3.8 Manage warehouse transfers (20957)
procedure (10374) 4.4.4 Operate outbound transportation (10341)
4.3.3.3 Manage quality samples (20956) 4.4.4.1 Plan, transport, and deliver outbound product
4.3.3.4 Record test results (10375) (10360)
4.3.3.5 Track and analyze non-conformance trends (12045) 4.4.4.2 Track carrier delivery performance (10361)
4.3.3.6 Perform root cause analysis (12046) 4.4.4.3 Manage transportation fleet (10362)
4.3.4 Maintain production records and manage lot traceability 4.4.4.4 Process and audit carrier invoices and documents
(10370) (10363)
5.0 Deliver Service (20590)
5.1 Manage health care delivery (17115) 5.2.3.1 Process encounter information (17161)
5.1.1 Generate medical informatics (17116) 5.2.3.2 Process capitation reimbursement (17162)
5.1.1.1 Perform existing network analysis (17117) 5.2.3.3 Process and reconcile specialized reimbursements
(17163)
5.1.1.2 Perform gap in care analysis (17118)
5.2.4 Perform medical management (17164)
5.1.1.3 Perform service and procedure analysis (17119)
5.2.4.1 Conduct utilization management (17165)
5.1.2 Perform health program management (17120)
5.2.4.2 Perform case management and disease
5.1.2.1 Manage health programs (17121)
management with members (17166)
5.1.2.2 Develop health management programs (17122)
5.2.4.3 Perform referral management for members
5.1.2.3 Manage health program enrollment (17123) (17167)
5.1.2.4 Perform health program analytics (17124) 5.2.4.4 Promote wellness and patient education (17168)
5.1.2.5 Deliver health programs (17125) 5.2.5 Manage service provider relationships (17169)
5.1.3 Perform medical policy management (17126) 5.2.5.1 Manage provider relationships and loyalty (17170)
5.1.3.1 Develop medical policy rules (17127) 5.2.5.2 Manage provider inquiry intake (17171)
5.1.3.2 Monitor medical policy (17128) 5.2.5.3 Perform provider research and resolve inquiries
5.1.3.3 Review medical policy appeal (17129) (17172)
5.1.4 Perform utilization management (17130) 5.2.5.4 Provide orientation, education, and feedback to
5.1.4.1 Manage prior-authorizations/pre-certify (17131) providers (17173)
5.1.4.2 Manage provider referral (17132) 5.2.6 Conduct provider performance management (17174)
5.1.4.3 Enforce medical policy (17133) 5.2.6.1 Coach and train providers (17175)
5.2 Support healthcare management (17134) 5.2.6.2 Terminate Provider contracts (17176)
5.2.6.3 Manage Provider service quality (17177)
5.2.1
Develop healthcare management policy, planning, and
strategy (17135) 5.2.7 Communicate with providers (17178)
5.2.1.1 Develop and maintain contracting and 5.2.7.1 Manage provider communication campaigns
reimbursement policies (17136) (17179)
5.2.1.2 Develop and maintain medical policies (17137) 5.2.7.2 Manage provider requests (17180)
5.2.1.3 Develop and maintain network strategy and 5.2.8 Conduct pharmacy benefit management (17181)
plan (17138) 5.2.8.1 Review member drug utilization (17182)
5.2.1.4 Develop contracting standards (17139) 5.2.8.2 Manage drug Formulary (17183)
5.2.1.5 Manage contract templates (17140) 5.2.8.3 Negotiate formulary rebate (17184)
5.2.1.6 Build and maintain standard fee schedules 5.2.8.4 Perform Mail order pharmacy with members
(17141) (17185)
5.2.1.7 Manage provider rate sheets (17142) 5.3 Adjudicate claims and process reimbursement (17186)
5.2.2 Develop and manage the network (17143) 5.3.1 Develop claim/encounter informatics (17187)
5.2.2.1 Identify and recruit providers (17144) 5.3.1.1 Manage and report on claim processing activity
5.2.2.2 Credential and re-credential providers (17145) (17188)
5.2.2.3 Negotiate and contract with providers (17146) 5.3.1.2 Manage quality assurance and auditing
5.2.2.4 Profile providers (17147) procedures (17189)
5.2.2.5 Manage provider practice/group arrangements 5.3.1.3 Manage critical inquiry process and appeals
(17148) (17190)
5.2.2.6 Assemble provider market intelligence (17149) 5.3.2 Adjudicate claims (17191)
5.2.2.7 Assemble provider performance indicators (17150) 5.3.2.1 Determine coverage/benefits (17192)
5.2.2.8 Manage and monitor providers (17151) 5.3.2.2 Perform clinical editing (17193)
5.2.2.9 Manage revenue cycle (17152) 5.3.2.3 Determine covered service (17194)
5.2.2.10 Develop provider communications (17153) 5.3.2.4 Determine eligibility (17195)
5.2.2.11 Educate and train providers (17154) 5.3.3 Process intake of claims (17196)
5.2.2.12 Maintain provider data and directories (17155) 5.3.3.1 Enter paper claims into claims system (17197)
5.2.2.13 Manage quality and performance of the 5.3.3.2 Enter OCR claims into claims system (17198)
network management process (17156) 5.3.3.3 Enter electronic claims into claims system (17199)
5.2.2.14 Manage ancillary services (17157) 5.3.3.4 Enter interactive claims into claims system
5.2.2.15 Manage lab services (17158) (17200)
5.2.2.16 Manage other ancillary services (17159) 5.3.3.5 Create claims imaging and record within claims
5.2.3 Perform pre-pay provider reimbursement (17160) system (17201)

5.3.3.6 Assign claim control ID (17202) 5.7.1.8 Measure forecast accuracy (20049)
5.3.3.7 Route claims for processing (17203) 5.7.2 Create and manage resource plan (20050)
5.3.3.8 Conduct pre-edit claims examination (17204) 5.7.2.1 Define and manage skills taxonomy (20051)
5.3.3.9 Validate claims (17205) 5.7.2.2 Create resource plan (20052)
5.3.4 Perform claim policy management (17206) 5.7.2.3 Match resource demand with capacity, skills,
5.3.4.1 Develop claim policy rules (17207) and capabilities (20053)
5.3.4.2 Monitor claim policy (17208) 5.7.2.4 Collaborate with suppliers and partners to
5.3.4.3 Review claim policy appeal (17209) supplement skills and capabilities (20054)
5.3.5 Communicate claim outcomes (17210) 5.7.2.5 Identify critical resources and supplier capacity
5.3.5.1 Generate remittance advise (17211) (20055)
5.3.5.2 Generate explanation of benefits (17212)
5.7.2.6 Monitor and manage resource capacity and
5.3.6 Perform benefits management (17213) availability (20056)
5.3.6.1 Provide benefits support (17214)
5.7.3 Enable service delivery resources (12127)
5.3.6.2 Provide benefits administration (17215)
5.7.3.1 Develop service delivery training plan (12128)
5.3.7 Prepare and process claims (17216)
5.7.3.2 Develop training materials (12129)
5.3.8 Process reimbursement and notification (17217)
5.3.9 Manage other party liabilities (17218) 5.7.3.3 Manage training schedule (12131)
5.7.3.4 Deliver operations training (12132)
5.4 Manage receipt and route of transactions (17219)
5.7.3.5 Deliver technical training (12133)
5.4.1 Process web-based transactions (17220)
5.7.3.6 Perform skill and capability testing (20057)
5.4.2 Process electronic data interchange (EDI) transactions
(17221) 5.7.3.7 Evaluate training effectiveness (12135)
5.4.3 Process paper transactions (mail room) (17222) 5.8 Deliver service to customer (20058)
5.5 Provide explanation of benefits to members (17223) 5.8.1 Initiate service delivery (20059)
5.6 Establish service delivery governance and strategies (20026) 5.8.1.1 Review contract and agreed terms (20060)
5.6.1 Establish service delivery governance (20027) 5.8.1.2 Understand customer requirements and define
5.6.1.1 Set up and maintain service delivery refine approach (20061)
governance and management system (20028) 5.8.1.3 Modify/revise and approve project plan (20062)
5.6.1.2 Manage service delivery performance (20029) 5.8.1.4 Review customer business objectives (20063)
5.6.1.3 Manage service delivery development and 5.8.1.5 Confirm environmental readiness (20064)
direction (20030) 5.8.1.6 Identify, select, and assign resources (20065)
5.6.1.4 Solicit feedback from customer on service
5.8.1.6.1 Establish people objectives (20066)
delivery satisfaction (20031)
5.6.2 Develop service delivery strategies (20032) 5.8.1.6.2 Establish engagement rules (20067)
5.6.2.1 Define service delivery goals (20033) 5.8.1.7 Plan for service delivery (20068)
5.6.2.2 Define labor policies (20034) 5.8.2 Execute service delivery (20069)
5.6.2.3 Evaluate resource availability (20035) 5.8.2.1 Analyze environment and customer needs (20070)
5.6.2.4 Define service delivery network and supply 5.8.2.2 Define solution (20071)
constraints (20036) 5.8.2.3 Validate solution (20072)
5.6.2.5 Define service delivery process (20037) 5.8.2.4 Identify changes (20073)
5.6.2.6 Review and validate service delivery procedures
(20038) 5.8.2.5 Obtain approval to proceed (20074)
5.6.2.7 Define service delivery workplace layout and 5.8.2.6 Make build/buy solution (20075)
infrastructure (20039) 5.8.2.7 Deploy solution (20076)
5.7 Manage service delivery resources (20040) 5.8.3 Complete service delivery (20077)
5.7.1 Manage service delivery resource demand (20041) 5.8.3.1 Conduct service delivery/project review and
5.7.1.1 Monitor pipeline (20042) evaluate success (20078)
5.7.1.2 Develop baseline forecasts (20043) 5.8.3.2 Complete/finalize financial management
5.7.1.3 Collaborate with customers (20044) activities (20079)
5.7.1.4 Develop consensus forecast (20045) 5.8.3.3 Confirm delivery according to contract terms
5.7.1.5 Determine availability of skills to deliver on (20080)
current and forecast customer orders (20046) 5.8.3.4 Release resources (20081)
5.7.1.6 Monitor activity against forecast and revise 5.8.3.5 Manage service delivery completion (20082)
forecast (20047) 5.8.3.6 Harvest knowledge (20083)
5.7.1.7 Evaluate and revise forecasting approach (20048)
5.8.3.7 Archive records and update systems (20084)
6.0 Manage Customer Service (17224)
6.1 Develop customer care/customer service strategy (10378) 6.2.4

Process returns (20094)
6.1.1
Define customer service requirements across the enterprise 6.2.4.1 Authorize return (10364)
(20086) 6.2.4.2 Process return and record reason (20095)
6.1.2 Define customer service experience (20087) 6.2.5 Report incidents and risks to regulatory bodies (12840)
6.1.3 Define and manage customer service channel strategy 6.2.6 Conduct correspondence management (17229)
(20088) 6.2.6.1 Track correspondence to case (17230)
6.1.4 Establish target service level for each customer segment 6.2.6.2 Retrieve correspondence image upon request
(10382) (17231)
6.1.5 Establish service levels for customers (10383) 6.2.7 Perform member outreach (17232)
6.1.6 Manage service protocols (17225) 6.2.7.1 Plan product information (17233)
6.1.6.1 Develop service policies and procedures (17226) 6.2.7.2 Provide wellness information to members (17234)
6.1.6.2 Manage service routing and workflow (17227) 6.2.8 Manage appeals and grievances (17235)
6.1.6.3 Manage documented service level agreements 6.2.8.1 Receive provider claims grievances (17236)
(17228)
6.2.8.2 Conduct provider claims appeals process (17237)
6.1.7 Define warranty offering (20089)
6.2.8.3 Receive member service grievances (17238)
6.1.7.1 Determine and document warranty policies
6.2.8.4 Conduct customer service grievances process
(16893)
(17239)
6.1.7.2 Create and manage warranty rules/claim codes
6.2.9 Perform membership inquiry/eligibility and coverage
for products (16890)
procedures (17240)
6.1.7.3 Agree on warranty responsibilities with
suppliers (20090) 6.2.10 Perform billing and payment support processes (17241)
6.1.7.4 Define warranty related offerings for customers 6.2.10.1 Request invoice by member (17242)
(20091) 6.2.10.2 Update billing and payment profile (17243)
6.1.7.5 Communicate warranty policies and offerings 6.2.10.3 Request payment status by member (17244)
(12673) 6.2.10.4 Send payment reminder to member (17245)
6.1.8 Develop recall strategy (20092) 6.2.11 Maintain nurse line help desk (17246)
6.2 Plan and manage customer service contacts (10379) 6.2.11.1 Provide wellness support to members (17247)
6.2.1 Plan and manage customer service work force (10387) 6.2.11.2 Supply pre-PCP visit support (17248)
6.2.1.1 Forecast volume of customer service contacts 6.2.12 Perform service analytics (17249)
(10390) 6.3 Manage customer relationships and billing (17250)
6.2.1.2 Schedule customer service work force (10391) 6.3.1 Create account paperwork (17251)
6.2.1.3 Track work force utilization (10392) 6.3.2 Manage account relationships (17252)
6.2.1.4 Monitor and evaluate quality of customer 6.3.3 Account member setup and maintenance (17253)
interactions with customer service
6.3.3.1 Manage account and member setup (17254)
representatives (10393)
6.2.2 Manage customer service problems, requests, and inquiries 6.4 Maintain member relationships and inquires (17255)
(10388) 6.4.1 Manage member relationships and loyalty (17256)
6.2.2.1 Receive customer problems, requests, and 6.4.2 Manage member inquiry intake (17257)
inquiries (10394) 6.4.3 Perform research and resolve inquiries (17258)
6.2.2.2 Analyze problems, requests, and inquiries (13482) 6.4.4 Perform tracking, follow-up, and reporting (17259)
6.2.2.3 Resolve customer problems, requests, and
inquiries (10395) 6.5 Service products after sales (12658)
6.2.2.4 Respond to customer problems, requests, and 6.5.1 Register products (20605)
inquiries (10396) 6.5.2 Process warranty claims (12669)
6.2.2.5 Identify and capture upsell/cross-sell 6.5.2.1 Receive warranty claim (20096)
opportunities (16928) 6.5.2.2 Validate warranty claim (12671)
6.2.2.6 Deliver opportunity to sales team (16937) 6.5.2.3 Investigate warranty issues (20097)
6.2.3 Manage customer complaints (10389) 6.5.2.3.1 Define issue (20098)
6.2.3.1 Receive customer complaints (10397) 6.5.2.3.2 Investigate issue/perform root cause
6.2.3.2 Route customer complaints (10398) analysis (20099)
6.2.3.3 Resolve customer complaints (10399) 6.5.2.3.3 Receive investigation result/
6.2.3.4 Respond to customer complaints (10400) recommendation for corrective
6.2.3.5 Analyze customer complaints and response/ action (20100)
redressal (19072) 6.5.2.4 Determine responsible party (20101)
6.5.2.5 Manage preauthorizations (20102) 6.6.6 Manage recall termination (20116)
6.5.2.6 Approve or reject warranty claim (12668) 6.7 Evaluate customer service operations and customer
6.5.2.7 Notify originator of approve/reject decision satisfaction (20595)
(20103)
6.5.2.8 Authorize payment (20104) 6.7.1
Measure customer satisfaction with customer problems,
6.5.2.9 Close claim (20105) requests, and inquiries handling (10401)
6.5.2.10 Reconcile warranty transaction disposition (12667) 6.7.2 Solicit customer feedback on customer service experience
6.5.3 Manage supplier recovery (20106) (11687)
6.5.3.1 Create supplier recovery claims (20107) 6.7.3 Analyze customer service data and identify improvement
6.5.3.2 Negotiate recoveries with suppliers (20108) opportunities (11688)
6.5.4 Service products (10218) 6.7.4 Provide customer feedback to product management on
6.5.4.1 Confirm specific service requirements for customer service experience (18126)
individual customer (10320) 6.7.5 Measure customer satisfaction with customer- complaint
6.5.4.1.1 Process customer request (10324) handling and resolution (10402)
6.5.4.1.2 Create customer profile (10325) 6.7.5.1 Solicit customer feedback on complaint handling
6.5.4.1.3 Generate service order (10326) and resolution (11236)
6.5.4.2 Identify and schedule resources to meet service 6.7.5.2 Analyze customer complaint data and identify
requirements (10321) improvement opportunities (11237)
6.5.4.2.1 Create resourcing plan and schedule 6.7.5.3 Identify common customer complaints (11689)
(10327)
6.7.6 Measure customer satisfaction with products and services
6.5.4.2.2 Create service order fulfillment
schedule (10328) (10403)
6.5.4.3 Provide service to specific customers (10322) 6.7.6.1 Gather and solicit post-sale customer feedback
6.5.4.3.1 Organize daily service order on products and services (11238)
fulfillment schedule (10330) 6.7.6.2 Solicit post-sale customer feedback on ad
6.5.4.3.2 Execute product repair (10331) effectiveness (11239)
6.5.4.3.3 Manage service order fulfillment 6.7.6.3 Solicit customer feedback on cross-channel
(10332) experience (20117)
6.5.4.4 Ensure quality of service (10323) 6.7.6.4 Analyze product and service satisfaction data
6.5.4.4.1 Identify completed service orders for and identify improvement opportunities (11240)
feedback (10334)
6.7.6.5 Provide feedback and insights to appropriate
6.5.4.4.2 Identify incomplete service orders
teams (product design/development, marketing,
and service failures (10335)
manufacturing) (11241)
6.5.4.4.3 Solicit customer feedback on
services delivered (10336) 6.7.7 Evaluate and manage warranty performance (12672)
6.5.4.4.4 Process customer feedback on 6.7.7.1 Measure customer satisfaction with warranty
services delivered (10337) handling and resolution (20118)
6.6 Manage product recalls and regulatory audits (20110) 6.7.7.2 Monitor and report on warranty management
6.6.1 Initiate recall (20111) metrics (12676)
6.6.2 Assess the likelihood and consequences of occurrence of 6.7.7.3 Identify improvement opportunities (20119)
any hazards (20112) 6.7.7.4 Identify opportunities to eliminate warranty
6.6.3 Manage recall related communications (20113) waste (12674)
6.6.4 Submit regulatory reports (20114) 6.7.7.5 Investigate fraudulent claims (20120)
6.6.5 Monitor and audit recall effectiveness (20115) 6.7.8 Evaluate recall performance (20121)

7.0 Develop and Manage Human Capital (10007)
7.1 Develop and manage human resources planning, policies, 7.2.1.7 Manage requisition dates (10452)
and strategies (17043) 7.2.2 Recruit/Source candidates (10440)
7.1.1 Develop human resources strategy (20958) 7.2.2.1 Determine recruitment methods and channels
7.1.1.1 Identify strategic HR needs (10418) (10453)
7.1.1.2 Define HR and business function roles and 7.2.2.2 Perform recruiting activities/events (10454)
accountability (10419) 7.2.2.3 Manage recruitment vendors (10455)
7.1.1.3 Determine HR costs (10420) 7.2.2.4 Manage employee referral programs (17047)
7.1.1.4 Establish HR measures (10421) 7.2.2.5 Manage recruitment channels (17048)
7.1.1.5 Communicate HR strategies (10422) 7.2.3 Screen and select candidates (20123)
7.1.1.6 Develop strategy for HR systems/technologies/ 7.2.3.1 Identify and deploy candidate selection tools
tools (10432) (10456)
7.1.1.7 Manage employer branding (20606) 7.2.3.2 Interview candidates (10457)
7.1.2 Develop and implement workforce strategy and policies 7.2.3.3 Test candidates (10458)
(17045) 7.2.3.4 Select and reject candidates (10459)
7.1.2.1 Gather skill requirements according to corporate 7.2.4 Manage new hire/re-hire (10443)
strategy and market environment (10423) 7.2.4.1 Draw up and make offer (10463)
7.1.2.2 Plan employee resourcing requirements per 7.2.4.2 Negotiate offer (10464)
business unit/organization (10424) 7.2.4.3 Hire candidate (10465)
7.1.2.3 Develop compensation plan (10425) 7.2.5 Manage applicant information (10444)
7.1.2.3.1 Establish incentive plan (10210) 7.2.5.1 Obtain candidate background information (10460)
7.1.2.4 Develop succession plan (10426) 7.2.5.2 Create applicant record (10466)
7.1.2.5 Develop high performers/leadership programs 7.2.5.3 Manage/track applicant data (10467)
(16938) 7.2.5.3.1 Complete position classification and
7.1.2.6 Develop employee diversity plan (10427) level of experience (20124)
7.1.2.7 Develop training program (11622) 7.2.5.4 Archive and retain records of non-hires (10468)
7.1.2.8 Develop recruitment program (11623) 7.3 Manage employee on-boarding, development, and
7.1.2.9 Develop other HR programs (10428) training (20599)
7.1.2.10 Develop HR policies (10429) 7.3.1 Manage employee orientation and deployment (10469)
7.1.2.11 Administer HR policies (10430) 7.3.1.1 Create/maintain employee on-boarding program
7.1.2.12 Plan employee benefits (10431) (10474)
7.1.2.13 Develop workforce strategy models (10433) 7.3.1.1.1 Develop employee induction program
7.1.2.14 Implement workforce strategy models (20122) (10477)
7.1.3 Monitor and update strategy, plans, and policies (10417) 7.3.1.1.2 Maintain/Update employee
7.1.3.1 Measure realization of objectives (10434) induction program (10478)
7.1.3.2 Measure contribution to business strategy (10435) 7.3.1.2 Evaluate the effectiveness of the employee
on-boarding program (11243)
7.1.3.3 Communicate plans and provide updates to
stakeholders (10436) 7.3.1.3 Execute on-boarding program (17050)
7.1.3.4 Review and revise HR plans (10438) 7.3.2 Manage employee performance (10470)
7.1.4 Develop competency management models (17046) 7.3.2.1 Define employee performance objectives (10479)
7.3.2.2 Review, appraise, and manage employee
7.2 Recruit, source, and select employees (10410)
performance (10480)
7.2.1 Manage employee requisitions (10439) 7.3.2.3 Evaluate and review performance program (10481)
7.2.1.1 Align staffing plan to work force plan and 7.3.3 Manage employee development (10472)
business unit strategies/resource needs (10445)
7.3.3.1 Define employee development guidelines (10487)
7.2.1.2 Develop and maintain job descriptions (10447) 7.3.3.2 Develop employee career plans and career
7.2.1.3 Open job requisitions (10446) paths (10488)
7.2.1.4 Post job requisitions (10448) 7.3.3.3 Manage employee skill and competency
7.2.1.5 Modify job requisitions (10450) development (17051)
7.2.1.6 Notify hiring manager (10451) 7.3.4 Develop and train employees (10473)
7.3.4.1 Align employee with organization development 7.5.2.2 Administer benefit enrollment (10505)
needs (10490) 7.5.2.3 Process claims (10506)
7.3.4.2 Define employee competencies (16940) 7.5.2.4 Perform benefit reconciliation (10507)
7.3.4.3 Align learning programs with competencies 7.5.3 Manage employee assistance and retention (10496)
(10491) 7.5.3.1 Deliver programs to support work/life balance
7.3.4.4 Establish training needs by analysis of required for employees (10508)
and available skills (10492) 7.5.3.2 Develop family support systems (10509)
7.3.4.5 Develop, conduct, and manage employee and/ 7.5.3.3 Review retention and motivation indicators
or management training programs (10493) (10510)
7.3.4.6 Manage examinations and certifications (20125) 7.5.3.4 Review compensation plan (10511)
7.3.4.6.1 Liaise with external certification 7.5.4 Administer payroll (10497)
authorities (20126)
7.6 Redeploy and retire employees (10413)
7.3.4.6.2 Administer certification tests (20127)
7.6.1 Manage promotion and demotion process (10512)
7.3.4.6.3 Appraise experience qualifications
(20128) 7.6.2 Manage separation (10513)
7.3.4.6.4 Administer certificate issue and 7.6.3 Manage retirement (10514)
maintenance (20129) 7.6.4 Manage leave of absence (10515)
7.6.5 Develop and implement employee outplacement (10516)
7.4 Manage employee relations (17052)
7.6.6 Manage workforce scheduling (20132)
7.4.1 Manage labor relations (10483)
7.6.6.1 Receive required resources/skills and capabilities
7.4.2 Manage collective bargaining process (10484) (20133)
7.4.3 Manage labor management partnerships (10485) 7.6.6.2 Manage resource deployment (10517)
7.4.4 Manage employee grievances (10531) 7.6.7 Relocate employees and manage assignments (17055)
7.5 Reward and retain employees (10412) 7.6.7.1 Manage expatriates (10520)
7.5.1 Develop and manage reward, recognition, and motivation 7.7 Manage employee information and analytics (17056)
programs (10494) 7.7.1 Manage reporting processes (10522)
7.5.1.1 Develop salary/compensation structure and 7.7.2 Manage employee inquiry process (10523)
plan (10498)
7.7.3 Manage and maintain employee data (10524)
7.5.1.2 Develop benefits and rewards plan (10499)
7.7.4 Manage human resource information systems HRIS (10525)
7.5.1.3 Perform competitive analysis of benefits and 7.7.5 Develop and manage employee metrics (10526)
rewards (10500)
7.7.6 Develop and manage time and attendance systems (10527)
7.5.1.4 Identify compensation requirements based on
7.7.7 Manage/Collect employee suggestions and perform
financial, benefits, and HR policies (10501)
employee research (10530)
7.5.1.5 Administer compensation and rewards to
employees (10502) 7.8 Manage employee communication (17057)
7.5.1.6 Reward and motivate employees (10503) 7.8.1 Develop employee communication plan (10529)
7.5.2 Manage and administer benefits (10495) 7.8.2 Conduct employee engagement surveys (16944)
7.5.2.1 Deliver employee benefits program (10504) 7.9 Deliver employee communications (10532)

8.0 Manage Information Technology (IT) (20607)
8.1 Develop and manage IT customer relationships (20608) 8.1.7.4 Synthesize and distribute IT performance
8.1.1 Understand IT customer needs (20609) information (20938)
8.1.1.1 Understand IT customer communities (20610) 8.2 Develop and manage IT business strategy (20652)
8.1.1.2 Assess IT customer operational capabilities 8.2.1
Define business technology and governance strategy
(20611) (20653)
8.1.2 Identify IT customer transformation needs (20612) 8.2.1.1 Build and maintain IT strategic intelligence
8.1.2.1 Understand business requirements for IT (20654)
capabilities (20613) 8.2.1.2 Monitor and map current and emerging
8.1.2.2 Understand IT landscape(20614) technologies (20655)
8.1.2.3 Develop IT visioning (20615) 8.2.1.3 Define and communicate digital transformation
8.1.2.4 Outline IT service expectations (20616) strategy (20656)
8.1.3 Plan and communicate IT services (20617) 8.2.1.4 Develop IT strategic alignment (20657)
8.1.3.1 Manage IT customer expectations (20618) 8.2.1.5 Articulate IT alignment principles (20658)
8.1.3.2 Define future IT services (20619) 8.2.1.6 Maintain IT strategic alignment (20659)
8.1.3.3 Determine IT performance indicators (20620) 8.2.2 Manage IT portfolio strategy (20660)
8.1.3.4 Create IT marketing messages (20621) 8.2.2.1 Establish and validate IT value criteria (20661)
8.1.3.5 Create IT service marketing plan (20622) 8.2.2.2 Determine IT portfolio investment balance
8.1.4 Provide IT transformation guidance (20623) (20662)
8.1.4.1 Develop IT transformation plans (20624) 8.2.2.3 Evaluate proposed IT investment projects (20663)
8.1.4.2 Collect IT customer requirements (20625) 8.2.2.4 Prioritize IT projects (20664)
8.1.4.3 Analyze IT customer requirements (20937) 8.2.2.5 Align IT resources to strategic priorities (20665)
8.1.4.4 Identify and prioritize IT opportunities (20626) 8.2.2.6 Align IT portfolio to business objectives (20667)
8.1.4.5 Facilitate solution design activities (20627) 8.2.3 Define and maintain enterprise architecture (20668)
8.1.4.6 Prioritize IT outcomes (20628) 8.2.3.1 Create and publish enterprise architecture
8.1.4.7 Develop business cases (20629) principles (20670)
8.1.4.8 Support business case (20630) 8.2.3.2 Establish and operate enterprise architecture
governance (20671)
8.1.4.9 Develop transformation roadmap (20631)
8.2.3.3 Research technologies to innovate IT services
8.1.5 Develop and manage IT service levels (20632)
and solutions (20672)
8.1.5.1 Understand IT service requirements (20633)
8.2.3.4 Provide input to definition and prioritization of
8.1.5.2 Forecast IT service demand (20634) IT projects (20673)
8.1.5.3 Maintain IT services catalog (20635) 8.2.4 Define IT service management strategy (20674)
8.1.5.4 Define service level agreement (20636) 8.2.4.1 Establish IT service management strategy and
8.1.5.5 Maintain IT customer contracts (20637) goals (20675)
8.1.5.6 Negotiate and establish service level 8.2.4.2 Identify IT service operating and process
agreements (20638) requirements (20676)
8.1.5.7 Develop and maintain improvement processes 8.2.4.3 Define IT service catalog (20677)
(20640) 8.2.4.4 Establish IT service management framework
8.1.6 Manage IT customer relationships (20641) (20678)
8.1.6.1 Establish relationship management 8.2.4.5 Define and implement IT service management
mechanisms (20642) (20679)
8.1.6.2 Understand IT customer strategy (20643) 8.2.4.6 Define and deploy support service management
8.1.6.3 Understand IT customer environment (20644) process tools and methods (20680)
8.1.6.4 Communicate IT capabilities (20645) 8.2.4.7 Monitor and report IT performance (20681)
8.1.6.5 Manage IT requirements (20646) 8.2.5 Control IT management system (20682)
8.1.7 Analyze service performance (20648) 8.2.5.1 Determine IT performance measures (20683)
8.1.7.1 Assess SLA compliance (20649) 8.2.5.2 Define IT control points and assurance
8.1.7.2 Triage SLA compliance issues (20650) procedures governance model (20684)
8.1.7.3 Collect feedback about IT products and services 8.2.5.3 Monitor and analyze overall IT performance
(20647) (20685)
8.2.5.4 Monitor and analyze IT financial performance 8.3.3.1 Evaluate enterprise regulatory and compliance
(20686) obligations (20722)
8.2.5.5 Monitor and analyze IT value and benefits 8.3.3.2 Analyze IT security threat impact (20723)
(20687) 8.3.3.3 Create and maintain IT compliance
8.2.5.6 Optimize IT resource allocation (20688) requirements (20724)
8.2.5.7 Manage IT projects and services 8.3.3.4 Create and maintain IT security policies,
interdependencies (20689) standards, and procedures (20942)
8.2.5.8 Report IT service and project performance 8.3.3.5 Develop and deploy risk management training
(20690) (20725)
8.2.5.9 Select, deploy, and operate IT performance 8.3.3.6 Establish risk reporting capabilities and
analytics tools (20692) responsibilities (20726)
8.2.6 Manage IT value portfolio (20693) 8.3.3.7 Establish communication standards (20727)
8.2.6.1 Assess performance against IT service and 8.3.3.8 Conduct IT risk and threat assessments (20728)
project value criteria (20694) 8.3.3.9 Monitor and manage IT activity risk (20729)
8.2.6.2 Quantify value of IT service and project 8.3.3.10 Identify, supervise and monitor IT risk
portfolio investments (20695) mitigation measures (20730)
8.2.6.3 Communicate business technology value 8.3.4 Plan and manage IT continuity (20731)
contribution (20696)
8.3.4.1 Evaluate IT continuity (20732)
8.2.6.4 Determine and implement IT portfolio
8.3.4.2 Identify IT continuity gaps (20733)
adjustments (20697)
8.3.4.3 Manage IT business continuity (20734)
8.2.7 Define and manage technology innovation (20699)
8.3.5 Develop and manage IT security, privacy, and data
8.2.7.1 Establish selection criteria for research
protection (20735)
initiatives (20700)
8.3.5.1 Assess IT regulatory and confidentiality
8.2.7.2 Analyze emerging technology concepts (20701)
requirements and policies (20736)
8.2.7.3 Identify technology concepts and capabilities
8.3.5.2 Create IT security, privacy, and data protection
(20702)
risk governance (20737)
8.2.7.4 Execute IT research projects (20703)
8.3.5.3 Define IT data security and privacy policies,
8.2.7.5 Evaluate IT research project outcomes (20939) standards, and procedures (20738)
8.2.7.6 Identify and promote viable concepts (20704) 8.3.5.4 Review and monitor physical and logical IT
8.2.7.7 Develop and plan IT investment projects data security measures (20739)
(20705) 8.3.5.5 Review and monitor application security
8.3 Develop and manage IT resilience and risk (20706) controls (20740)
8.3.1 Develop IT compliance, risk, and security strategy (20707) 8.3.5.6 Review and monitor IT physical environment
8.3.1.1 Determine and evaluate IT regulatory and audit security controls (20741)
requirements (20708) 8.3.5.7 Monitor/analyze network intrusion detection
8.3.1.2 Understand business unit risk tolerance (20940) data and resolve threats (20742)
8.3.1.3 Establish IT risk tolerance (20709) 8.3.6 Conduct and analyze IT compliance assessments (20743)
8.3.1.4 Establish risk ownership (20710) 8.3.6.1 Conduct projects to enhance IT compliance and
remediate risk (20744)
8.3.1.5 Establish and maintain risk management roles
(20711) 8.3.6.2 Conduct IT compliance control auditing of
internal and external services (20745)
8.3.1.6 Establish compliance objectives (20712)
8.3.6.3 Perform IT compliance reporting (20746)
8.3.1.7 Identify systems to support compliance (20941)
8.3.6.4 Identify and escalate IT compliance issues and
8.3.1.8 Identify and evaluate IT risk (20713)
remediation requirements (20747)
8.3.1.9 Evaluate IT-related risks resiliency (20714)
8.3.6.5 Support external audits and reports (20748)
8.3.1.10 Create IT risk mitigation strategies and
8.3.7 Develop and execute IT resilience and continuity
approaches (20715)
operations (20749)
8.3.2 Develop IT resilience strategy (20716)
8.3.7.1 Conduct IT resilience improvement projects
8.3.2.1 Determine IT delivery resiliency (20717) (20750)
8.3.2.2 Determine critical IT risks (20718) 8.3.7.2 Develop, document, and maintain IT business
8.3.2.3 Prioritize IT risks (20719) continuity planning (20751)
8.3.2.4 Establish mitigation approaches for IT risks (20720) 8.3.7.3 Implement and enforce change control
8.3.3 Control IT risk, compliance, and security (20721) procedures (20752)

8.3.7.4 Execute recurring IT service provider business 8.5.1.1 Determine IT service/solution development
continuity (20753) (20786)
8.3.7.5 Provide IT resilience training (20754) 8.5.1.2 Define IT service/solution development
8.3.7.6 Execute recurring IT business operations processes/standards (20787)
continuity (20755) 8.5.1.3 Identify, deploy, and support development
8.3.8 Manage IT user identity and authorization (20756) methodologies and tools (20788)
8.3.8.1 Support integration of identity and 8.5.1.4 Establish service component criteria (20789)
authorization policies (20757) 8.5.1.5 Understand and select reusable service
8.3.8.2 Manage IT user directory (20758) components (20790)
8.3.8.3 Manage IT user authorization (20759) 8.5.1.6 Maintain service component portfolio (20791)
8.3.8.4 Manage IT user authentication mechanisms 8.5.1.7 Establish development standards exception
(20760) governance (20792)
8.3.8.5 Audit IT user identity and authorization systems 8.5.2 Manage service/solution lifecycle planning (20793)
(20761) 8.5.2.1 Monitor and track emerging technology
8.3.8.6 Respond to IT information security and network capabilities (20794)
breaches (20762) 8.5.2.2 Identify IT services/solutions (20795)
8.3.8.7 Conduct penetration testing (20763) 8.5.2.3 Determine IT service/solution approach (20796)
8.3.8.8 Audit integration of user identity and 8.5.2.4 Define IT solution lifecycle (20797)
authorization systems (20764) 8.5.2.5 Develop IT service/solution “sunset” plans
8.4 Manage information (20765) (20798)
8.5.3 Develop and manage service/solution architecture (20799)
8.4.1 Define business information and analytics strategy (20766)
8.5.3.1 Assess IT application and infrastructure
8.4.1.1 Establish data, information, and analytic
architecture constraints (20800)
objectives (20767)
8.5.3.2 Assess business constraints on IT service/
8.4.1.2 Establish data, information, and analytic
solution (20801)
governance (20768)
8.5.3.3 Determine IT component integration
8.4.1.3 Access IT data/analytic capabilities (20769)
8.4.2 Define and maintain business information architecture
8.5.3.4 Identify opportunities for IT component reuse
(20770)
(20803)
8.4.2.1 Determine enterprise business information
8.5.3.5 Promote adoption of existing service/solution
architecture (20804)
8.4.2.2 Define enterprise data models (20772)
8.5.3.6 Develop and maintain service/solution
8.4.2.3 Identify and understand external data sources
architectures (20805)
(20773)
8.5.3.7 Assess IT service/solution architecture
8.4.2.4 Establish data ownership and stewardship
conformance (20806)
responsibilities (20774)
8.5.3.8 Manage architectural exceptions (20807)
8.4.2.5 Maintain and evolve enterprise data and
8.5.4 Execute IT service/solution creation and testing (20808)
information architecture (20775)
8.5.4.1 Execute IT service/solution development
8.4.3 Define and execute business information lifecycle
lifecycle (20809)
planning and control (20776)
8.5.4.1.1 Assess and validate IT service/
8.4.3.1 Define and maintain enterprise information
solution requirements (20810)
policies, standards, and procedures (20777)
8.5.4.1.2 Create service/solution design (20811)
8.4.3.2 Implement and execute data administration
responsibilities (20778) 8.5.4.1.3 Build and test IT service/solution
components (20812)
8.4.4 Manage business information content (20779)
8.5.4.1.4 Integrate IT components and
8.4.4.1 Monitor and control business information (20780)
services (20813)
8.4.4.2 Maintain business information feeds and
8.5.4.1.5 Execute IT service/solution
repositories (20781)
validation (20814)
8.4.4.3 Perform internal usage audits (20782)
8.5.4.1.6 Bundle service/solution deployment
8.4.4.4 Implement and administer business information
packaging (20815)
access (20783)
8.5.4.1.7 Manage service/solution process
8.5 Develop and manage services/solutions (20784) exceptions (20816)
8.5.1 Develop service/solution and integration strategy (20785) 8.5.5 Perform service/solution maintenance and testing (20817)
8.5.5.1 Execute IT service/solution maintenance 8.6.5 Perform service and solution rollout (20858)
lifecycle (20818) 8.6.5.1 Conduct IT training (20859)
8.5.5.1.1 Assess IT remediation (20819) 8.6.5.2 Prepare and distribute service/solution
8.5.5.1.2 Modify service/solution design (20820) communications (20860)
8.5.5.1.3 Perform IT service/solution 8.6.5.3 Support organizational changes (20861)
remediation (20821) 8.6.5.4 Execute rollout plans (20862)
8.5.5.1.4 Manage service/solution operations 8.6.5.5 Provide rollout support (20863)
(20822) 8.6.5.6 Manage rollout support capabilities (20864)
8.5.5.1.5 Prepare fixed/enhanced service/ 8.6.5.7 Monitor and record rollout issues (20865)
solution packaging (20823)
8.7 Create and manage support services/solutions (20866)
8.6 Deploy services/solutions (20824)
8.7.1 Define and establish service delivery strategy (20867)
8.6.1
Develop and manage service/solution deployment strategy
8.7.1.1 Assess business objectives and IT service
(20825)
delivery (20868)
8.6.1.1 Assess IT deployment business impact (20826)
8.7.1.2 Define IT service delivery portfolio (20869)
8.6.1.2 Establish IT deployment policies (20827)
8.7.1.3 Create and maintain IT service delivery model
8.6.1.3 Define and create deployment procedure (20870)
workflow (20828)
8.7.1.4 Determine IT service delivery locations and
8.6.1.4 Define IT change/release standards (20829) activities (20871)
8.6.1.5 Assign deployment approval responsibilities 8.7.1.5 Define IT service delivery sourcing strategy
(20830) (20872)
8.6.1.6 Analyze deployments outcomes (20831) 8.7.2 Define and develop service support strategy (20873)
8.6.2 Plan service and solution implementation (20832) 8.7.2.1 Assess business objectives and IT service
8.6.2.1 Assess IT deployment risk (20833) support delivery (20874)
8.6.2.2 Define implementation schedule and roll-out 8.7.2.2 Define IT service support portfolio (20875)
sequence (20834) 8.7.2.3 Create and maintain IT support model (20876)
8.6.2.3 Determine implementation requirements (20835) 8.7.2.4 Develop IT support service sourcing strategy
8.6.2.4 Plan and align user testing and resources (20836) (20877)
8.6.2.5 Develop IT training (20837) 8.7.2.5 Establish support service framework (20878)
8.6.2.6 Create implementation communications (20838) 8.7.2.6 Provide service support tools and technology
8.6.2.7 Manage IT roll-back procedures (20839) (20879)
8.6.3 Manage change deployment control (20840) 8.7.3 Plan and manage service delivery control (20880)
8.6.3.1 Asses IT change/release impact (20841) 8.7.3.1 Plan operational activities for IT service
8.6.3.2 Confirm change/release compliance (20842) delivery (20881)
8.6.3.3 Assess IT change/release risk (20843) 8.7.3.1.1 Schedule service delivery resources
8.6.3.4 Consolidate IT change (20844) (20882)
8.6.3.5 Create and communicate deployment schedule 8.7.3.1.2 Maintain/optimize batch job
(20845) schedule (20883)
8.6.3.6 Approve change/release deployment (20846) 8.7.3.1.3 Schedule change/release windows
(20884)
8.6.3.7 Document IT change/release outcome (20847)
8.7.3.1.4 Schedule/optimize backup and
8.6.4 Implement technology solutions (20848)
archive activities (20885)
8.6.4.1 Confirm hardware/software operational status
8.7.3.1.5 Balance operational workloads
(20849)
across available infrastructure
8.6.4.2 Confirm operational availability (20850) components (20886)
8.6.4.3 Execute internal IT implementation plan (20851) 8.7.3.1.6 Determine specific problem support
8.6.4.4 Confirm implementation completion (20852) procedures (20887)
8.6.4.5 Implement software change/release (20853) 8.7.4 Develop and manage infrastructure resource planning
8.6.4.6 Perform post-installation testing (20854) (20888)
8.6.4.7 Distribute software components network-wide 8.7.4.1 Develop IT service delivery strategy (20889)
(20855) 8.7.4.2 Assess IT infrastructure business objectives
8.6.4.8 Verify change/release implementation success (20890)
(20856) 8.7.4.3 Determine ongoing IT infrastructure capabilities
8.6.4.9 Execute roll-back plan (20857) (20891)

8.7.4.4 Plan IT infrastructure change (20892) 8.7.6.5 Respond to unplanned operational issues (20910)
8.7.4.5 Plan and budget IT license usage volumes (20893) 8.7.6.6 Produce and distribute output media (20911)
8.7.5 Define service support planning (20895) 8.7.6.7 Monitor IT infrastructure security (20912)
8.7.5.1 Understand IT support demand patterns (20896) 8.7.6.8 Manage IT infrastructure/data recovery (20913)
8.7.5.2 Determine required support resource levels, 8.7.7 Manage infrastructure resource administration (20914)
responsibilities, and capabilities (20897)
8.7.7.1 Manage infrastructure configuration (20915)
8.7.5.3 Maintain service support knowledge repository
8.7.7.2 Perform infrastructure component maintenance
(20898)
(20916)
8.7.5.4 Maintain service support learning (20943)
8.7.7.3 Install/configure/upgrade infrastructure
8.7.5.5 Communicate service support needs (20899)
components (20917)
8.7.5.6 Define IT escalation mechanisms (20900)
8.7.7.4 Maintain IT asset records (20918)
8.7.5.7 Manage IT service support resources (20901)
8.7.7.5 Administer IT licenses/user agreements (20919)
8.7.5.8 Coordinate with external support providers
(20902) 8.7.7.6 Provide IT infrastructure service and capabilities
(20920)
8.7.5.9 Triage IT service delivery incidents (20903)
8.7.5.10 Monitor IT service support performance (20904) 8.7.8 Operate IT user support (20921)
8.7.6 Develop and manage service delivery operations (20905) 8.7.8.1 Triage IT issues/requests (20922)
8.7.6.1 Operate and monitor online systems (20906) 8.7.8.2 Provide IT resolution capabilities (20923)
8.7.6.2 Run and monitor batch job schedule (20907) 8.7.8.3 Manage IT user requests (20925)
8.7.6.3 Manage service delivery workloads (20908) 8.7.8.4 Escalate IT requests (20926)
8.7.6.4 Manage infrastructure performance and 8.7.8.5 Resolve IT issues/requests (20927)
capacity (20909) 8.7.8.6 Execute IT continuity and recovery action (20928)
9.0 Manage Financial Resources (17058)
9.1 Perform planning and management accounting (10728) 9.2.3.2 Receive/Deposit customer payments (10800)
9.1.1 Perform planning/budgeting/forecasting (10738) 9.2.3.3 Apply cash remittances (10801)
9.1.1.1 Develop and maintain budget policies and 9.2.3.4 Prepare AR reports (10802)
procedures (10771) 9.2.3.5 Post AR activity to the general ledger (10803)
9.1.1.2 Prepare periodic budgets and plans (10772) 9.2.4 Manage and process collections (10745)
9.1.1.3 Operationalize and implement plans to achieve 9.2.4.1 Establish policies for delinquent accounts (10804)
budget (20135) 9.2.4.2 Analyze delinquent account balances (10805)
9.1.1.4 Prepare periodic financial forecasts (10773) 9.2.4.3 Correspond/Negotiate with delinquent accounts
9.1.1.5 Perform variance analysis against forecasts and (10806)
budgets (20136) 9.2.4.4 Discuss account resolution with internal parties
9.1.2 Perform cost accounting and control (10739) (10807)
9.1.2.1 Perform inventory accounting (10774) 9.2.4.5 Process adjustments/write off balances (10808)
9.1.2.2 Perform profit center accounting (14057) 9.2.4.6 Perform recovery workout (14007)
9.1.2.3 Perform cost of sales analysis (10775) 9.2.4.7 Manage default accounts (14008)
9.1.2.4 Perform product costing (10776) 9.2.5 Manage and process adjustments/deductions (10746)
9.1.2.5 Perform variance analysis (10777) 9.2.5.1 Establish policies/procedures for adjustments
9.1.2.6 Report on profitability (11175) (10809)
9.1.3 Perform cost management (10740) 9.2.5.2 Analyze adjustments (10810)
9.1.3.1 Determine key cost drivers (10778) 9.2.5.3 Correspond/Negotiate with customer (10811)
9.1.3.2 Measure cost drivers (10779) 9.2.5.4 Discuss resolution with internal parties (10812)
9.1.3.3 Determine critical activities (10780) 9.2.5.5 Prepare chargeback invoices (10813)
9.1.3.4 Manage asset resource deployment and 9.2.5.6 Process related entries (10814)
utilization (10781) 9.2.6 Manage and Process Risk Adjustments (17285)
9.1.4 Evaluate and manage financial performance (10741) 9.2.6.1 Collect data related to Medicare and exchange
9.1.4.1 Assess customer and product profitability (10782) business (17286)
9.1.4.2 Evaluate new products (10783) 9.2.6.2 Coordinate experience analysis with medical
9.1.4.3 Perform life cycle costing (10784) management (17287)
9.1.4.4 Optimize customer and product mix (10785) 9.2.6.3 Validate clinical codes and documentation (17288)
9.1.4.5 Track performance of new-customer and 9.2.6.4 Update risk scores assumed in pricing (17289)
product strategies (10786) 9.2.6.5 Report updated information to CMS (17290)
9.1.4.6 Prepare activity-based performance measures 9.2.6.6 Estimate risk-score related adjustments (17291)
(10787) 9.2.6.7 Coordinate with finance about payable/
9.1.4.7 Manage continuous cost improvement (10788) receivable (17292)
9.2 Perform revenue accounting (10729) 9.2.6.8 Record and report CMS true-up (17293)
9.2.1 Process customer credit (10742) 9.3 Perform general accounting and reporting (10730)
9.2.1.1 Establish credit policies (10789) 9.3.1 Manage policies and procedures (10747)
9.2.1.2 Analyze/Approve new account applications 9.3.1.1 Negotiate service-level agreements (10815)
(10790) 9.3.1.2 Establish accounting policies (10816)
9.2.1.3 Analyze credit scoring history (14187) 9.3.1.3 Publish accounting policies (20604)
9.2.1.4 Forecast credit scoring requirement (14188) 9.3.1.4 Set and enforce approval limits (10817)
9.2.1.5 Review existing accounts (10791) 9.3.1.5 Establish common financial systems (10818)
9.2.1.6 Produce credit/collection reports (10792) 9.3.2 Perform general accounting (10748)
9.2.1.7 Reinstate or suspend accounts based on credit 9.3.2.1 Maintain chart of accounts (10819)
policies (10793) 9.3.2.2 Process journal entries (10820)
9.2.2 Invoice customer (10743) 9.3.2.3 Process allocations (10821)
9.2.2.1 Maintain customer/product master files (10794) 9.3.2.4 Process period end adjustments (10822)
9.2.2.2 Generate customer billing data (10795) 9.3.2.5 Post and reconcile intercompany transactions
9.2.2.3 Transmit billing data to customers (10796) (10823)
9.2.2.4 Post receivable entries (10797) 9.3.2.6 Reconcile general ledger accounts (10824)
9.2.2.5 Resolve customer billing inquiries (10798) 9.3.2.7 Perform consolidations and process eliminations
9.2.3 Process accounts receivable (AR) (10744) (10825)
9.2.3.1 Establish AR policies (10799) 9.3.2.8 Prepare trial balance (10826)

9.3.2.9 Prepare and post management adjustments 9.5.1.5 Analyze and report employee utilization (10857)
(10827) 9.5.2 Manage pay (10754)
9.3.3 Perform fixed-asset accounting (10749) 9.5.2.1 Enter employee time worked into payroll system
9.3.3.1 Establish fixed-asset policies and procedures (10858)
(10828) 9.5.2.2 Maintain and administer employee earnings
9.3.3.2 Maintain fixed-asset master data files (10829) information (10859)
9.3.3.3 Process and record fixed-asset additions and 9.5.2.3 Maintain and administer applicable deductions
retires (10830) (10860)
9.3.3.4 Process and record fixed-asset adjustments, 9.5.2.4 Monitor changes in tax status of employees
enhancements, revaluations, and transfers (10861)
(10831) 9.5.2.5 Process and distribute payments (10862)
9.3.3.5 Process and record fixed-asset maintenance 9.5.2.6 Process and distribute manual checks (10863)
and repair expenses (10832) 9.5.2.7 Process period-end adjustments (10864)
9.3.3.6 Calculate and record depreciation expense (10833) 9.5.2.8 Respond to employee payroll inquiries (10865)
9.3.3.7 Reconcile fixed-asset ledger (10834) 9.5.3 Process payroll taxes (10755)
9.3.3.8 Track fixed-assets including physical inventory 9.5.3.1 Develop tax plan (14075)
(10835)
9.5.3.2 Manage tax plan (14076)
9.3.3.9 Provide fixed-asset data to support tax,
9.5.3.3 Calculate and pay applicable payroll taxes (10866)
statutory, and regulatory reporting (10836)
9.5.3.4 Produce and distribute employee annual tax
9.3.4 Perform financial reporting (10750)
statements (10867)
9.3.4.1 Prepare business unit financial statements (10837)
9.5.3.5 File regulatory payroll tax forms (10868)
9.3.4.2 Prepare consolidated financial statements (10838)
9.6 Process accounts payable and expense reimbursements
9.3.4.3 Perform business unit reporting/review (10733)
management reports (10839)
9.3.4.4 Perform consolidated reporting/review of cost 9.6.1
Process accounts payable (AP) (10756)
management reports (10840) 9.6.1.1 Verify AP pay file with purchase order vendor
9.3.4.5 Prepare statements for board review (10841) master file (10869)
9.3.4.6 Produce quarterly/annual filings and 9.6.1.2 Maintain/Manage electronic commerce (10870)
shareholder reports (10842) 9.6.1.3 Audit invoices and key data in AP system (10871)
9.3.4.7 Produce regulatory reports (10843) 9.6.1.4 Approve payments (10872)
9.3.4.8 Perform legal and management consolidation 9.6.1.5 Process financial accruals and reversals (10873)
(14074) 9.6.1.6 Process payable taxes (10874)
9.4 Manage fixed-asset project accounting (10731) 9.6.1.7 Research/Resolve payables exceptions (10875)
9.4.1 Perform capital planning and project approval (10751) 9.6.1.8 Process payments (10876)
9.4.1.1 Develop capital investment policies and 9.6.1.9 Respond to AP inquiries (10877)
procedures (10844) 9.6.1.10 Retain records (10878)
9.4.1.2 Develop and approve capital expenditure plans 9.6.1.11 Adjust accounting records (10879)
and budgets (10845) 9.6.2 Process expense reimbursements (10757)
9.4.1.3 Review and approve capital projects and fixed- 9.6.2.1 Establish and communicate expense
asset acquisitions (10846) reimbursement policies and approval limits
9.4.1.4 Conduct financial justification for project (10880)
approval (10847) 9.6.2.2 Capture and report relevant tax data (10881)
9.4.2 Perform capital project accounting (10752) 9.6.2.3 Approve reimbursements and advances (10882)
9.4.2.1 Create project account codes (10848) 9.6.2.4 Process reimbursements and advances (10883)
9.4.2.2 Record project-related transactions (10849) 9.6.2.5 Manage personnel accounts (10884)
9.4.2.3 Monitor and track capital projects and budget 9.6.3 Manage corporate credit cards (20929)
spending (10850) 9.6.3.1 Establish corporate credit card policies and
9.4.2.4 Close/capitalize projects (10851) approval limits (20930)
9.4.2.5 Measure financial returns on completed capital 9.6.3.2 Process corporate credit card requests (20931)
projects (10852) 9.6.3.3 Order corporate credit cards (20932)
9.5 Process payroll (10732) 9.6.3.4 Manage corporate credit card accounts (20933)
9.5.1 Report time (10753) 9.6.3.5 Approve/Change credit limits (20934)
9.5.1.1 Establish policies and procedures (10853) 9.6.3.6 Cancel/Deactivate credit card (20935)
9.5.1.2 Collect and record employee time worked (10854) 9.7 Perform liability and insurance reserve valuations (17294)
9.5.1.3 Analyze and report paid and unpaid leave (10855) 9.7.1 Reconcile claim cash flows (17295)
9.5.1.4 Monitor regular, overtime, and other hours (10856) 9.7.1.1 Compile check register entries (17296)
9.7.1.2 Compare check register to cash flow invoices 9.8.2.5 Manage cash flows (10897)
(17297) 9.8.2.6 Produce cash management accounting
9.7.1.3 Reconcile differences (17298) transactions and reports (10898)
9.7.1.4 Process prior period membership eligibility- 9.8.2.7 Manage and oversee banking relationships (10899)
related adjustments (17299) 9.8.2.8 Analyze, negotiate, resolve, and confirm bank
9.7.1.5 Process prior period inter-company fees (10900)
subrogation-related adjustments (17300) 9.8.3 Manage in-house bank accounts (10760)
9.7.1.6 Allocate other top side adjustments (17301) 9.8.3.1 Manage in-house bank accounts for subsidiaries
9.7.2 Apply valuation standards (17302) (10901)
9.7.2.1 Compile claim data into required format (17303) 9.8.3.2 Manage and facilitate inter-company borrowing
9.7.2.2 Validate data form and content (17304) transactions (10902)
9.7.2.3 Apply business conditions, operating 9.8.3.3 Manage centralized outgoing payments on
environment and other assumptions (17305) behalf of subsidiaries (10903)
9.7.2.4 Perform calculations per actuarial and 9.8.3.4 Manage central incoming payments on behalf
regulatory standards (17306) of subsidiaries (10904)
9.7.2.5 Reconcile and validate results for changes in 9.8.3.5 Manage internal payments and netting
business and/or operating environment (17307) transactions (10905)
9.7.2.6 Review results of analysis with management 9.8.3.6 Calculate interest and fees for in-house bank
(17308) accounts (10906)
9.7.2.7 Process ledger entries to line of business and 9.8.3.7 Provide account statements for in-house bank
legal entity (17309) accounts ( 10907)
9.7.2.8 Issue actuarial opinion by qualified actuary 9.8.4 Manage debt and investment (10761)
(17310) 9.8.4.1 Establish investment policy (14079)
9.7.3 Manage reserving controls, policies and procedures (17311) 9.8.4.2 Manage financial intermediary relationships (10908)
9.7.3.1 Establish scope and governance of reserve 9.8.4.3 Manage liquidity (10909)
setting function (17312) 9.8.4.4 Manage issuer exposure (10910)
9.7.3.2 Establish and publish security and controls 9.8.4.5 Process and oversee debt and investment
guidelines (17313) transactions (10911)
9.7.3.3 Document reserve setting protocols and 9.8.4.6 Process and oversee foreign currency transactions
responsibilities (17314) (10912)
9.7.3.4 Monitor reserve setting and claim 9.8.4.7 Produce debt and investment accounting
reconciliation procedures (17315) transaction reports (10913)
9.7.3.5 Audit reserve setting procedures (17316) 9.8.4.8 Process and oversee interest rate transactions
9.7.3.6 Revise and update reserve and liability (14210)
determination procedures for regulatory or 9.8.4.9 Manage reserves compliance (17320)
controls related items (17317) 9.8.5 Monitor and execute risk and hedging transactions (11208)
9.7.3.7 Develop and confirm internal controls (17318) 9.8.5.1 Develop risk management/hedging strategy
9.7.3.8 Define system security requirements and (12974)
permissions (17319) 9.8.5.2 Manage interest rate risk (11209)
9.8 Manage treasury operations (10734) 9.8.5.2.1 Manage interest rate market data
9.8.1 Manage treasury policies and procedures (10758) (19575)
9.8.1.1 Establish scope and governance of treasury 9.8.5.2.2 Determine interest rate exposure for
operations (10885) all markets (19576)
9.8.1.2 Establish and publish treasury policies (10886) 9.8.5.2.3 Determine interest rate hedge
9.8.1.3 Develop treasury procedures (10887) requirements in accordance with risk
policy (19577)
9.8.1.4 Monitor treasury procedures (10888)
9.8.5.2.4 Execute interest rate trades (19578)
9.8.1.5 Audit treasury procedures (10889)
9.8.5.3 Manage foreign exchange risk (11210)
9.8.1.6 Revise treasury procedures (10890)
9.8.5.3.1 Manage foreign exchange market
9.8.1.7 Develop and confirm internal controls for data (19579)
treasury (10891)
9.8.5.3.2 Determine foreign exchange
9.8.1.8 Define system security requirements (10892) exposure for all currencies (19580)
9.8.2 Manage cash (10759) 9.8.5.3.3 Determine foreign exchange hedge
9.8.2.1 Manage and reconcile cash positions (10893) requirements in accordance with risk
9.8.2.2 Manage cash equivalents (10894) policy (19581)
9.8.2.3 Process and oversee electronic fund transfers 9.8.5.3.4 Execute foreign exchange trades (19582)
(EFTs) (10895) 9.8.5.3.5 Manage foreign exchange balance
9.8.2.4 Develop cash flow forecasts (10896) sheet risk (19583)

9.8.5.4 Manage exposure risk (11211) 9.10 Manage internal controls (10735)
9.8.5.4.1 Determine current customer exposures 9.10.1 Establish internal controls, policies, and procedures (10762)
and limit exceptions (19584)
9.10.1.1 Establish board of directors and audit
9.8.5.4.2 Resolve customer exposure limit committee (10914)
violations (19585)
9.10.1.2 Define and communicate code of ethics (10915)
9.8.5.4.3 Manage customer collateral (19586)
9.10.1.3 Assign roles and responsibility for internal
9.8.5.4.4 Perform annual customer credit controls (10916)
reviews (19587)
9.10.1.4 Define business process objectives and risks
9.8.5.5 Execute hedging transactions (20137) (11250)
9.8.5.5.1 Measure physical positions (19588) 9.10.1.5 Define entity/unit risk tolerances (11251)
9.8.5.5.2 Establish hedges (19589) 9.10.2 Operate controls and monitor compliance with internal
9.8.5.5.3 Unwind hedges (19590) controls policies and procedures (10763)
9.8.5.5.4 Evaluate and refine hedging positions 9.10.2.1 Design and implement control activities (10917)
(11213) 9.10.2.2 Monitor control effectiveness (10918)
9.8.5.5.5 Monitor credit (11215) 9.10.2.3 Remediate control deficiencies (10919)
9.8.5.6 Produce hedge accounting transactions and 9.10.2.4 Create compliance function (10920)
reports (11214)
9.10.2.5 Operate compliance function (10921)
9.8.6 Manage financial fraud/dispute cases (16958)
9.10.2.6 Implement and maintain controls-related
9.9 Perform risk based capital and other solvency based enabling technologies and tools (10922)
reporting (17321) 9.10.3 Report on internal controls compliance (10764)
9.9.1
Collect required documentation and national association 9.10.3.1 Report to external auditors (10923)
insurance commissioners guidelines (17322) 9.10.3.2 Report to regulators, share-/debt-holders,
9.9.1.1 Procure update national association insurance securities exchanges, etc. (10924)
commissioners guidelines (17323) 9.10.3.3 Report to third parties (10925)
9.9.1.2 Update procedures manual and tools (17324) 9.10.3.4 Report to internal management (10926)
9.9.1.3 Manage data collection (17325)
9.11 Manage taxes (10736)
9.9.2 Compile documentation associated with each risk based
capital component (17326) 9.11.1 Develop tax strategy and plan (10765)
9.9.2.1 Validate associated reported amounts within 9.11.1.1 Develop foreign, national, state, and local tax
each risk based capital risk categories (17327) strategy (10927)
9.9.2.2 Manage collection of documentation 9.11.1.2 Consolidate and optimize total tax plan (10928)
supporting each entry (17328) 9.11.1.3 Maintain tax master data (10929)
9.9.2.3 Update reported amounts and documentation 9.11.2 Process taxes (10766)
(17329) 9.11.2.1 Perform tax planning/strategy (10930)
9.9.3 Quantify risks in risk based capital formula and worksheets 9.11.2.2 Prepare tax returns (10931)
(17330) 9.11.2.3 Prepare foreign taxes (10932)
9.9.3.1 Manage application of risk factors (17331) 9.11.2.4 Calculate deferred taxes (10933)
9.9.3.2 Validate risk exposures against enterprise risk 9.11.2.5 Account for taxes (10934)
management risk appetites (17332)
9.11.2.6 Monitor tax compliance (10935)
9.9.3.3 Record quantified risk amounts in models (17333)
9.11.2.7 Address tax inquiries (10936)
9.9.4 Validate calculations against regulatory updates (17334)
9.9.4.1 Manage collection of calculated amounts (17335) 9.12 Manage international funds/consolidation (10737)
9.9.4.2 Validate regulatory guidance and policies (17336) 9.12.1 Monitor international rates (10767)
9.9.5 Perform sensitivity testing (17337) 9.12.2 Manage transactions (10768)
9.9.5.1 Design sensitivity tests and scenarios (17338) 9.12.3 Monitor currency exposure/hedge currency (10769)
9.9.5.2 Review testing parameters with business 9.12.4 Report results (10770)
owners (17339) 9.13 Conduct actuarial services (17346)
9.9.5.3 Perform sensitivity tests (17340)
9.13.1 Develop trends analysis (17347)
9.9.5.4 Discuss risk and sensitivity results (17341)
9.13.1.1 Develop cost trend projects (17348)
9.9.5.5 Escalate risk awareness against strategies and
market objectives (17342) 9.13.2 Conduct actuarial informatics/reporting (17349)
9.9.6 Update analysis for changes in treasury management, 9.13.3 Manage experience rating (17350)
business operations (17343) 9.13.3.1 Perform pre-sale underwriting review (17351)
9.9.7 Finalize and file risk based capital report (17344) 9.13.3.2 Review claim experience (17352)
9.9.8 Coordinate required amounts with treasury (cash) 9.13.3.3 Determine premium (17353)
management (17345) 9.13.4 Perform pool/block rating management (17354)
9.13.4.1 File with department of insurance (17355)
9.13.4.2 Develop rating methodology (17356) 9.13.7.6 Issue actuarial memorandum by qualified
9.13.4.3 Publish pool/block rates (17357) actuary (17369)
9.13.4.4 Manage rating tools (17358) 9.14 Perform global trade services (17059)
9.13.5 Conduct pool/block underwriting (17359)
9.14.1 Screen sanctioned party list (14090)
9.13.5.1 Review experience and history(17360)
9.13.5.2 Determine pool/block premium (17361) 9.14.2 Control exports and imports (14091)
9.13.6 Provide underwriting support (17362) 9.14.3 Classify products (14092)
9.13.7 Manage regulatory requirements and compliance (17363) 9.14.4 Perform currency conversion (19593)
9.13.7.1 Compile rate filing documentation (17364) 9.14.5 Calculate duty (14093)
9.13.7.2 Upload information into state rating system(s) 9.14.6 Communicate with customs (14094)
(17365)
9.14.7 Document trade (14095)
9.13.7.3 Perform quality control testing on load (17366)
9.13.7.4 Validate rate load and internal system 9.14.8 Process trade preferences (14096)
consistency (17367) 9.14.9 Handle restitution (14097)
9.13.7.5 Compile rate assumptions and documentation 9.14.10 Prepare letter of credit (14098)
(17368)

10.0 Acquire, Construct, and Manage Assets (19207)
10.1 Plan and acquire assets (10937) 10.2.4.2 Undertake construction quality control (19226)
10.1.1 Develop property strategy and long term vision (10941) 10.2.4.3 Create work and asset records (19227)
10.1.1.1 Confirm alignment of property requirements 10.2.4.4 Manage safety, security, and access to sites
with business strategy (10955) (19228)
10.1.1.2 Appraise the external environment (10956) 10.3 Maintain productive assets (19238)
10.1.1.3 Determine build or buy decision (10957) 10.3.1 Plan asset maintenance (19239)
10.1.2 Plan facility (10943) 10.3.1.1 Develop maintenance strategies (19240)
10.1.2.1 Design facility (10958) 10.3.1.2 Analyze assets and predict maintenance
10.1.2.2 Analyze budget (10959) requirements (10967)
10.1.2.3 Select property (10960) 10.3.1.3 Specify maintenance policies (19241)
10.1.2.4 Negotiate terms for facility (10961) 10.3.1.4 Integrate preventive maintenance into
10.1.2.5 Manage construction or modification to building operations schedule (10968)
(10962) 10.3.1.5 Identify work management tasks & priorities
10.1.3 Provide workspace and facilities (10944) (19242)
10.1.3.1 Acquire workspace and facilities (10963) 10.3.1.6 Conduct resource planning (19243)
10.1.3.2 Change fit/form/function of workspace and 10.3.1.7 Create work plans (19244)
facilities (10964) 10.3.2 Manage asset maintenance (19245)
10.1.4 Manage facilities operations (10949) 10.3.2.1 Schedule maintenance work (19246)
10.1.4.1 Relocate people (10965) 10.3.2.2 Obtain required resources (19247)
10.1.4.2 Relocate material and tools (10966) 10.3.2.3 Undertake quality control (19248)
10.2 Design and construct productive assets (19208) 10.3.2.4 Update work and asset records (19249)
10.2.1 Manage capital program for productive assets (19209) 10.3.2.5 Manage maintenance work safety (19250)
10.2.1.1 Define capital investment plan (19210) 10.3.2.6 Define maintenance performance targets (19251)
10.2.1.2 Monitor capital program (19211) 10.3.2.7 Monitor maintenance performance against
targets/contracts (19252)
10.2.1.3 Secure construction financing (19212)
10.3.3 Perform asset maintenance (19253)
10.2.2 Design and plan asset construction (20139)
10.3.3.1 Perform preventative asset maintenance (10947)
10.2.2.1 Develop construction strategy (19220)
10.3.3.2 Perform routine asset maintenance (19254)
10.2.2.2 Perform construction performance management
(11276) 10.3.3.3 Perform corrective asset maintenance and
repairs (19255)
10.2.2.3 Obtain construction permissions (19221)
10.3.3.4 Identify unplanned maintenance requirements
10.2.2.4 Design assets (19222)
(19256)
10.2.2.5 Plan construction resources (19223)
10.3.3.5 Perform unplanned maintenance and repairs
10.2.3 Schedule and perform construction work (19229) (19257)
10.2.3.1 Schedule construction work (19230)
10.4 Dispose of assets (10940)
10.2.3.2 Obtain resources (19231)

10.4.1 Develop exit strategy (10952)
10.2.3.3 Construct new assets (19232)
10.2.3.4 Augment existing assets (19233) 10.4.2 Decommission productive assets (19258)
10.2.3.5 Renew/Replace assets (19234) 10.4.3 Perform sale or trade (10953)
10.2.4 Manage asset construction (19224) 10.4.4 Perform abandonment (10954)
10.2.4.1 Monitor work performance (19225) 10.4.5 Perform waste and hazardous goods management (16970)
11.0 Manage Enterprise Risk, Compliance,
Remediation, and Resiliency (16437)
11.1 Manage enterprise risk (17060) 11.2.2.2 Identify applicable regulatory requirements (16465)
11.1.1 Establish the enterprise risk framework and policies (16439) 11.2.2.3 Monitor the regulatory environment for
11.1.1.1 Determine risk tolerance for organization (16440) changing or emerging regulations (16466)
11.1.1.2 Develop and maintain enterprise risk policies 11.2.2.4 Assess current compliance position and identify
and procedures (16441) weaknesses or shortfalls therein (16467)
11.1.1.3 Identify and implement enterprise risk 11.2.2.5 Implement missing or stronger regulatory
management tools (16442) compliance controls and policies (16468)
11.1.1.4 Coordinate the sharing of risk knowledge 11.2.2.6 Monitor and test regulatory compliance position
across the organization (16443) and existing controls (16469)
11.1.1.5 Prepare and report enterprise risk to executive 11.2.2.7 Compile and communicate compliance
management and board (16444) scorecard(s) (19595)
11.1.2 Oversee and coordinate enterprise risk management 11.2.2.8 Compile and communicate internal and
activities (16445) regulatory compliance reports (19596)
11.1.2.1 Identify enterprise level risks (16446) 11.2.2.9 Maintain relationships with regulators as
appropriate (16470)
11.1.2.2 Assess risks to determine which to mitigate
(16447) 11.3 Manage remediation efforts (11185)
11.1.2.3 Develop risk mitigation and management 11.3.1 Create remediation plans (11201)
strategy and integrate with existing 11.3.2 Contact and confer with experts (11202)
performance management processes (16448)
11.3.3 Identify/dedicate resources (11203)
11.1.2.4 Verify business unit and functional risk
11.3.4 Investigate legal aspects (11204)
mitigation plans are implemented (16449)
11.3.5 Investigate damage cause (11205)
11.1.2.5 Ensure risks and risk mitigation actions are
monitored (16450) 11.3.6 Amend or create policy (11206)
11.1.2.6 Report on risk activities (16451) 11.4 Manage fraud, abuse, and payment integrity (17373)
11.1.3 Coordinate business unit and functional risk management 11.4.1 Develop strategy and monitoring program (17374)
activities (16452) 11.4.1.1 Determine capacity and size of investigation
11.1.3.1 Ensure that each business unit/function follows unit (17375)
the enterprise risk management process (16453) 11.4.1.2 Agree on pre-adjudication approach and
11.1.3.2 Ensure that each business unit/function follows technology (17376)
the enterprise risk reporting process (16454) 11.4.1.3 Agree on post-adjudication approach and
11.1.4 Manage business unit and function risk (16455) technology (17377)
11.1.4.1 Identify risks (16456) 11.4.1.4 Agree on retrospective/post payment approach
11.1.4.2 Assess risks using enterprise risk framework and recovery (17378)
policies and procedures (16457) 11.4.1.5 Conduct a vendor selection process (17379)
11.1.4.3 Develop mitigation plans for risks (16458) 11.4.1.6 Implement anti-fraud and abuse solution (17380)
11.1.4.3.1 Assess adequacy of insurance 11.4.2 Manage investigation unit and anti fraud and abuse
coverage (18129) operations (17381)
11.1.4.4 Implement mitigation plans for risks (16459) 11.4.2.1 Set program thresholds to match investigation
11.1.4.5 Monitor risks (16460) unit capacity (17382)
11.1.4.6 Analyze risk activities and update plans (16461) 11.4.2.2 Scan incoming claims to detect anomalies and
11.1.4.7 Report on function risk activities (16462) suspicious patterns (17383)
11.1.4.8 Manage ORSA regulatory compliance process 11.4.2.3 Score and prioritize transactions according to
(17370) risk level (17384)
11.2 Manage compliance (17467) 11.4.2.4 Flag and hold suspicious transactions for
further investigation (17385)
11.2.1 Establish compliance framework and policies (17468)
11.4.2.5 Manage investigation case and bring to
11.2.1.1 Develop enterprise compliance policies and conclusion (17386)
procedures (17469)
11.5 Manage business resiliency (11216)
11.2.1.2 Implement enterprise compliance activities
(17470) 11.5.1 Develop the business resilience strategy (11221)
11.2.1.3 Manage internal audits (14133) 11.5.2 Perform continuous business operations planning (11222)
11.2.1.4 Maintain controls-related technologies and 11.5.3 Test continuous business operations (11223)
tools (14137) 11.5.4 Maintain continuous business operations (11224)
11.2.2 Manage regulatory compliance (16463) 11.5.5 Share knowledge of specific risks across other parts of
11.2.2.1 Develop regulatory compliance procedures (16464) the organization (16471)

12.0 Manage External Relationships (10012)
12.1 Build investor relationships (11010) 12.4.2 Manage corporate governance policies (11045)
12.1.1 Plan, build, and manage lender relations (11035) 12.4.3 Develop and perform preventive law programs (11046)
12.1.2 Plan, build, and manage analyst relations (11036) 12.4.4 Ensure compliance (11047)
12.1.3 Communicate with shareholders (11037) 12.4.4.1 Plan and initiate compliance program (11053)
12.4.4.2 Execute compliance program (11054)
12.2 Manage government and industry relationships (11011)
12.4.5 Manage outside counsel (11048)
12.2.1 Manage government relations (11038) 12.4.5.1 Assess problem and determine work
12.2.1.1 Assess relationships (12869) requirements (11056)
12.2.1.2 Appoint responsible executives (12870) 12.4.5.2 Engage/Retain outside counsel if necessary
12.2.1.3 Monitor relationships (12871) (11057)
12.2.1.4 Receive input from internal advisors (12872) 12.4.5.3 Receive strategy/budget (11058)
12.2.1.5 Receive input from external advisors (12873) 12.4.5.4 Receive work product and manage/monitor
12.2.1.6 Liaise with authorities (12874) case and work performed (11059)
12.2.2 Manage relations with quasi-government bodies (11039) 12.4.5.5 Process payment for legal services (11060)
12.2.2.1 Establish relationships with agencies (12875) 12.4.5.6 Track legal activity/performance (11061)
12.2.2.2 Respond to audit inquiries (12876) 12.4.6 Protect intellectual property (11049)
12.2.2.3 Maintain documentation of contacts (12877) 12.4.6.1 Manage copyrights, patents, and trademarks
(11062)
12.2.2.4 Plan and manage meetings (12878)
12.4.6.2 Maintain intellectual property rights and
12.2.3 Manage relations with trade or industry groups (11040)
restrictions (11063)
12.2.3.1 Evaluate the requirements for strategic
12.4.6.3 Administer licensing terms (11064)
relationships (12879)
12.4.6.4 Administer options (11065)
12.2.3.2 Monitor the success of the partnerships (12880)
12.4.7 Resolve disputes and litigations (11050)
12.2.3.3 Extend or change the relationships (12881)
12.4.8 Provide legal advice/counseling (11051)
12.2.4 Manage lobby activities (11041)
12.4.9 Negotiate and document agreements/contracts (11052)
12.2.5 Manage government review (17387)
12.5 Manage public relations program (11014)
12.3 Manage relations with board of directors (11012)
12.5.1 Manage community relations (11066)
12.3.1 Report financial results (11042)
12.5.2 Manage media relations (11067)
12.3.2 Report audit findings (11043)
12.5.3 Promote political stability (11068)
12.4 Manage legal and ethical issues (11013) 12.5.4 Create press releases (11069)
12.4.1 Create ethics policies (11044) 12.5.5 Issue press releases (11070)
13.0 Develop and Manage Business Capabilities (10013)
13.1 Manage business processes (16378) 13.2.3.1.5 Develop project measures and
indicators (11121)
13.1.1 Establish and maintain process management governance
(16379) 13.2.3.2 Identify appropriate project management
methodologies (11119)
13.1.1.1 Define and manage governance approach (16380)
13.2.3.3 Develop project plans (16413)
13.1.1.2 Establish and maintain process tools and
templates (16381) 13.2.3.3.1 Define roles and resources (11123)
13.1.1.3 Assign and support process ownership (16382) 13.2.3.3.2 Acquire/secure project resources
(20142)
13.1.1.4 Perform process governance activities (16383)
13.2.3.3.3 Identify specific IT requirements (11124)
13.1.2 Define and manage process frameworks (16384)
13.2.3.3.4 Create training and communication
13.1.2.1 Establish and maintain process framework (16385)
plans (11125)
13.1.2.2 Identify cross-functional processes (16386)
13.2.3.3.5 Design recognition and reward
13.1.3 Define processes (16387) approaches (11127)
13.1.3.1 Scope processes (16388) 13.2.3.3.6 Design and plan launch of project
13.1.3.2 Analyze processes (16389) (11128)
13.1.3.2.1 Identify published best practices (20140) 13.2.3.3.7 Deploy the project (11129)
13.1.3.3 Model and document processes (16390) 13.2.3.4 Execute projects (16414)
13.1.3.4 Publish processes (16391) 13.2.3.4.1 Evaluate impact of project
13.1.4 Manage process performance (16392) management (strategy and projects)
13.1.4.1 Provide process training (16393) on measures and outcomes (11131)
13.1.4.2 Support process execution (16394) 13.2.3.4.2 Report the status of project (16415)
13.1.4.3 Measure and report process performance (16395) 13.2.3.4.3 Manage project scope (16416)
13.1.4.3.1 Identify additional metrics as required 13.2.3.4.4 Promote and sustain activity and
(20141) involvement (11132)
13.1.5 Improve processes (16396) 13.2.3.4.5 Realign and refresh project management
strategy and approaches (11133)
13.1.5.1 Identify and select improvement opportunities
(16397) 13.2.3.5 Review and report project performance (16417)
13.1.5.2 Manage improvement projects (16398) 13.2.3.6 Close projects (16418)
13.1.5.3 Perform continuous improvement activities (16399) 13.3 Manage enterprise quality (17471)
13.2 Manage portfolio, program, and project (16400) 13.3.1 Establish quality requirements (17472)
13.2.1 Manage portfolio (16401) 13.3.1.1 Define critical-to-quality characteristics (17473)
13.2.1.1 Establish portfolio strategy (16402) 13.3.1.2 Define preventive quality activities (17474)
13.2.1.2 Define portfolio governance (16403) 13.3.1.3 Develop quality controls (17475)
13.2.1.3 Monitor and control portfolio (16404) 13.3.1.3.1 Define process steps for controls (or
integration points) (17476)
13.2.2 Manage programs (16405)
13.3.1.3.2 Define sampling plan (17477)
13.2.2.1 Establish program structure and approach (16406)
13.3.1.3.3 Identify measurement methods (17478)
13.2.2.2 Manage program stakeholders and partners
(16407) 13.3.1.3.4 Define required competencies (17479)
13.2.2.3 Manage program execution (16408) 13.3.1.4 Prove capability to assess compliance with
13.2.2.4 Review and report program performance (16409)
13.3.1.5 Finalize quality plan (17481)
13.2.3 Manage projects (16410)
13.3.2 Evaluate performance to requirements (17482)
13.2.3.1 Establish project scope (16411)
13.3.2.1 Test against quality plan (17483)
13.2.3.1.1 Identify project requirements and
objectives (11117) 13.3.2.1.1 Conduct test and collect data (17484)
13.2.3.1.2 Identify project resource requirements 13.3.2.1.2 Record result(s) (17485)
(16412) 13.3.2.1.3 Determine disposition of result(s)
13.2.3.1.3 Assess culture and readiness for (17486)
project management approach (11118) 13.3.2.2 Assess results of tests (17487)
13.2.3.1.4 Create business case and obtain 13.3.2.2.1 Assess sample significance (17488)
funding (11120) 13.3.2.2.2 Summarize result(s) (17489)

13.3.2.2.3 Recommend actions (17490) 13.4.2.1 Assess connection to other initiatives (11152)
13.3.2.2.4 Decide next steps (17491) 13.4.2.2 Develop change management plans (11153)
13.3.3 Manage non-conformance (17492) 13.4.2.3 Develop training plan (11154)
13.3.3.1 Assess potential impact (17493) 13.4.2.4 Develop communication plan (11155)
13.3.3.2 Determine immediate action(s) (17494) 13.4.2.5 Assign change champion(s) (20145)
13.3.3.3 Identify root cause(s) (17495) 13.4.2.6 Develop rewards/incentives plan (11156)
13.3.3.4 Take corrective or preventative action (17496) 13.4.2.7 Establish change adoption metrics (11157)
13.3.3.5 Close non-conformance (17497) 13.4.2.8 Establish/Clarify new roles (11158)
13.3.4 Implement and maintain the enterprise quality 13.4.2.9 Identify budget/roles (11159)
management system (EQMS) (17498) 13.4.3 Implement change (11136)
13.3.4.1 Define the quality strategy (17499) 13.4.3.1 Create commitment for improvement/change
13.3.4.2 Plan and deploy the EQMS scope, targets, and (11160)
goals (17500) 13.4.3.2 Reengineer business processes and systems
13.3.4.3 Identify core EQMS processes, controls, and (11161)
metrics (17501) 13.4.3.3 Support transition to new roles or exit
13.3.4.4 Develop and document EQMS policies, strategies for incumbents (11162)
procedures, standards, and measures (17502) 13.4.3.4 Monitor change (11163)
13.3.4.5 Assess the EQMS performance (17503) 13.4.3.5 Report on change (20146)
13.3.4.6 Create environment and capability for EQMS 13.4.4 Sustain improvement (11137)
improvement(s) (17504)
13.4.4.1 Monitor improved process performance (11164)
13.3.4.6.1 Reward quality excellence (17505)
13.4.4.2 Capture and reuse lessons learned from change
13.3.4.6.2 Create and maintain quality process (11165)
partnerships (17506)
13.4.4.3 Take corrective action as necessary (11166)
13.3.4.6.3 Maintain talent capabilities and
competencies (17507) 13.5 Develop and manage enterprise-wide knowledge
management (KM) capability (11073)
13.3.4.6.4 Incorporate EQMS messaging into
communication channels (17508) 13.5.1 Develop KM strategy (11095)
13.3.4.6.5 Assure independent EQMS 13.5.1.1 Develop governance model with roles and
management access to appropriate accountability (11100)
authority in the organization (17509) 13.5.1.2 Define roles and accountability of core group
13.3.4.6.6 Transfer proven EQMS methods versus operating units (11102)
(17510) 13.5.1.3 Develop funding models (11103)
13.4 Manage change (11074) 13.5.1.4 Identify links to key initiatives (11104)
13.4.1 Plan for change (11134) 13.5.1.5 Develop core KM methodologies (11105)
13.4.1.1 Select process improvement methodology (11138) 13.5.1.6 Assess IT needs and engage IT function (11106)
13.4.1.2 Determine stakeholders (11140) 13.5.1.7 Develop training and communication plans (11107)
13.4.1.3 Assess readiness for change (11139) 13.5.1.8 Develop change management approaches (11108)
13.4.1.4 Identify change champion(s) (11141) 13.5.1.9 Develop strategic measures and indicators (11109)
13.4.1.5 Form design team (11142) 13.5.2 Assess KM capabilities (11096)
13.4.1.6 Define scope (11143) 13.5.2.1 Assess maturity of existing KM initiatives (11110)
13.4.1.7 Understand current state (11144) 13.5.2.2 Evaluate existing KM approaches (11111)
13.4.1.8 Define future state (11145) 13.5.2.3 Identify gaps and needs (11112)
13.4.1.9 Conduct organizational risk analysis (11146) 13.5.3 Design and implement KM capabilities (20965)
13.4.1.10 Assess cultural issues (11147) 13.5.3.1 Develop new KM approaches (11114)
13.4.1.11 Identify impacted groups (20143) 13.5.3.2 Design resource model for KM approaches (20966)
13.4.1.12 Determine degree/extent of impact (20144) 13.5.3.3 Implement new KM approaches (11115)
13.4.1.13 Establish accountability for change management 13.5.3.4 Leverage and enhance IT for KM approaches
(11148) (20967)
13.4.1.14 Identify barriers to change (11149) 13.5.3.5 Develop measures (20968)
13.4.1.15 Determine change enablers (11150) 13.5.4 Evolve and sustain KM capabilities (20969)
13.4.1.16 Identify resources and develop measures (11151) 13.5.4.1 Enhance/Modify existing KM approaches (11113)
13.4.2 Design the change (11135) 13.5.4.2 Sustain awareness and engagement (20970)
13.5.4.3 Expand KM infrastructure to meet demand (20971) 13.7 Manage environmental health and safety (EHS) (11179)
13.6 Measure and benchmark (16436) 13.7.1 Determine environmental health and safety impacts (11180)
13.6.1 Create and manage organizational performance strategy 13.7.1.1 Evaluate environmental impact of products,
(11071) services, and operations (11186)
13.6.1.1 Create enterprise measurement systems model 13.7.1.2 Conduct health and safety and environmental
(11075) audits (11187)
13.6.1.2 Measure process efficiency (11076) 13.7.2 Develop and execute functional EHS program (11181)
13.6.1.3 Measure cost effectiveness (11077) 13.7.2.1 Identify regulatory and stakeholder requirements
(11188)
13.6.1.4 Measure staff productivity (11078)
13.7.2.2 Assess future risks and opportunities (11189)
13.6.1.5 Measure cycle time (11079)
13.7.2.3 Create EHS policy (11190)
13.6.2 Benchmark performance (11072)
13.7.2.4 Record and manage EHS events (11191)
13.6.2.1 Conduct performance assessments (11083)
13.7.3 Train and educate functional employees (11182)
13.6.2.2 Develop benchmarking capabilities (11084)
13.7.3.1 Communicate EHS issues to stakeholders and
13.6.2.3 Conduct internal process and external
provide support (11192)
competitive benchmarking (11085)
13.7.4 Monitor and manage functional EHS management program
13.6.2.4 Conduct gap analysis (11087)
(11183)
13.6.2.5 Establish need for change (11088)
13.7.4.1 Manage EHS costs and benefits (11193)
13.6.3 Evaluate process performance (20147)
13.7.4.2 Measure and report EHS performance (11194)
13.6.3.1 Establish appropriate performance indicators
13.7.4.3 Implement emergency response program (11196)
(metrics) (10270)
13.7.4.4 Implement pollution prevention program (11197)
13.6.3.2 Establish monitoring frequency (10271)
13.7.4.5 Provide employees with EHS support (11195)
13.6.3.3 Collect performance data (20148)
13.6.3.4 Calculate performance measures (10272) 13.8 Develop, Manage, and Deliver Analytics (20959)
13.6.3.5 Identify performance trends (10273) 13.8.1 Develop and manage hypotheses (20960)
13.6.3.6 Analyze performance against benchmark data 13.8.2 Collect data (20961)
(10274) 13.8.3 Analyze data (20962)
13.6.3.7 Prepare reports (10275) 13.8.4 Report on data (20963)
13.6.3.8 Develop performance improvement plan (10276) 13.8.5 Identify remedial actions (20964)

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K07155 - Health Insurance Payor - 721 - 021319 - April 2023

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HE ALT H INSUR ANCE PAYOR

PROCE S S CL A S SIFIC AT ION FR AME WORK®

HEALTH INSURANCE PAYOR PCF

used within organizations around the world.

Industry PCF® v7.2.1. This version of the PCF

within the industry. APQC provided much

THE FRAMEWORK FOR

The PCF is written in United States English language format.

Version 7.2.1-en-XI • January 2019 1

LOOKING FORWARD work, and succeed in a competitive marketplace. With a focus

PROCESS CLASSIFICATION FRAMEWORK® TABLE OF CONTENTS

COPYRIGHT AND ATTRIBUTION

PROCESS ELEMENT NUMBERING SCHEME

Version 7.2.1-en-XI • January 2019 3

Version 7.2.1-en-XI • January 2019 5

Version 7.2.1-en-XI • January 2019 7

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Version 7.2.1-en-XI • January 2019 13

6.1 Develop customer care/customer service strategy (10378) 6.2.4

Version 7.2.1-en-XI • January 2019 16

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Version 7.2.1-en-XI • January 2019 34

Permission granted to photocopy for personal use. ©2019 APQC

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