本論文研究目的在於探討保單售後服務導向數位化後，壽險公司對於保單行政承辦人員、作業流程與系統之間所衍生的作業風險控管與應對。透過訪談國內金控、非金控及外商壽險公司現行擔任保單行政作業主管與資深承辦人員，以及資訊部門主管與資深承辦人員，受訪公司計13家，受訪專業人士共30位。 經訪談結果發現，就保單行政作業而言，將審核條件(含壽險裁罰案及金融檢查提出須改善要項)納入自動檢核後，不僅能提升結案效率，更能成為作業風險控管的第一道防線。而將保單售後服務案件依據來源分為書面及數位兩種來源進行辦理，更能有效控管。以數位平台案件滲透度來看，投資型保單較傳統型保單高出許多，也讓保單行政人員可以仰賴系統同時進行多項檢核。然主管機關頒布法令與應遵循規範繁多，常有保單核心系統與數位平台系統功能開發或因應不及，甚而作業程序未能及時變更，導致人為交易疏漏。此外，系統異常難以事前檢驗，主要仰仗緊急應變措施；而數位服務使用者權限冒用，也有難以即時查驗之疑慮。 本研究提出幾點建議：應明訂計算比例及標準後入績效考核、應引進新科技強化數位身分驗證及應建置委外數位服務廠商評鑑資訊，期望能供壽險業規劃數位服務作業風險控管機制之參考。 This study aims at discussing the corresponding responses of life insurance corporations to the Operational Risk Management Mechanism deriving from policy administrative managers, operational procedures and system after the policy after-sales service turned into digital-oriented. This research was conducted by interviewing 13 companies and 30 professionals including current policy administrative directors, senior case officer as well as information department directors of domestic financial and non-financial holding companies as well as foreign life insurance corporations. According to the interview, in terms of policy administrative works, the settlement efficiency would not only be improved but also serve as the first line of defense of operational risk management after the auditing conditions (including life insurance penalty cases and must-improve items required after financial inspections) were recognized as automatic check. Furthermore, it’s beneficial for improving the control effectiveness by managing the policy after-service cases according to the source, in written and digital forms. With respect to case penetration in digital platforms, the number of investment link (Unit Link) policies significantly outweighs that of traditional policies which ensures policy administrative personnel’s reliance on system and at the same time undertaking multiple inspections. While the man-made transaction omissions occur from time to time due to compliance with red tapes issued by competent authorities, unappeasable or poor functional development of core system and digital platform systems of policy and even failure to upgrade operational procedures in timely manner. In addition, the system abnormality inspection depend mostly on emergency measures instead of inspections in advance; and there are concerns on failing to examine user permissions exploits of digital services in timely manner. This research provides several suggestions based on the findings: firstly, the calculation ratios and standards should be recognized as one performance assessment index after they are expressly stated; secondly, company should introduce new technologies to strengthen digital identity authentication and establish outsourced digital service provider evaluation information. All of which are expected to be the references for life insurance industry’s planning of operational risk management mechanism of digital service.
