Automated Claim handling via a BPM framework

Automated Claim handling via a BPM framework

Kari Laine / Jan Winbrant

External Talk, Oslo18.11.2014

218.11.2014Kari Laine / Jan Winbrant Version 1.0

Classic claims handling in If, early 200X

User Interface

Insurance

System

User Interface

Claims

Systems

User Interface

Customer

System

Insurance

Database

Customer

Database

Claims

Databases

User Interface

External

Systems

External

Databases


Scanning and document management

User Interface

Insurance

System

User Interface

Claims

Systems

User Interface

Customer

System

Insurance

Database

Customer

Database

Claims

Databases

User Interface

External

Systems

External

Databases

Document

Database


Mental business process with claims

Registration

Decision

Payment

Recourse…

Closing


Service-enabling the legacy core systems

Insurance

Services

Claims

Services

Customer

Services

Insurance

Database

Customer

Database

Claims

Databases

External

Services

External

Databases

Document

Database

Process Management Solution


Business process management

Insurance

Database

Customer

Database

Claims

Databases

External

Databases

Customer

Services

Insurance

Services

Claims

Services

External

Services

Registration Decision Payment Recourse… Closing

Human Task

Management

Document

Database



Common integration layer a.k.a. ESB

Insurance

Database

Customer

Database

Claims

Databases

External

Databases


Human Task

Management

Common Integration Layer (ESB)

Customer

Services

Insurance

Services

Claims

Services

External

Services

Document

Database



Decision management and predictive analytics

Customer

Database

Claims

Databases

External

Databases



External

Services

Human Task

Management

Customer

Services

Insurance

Services

Insurance

Database

Analytics

Databases

Decision and

Analytics

Services

Claims

Services

Document

Database



Claims handling as it should be!

Customer

Database

Claims

Databases

External

Databases



External

Services

Human Task

Management

and “Scripting”

Customer

Services

Insurance

Services

Insurance

Database

Analytics

Databases

Decision and

Analytics

Services

Claims

Services

Document

Database

“Relax, we’ll help you …”


Automated claims process – result I


Automated claims process – result II

Overall result


Same money out

to happier customers

with much less work!

Behind the business view: walk through the disciplines


Initial planning

Production

Requirements/analyse/design: Model driven approach


FOUNDATION MODELS

BUSINESS TERMS

BUSINESS MODEL

COMMON DOMAINMODEL

PROCESS MODELS

ANALYSIS PROCESS MODEL

If Waypoint

IMPLEMENTATION PROCESS MODEL

Requirements/analyse/design: Process design


15

Main Statefull Long Running (Implementation of Common Use Case for all Claims)

Decsion_Travel/Motor_NO/SE/FI

Registration_NO/SE/FIClosing_NO/SE/FI

Payment_NO/SE/FI

Dec_Compensation_Common

Requirements/analyse/design: Use Case Spec


1.1 Identify customerand defineclaim type

1.4 Validatecoverage

1.5 Check multiclaims

internal

1.6 Registerclaim

1.7 Check multi

claims external

Registeredclaim

1.2 Retrieve and

present questions

1.3 Collect answers

1.1 Claims Use Case Specification: REG1: Identify customer and define claim type

1.1.1 Claims Use Case Specification: REG1-HT: Identify customer

1.4 Claims Use Case Specification: REG2 :Validate Coverage

1.5 Claims Use Case Specification: REG3: Check multi claims internal

1.6 Claims Use Case Specification: REG5: Register claim

1.7 Claims Use Case Specification: REG6: Check multi claims external

“Relax, we’ll help you …”

Implementation: Framework Logical View


Core systems

Automated claims process

Decision Payment Recourse… ClosingRegistration

Human tasks

Documentum External systems

Content

services

External

services

External dataCustomer

documentsCore data

JRules & AutoScoreProcess data (CDM)

Rules and

analytics data

Common Data

Storage

Decision and

analytics services

Process data

servicesCore services

Task queues“Scripting”

Claim

handlers managers

Claim

managersCustomers

Customer

Communication

Business activity

monitoring

Partners

Partner

Communication

Claim notification

data

E-invoice data

Invoicing Invoicing

firms

E-invoicing

Web Forms

Engine

Customers

Preparation

Core System

Core services

Implementation: Integration Layer

1818.11.2014

Kari Laine / Jan Winbrant Version 1.0

Integration Layer / Services / Common Domain Model (ESB)

Party Policy Claim

Core System

Core services

Entity Service

Conversion

Common

Domain

ObjectsEntity Service

Conversion

Common

Domain

Objects

Core System

Core services

Core System

Core services

Entity Service

Conversion

Common

Domain


Conversion

Common

Domain

Objects

Core System

Core services

Core System

Entity Service

Conversion

Common

Domain


Conversion

Common

Domain

Objects

Any System

Entity Service

Some

Proprietary

Format

Other

Core services Service

Implementation: Configuration


Node1: BPM EngineRule Engine

Node2: BPM EngineRule Engine

Node1 ESB Node2 ESB

Cluster 1

Cluster 2

UI Forms

UI TaskHandler

UI Monitor

UI Cluster

Implementation / Test: Continius Integration


Build Server(JUnit/Maven/Ant/Gradle)

SVN

Nexus

Integration Tests(SoapUI)

Deploy(DeployIT)

PROD

ITEST

ATEST

STEST

Evaluation:


Some claims volumes in 2013:

• 1,5 million claims, over one third of which reported via Internet

• Two thirds of claim notifications from Finnish Private customers reported

in Internet

• Over 200 million Euros paid for house or other property damages

• Over 400 000 damaged cars handled

• Thousands of stolen or damaged mobile phones compensated

Questions, comments?


Sampo / If video presentation

Automated Claim handling via a BPM framework

Documents

Transcript of Automated Claim handling via a BPM framework