software modelling 1

SOFTWARE MODELLING 1

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Insurance Claim Management

Nidhi Sharma (Project Manager)

Date 05/12/2016


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Table of Contents Project Summary .......................................................................................................................................... 3

Background ............................................................................................................................................... 3

Project Purpose ......................................................................................................................................... 4

Project Scope ................................................................................................................................................ 4

Artifacts ........................................................................................................................................................ 6

Product Backlog ........................................................................................................................................ 6

UML Diagrams ......................................................................................................................................... 8

Activity diagram. .................................................................................................................................. 9

Component diagram ............................................................................................................................ 10

Class diagram ...................................................................................................................................... 10

Sequence diagram. .............................................................................................................................. 11

Use case diagram. ............................................................................................................................... 12

Deployment ………………………………………………………………………………………………………………………………………. 14

References .................................................................................................................................................. 14


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Project Summary

Background

The main objective of this project is to develop a better claims management workflow

automation system for our client who owns a small insurance company. Claim management is one

of the important aspect of insurance. Claim is defined as the right of insured to receive the

amount secured under policy of insurance contract promised by insurer. Insurance has emerged

as an integral part of life of manual over the globe. The proverb ‘Need is the mother of

invention’ is proving equally correct in case of insurance. It is complex in nature that is true but

it is a driving force to plant confidence in the hearts of people.

Claims management means and includes all the managerial decisions and processes

concerning the settlement and payment of claims in accordance with the terms of insurance

contract. It includes carrying out the entire claims process with a particular emphasis on

monitoring and lowering the claims costs. The important elements of claims management are

claims preparation, claims philosophy, claims processing and claims settlement. Claims

management is an expert system which generates the rules and regulations for the assessment of

general damages using the key information contained in medical reports, surveyor report, loss

assessor’ reports, claimant’s petition and the procedures or conditions and warranties contained


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in the policy document. The claims management regulates the payment of general damages and

also payment of the loss of future earnings.

Claims Management is one of the most challenging business processes in the insurance

industry. With the number of stakeholders involved, the dependencies and the logistics, there is

a need is to eliminate manual interventions. For many organizations, claim management and

administration is viewed solely as a service operation. Claim management is expected to run the

claim process efficiently and keep expenses low, but little attention is given to leveraging high-

impact opportunities afforded through effective data management. In fact, the data captured in

the claim process, which all too often are underutilized, are rich in valuable information for

those who know how to extract and analyze it

Project Purpose

The main objective of this project is to develop a better claims management workflow

automation system for our client who owns a small insurance company. As part of the solutions

architect and Agile SCRUM team, we need to ensure the system meets the internal and external

architectural standards and guidelines, and to generate claim reports to the company. To develop

a comprehensive software model for the project to include application, solution and network

domains. This will include a high-level model covering the solution and network domains and

how application logic will integrate with hardware.

Project Scope


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Is to meet the requirement mentioned in the product backlog, the medical provide and

insurance company as User should be able to have following functions:

Medical provider should be able to

Login into the site

Add/delete/modify personal details

Check insurance policy details

Check insurance eligibility

Check service codes covered under insurance

Accuracy in bill calculation :co- pay

Generate bill report

Raise a claim request

Insurance company should be able to

Login into the site

Add/delete/modify personal details

Check insurance plans


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Check insurance eligibility

Check service codes

Maintain bank details of patient

Maintain accuracy while calculating bills

Process claims

Maintain claim status

Generate reports

Artifacts

Product Backlog

.In order to start with software modeling of Claim management we need to understand

and penned down the requirement needed at the end of Users. For this we need to create Product

backlog. Before beginning with the product backlog for claim management we need to

understand the product backlog.

What is the product backlog? The product backlog is a prioritized list of work to be

delivered order for the development team that is derived from the roadmap and its requirement.

It consists of features, bug fixes, non-functional requirements, etc., whatever must be done to

successfully deliver a viable product.


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Who create the product backlog ? .The product owner creates, maintain ,reorders the

product back log items (PBIs) based on considerations such as risk, business value,

dependencies, and date needed. The product owner own the responsibility of product backlog

and the business value of listed requirements in PBIs and they can be changed only with the

consent and approval of the product owner. Items added to a backlog are commonly written in

story format. The most important items are shown at the top of the product backlog so the team

knows what to deliver first. The complexity of PBIs are determined by development team, who

contributes by sizing items, either in story points or in estimated hours. The development team

doesn't work through the backlog at the product owner space and the product owner isn't

pushing work to the development team. But the development team extract work from the

product backlog as there is capacity for it, by either methods:

Continuous (Kanban)

Iteration (scrum)

What is the functionality of Product backlog?

Enables the product owner to modify, adapt the product with new emerging

requirement, market trends, customer feedback and fixing issues.

Extract the quality work from the development team which in turn maximizes

business benefit to the product owner.

The product backlog for the topic under discussion is mentioned below which will

enlist the requirement of User as Insurance Company and Medical provider. The product


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backlog comprise following headings: Story ID to uniquely identify each requirement, Owner

of the requirement, Issue type, Criteria to close the requirement.

Claim Management

Product Backlog.docx

UML Diagrams

The Unified Modeling Language (UML) is a standardized modeling language enabling

developers to specify, visualize, construct and document artifacts of a software system. Thus,

UML makes these artifacts scalable, secure and robust in execution. UML is an important

aspect involved in object-oriented software development. UML is not a programming language

but tools can be used to generate code in various languages using UML diagrams. UML

diagrams helps to understand a system in better and simple way. A single diagram is not enough

to cover all aspects of the system. So UML defines various kinds of diagrams to cover most of

the aspects of a system. Diagrams are generally made in an incremental and iterative way. There

are two broad categories of diagrams and then are again divided into sub-categories:

Behavioral diagrams: basically capture the dynamic aspect of a system. Dynamic

aspect can be further described as the changing/moving parts of a system.

Example- Activity diagram, Sequence diagram, Use case diagram.


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Structure diagrams: represent the static aspect of the system. These static aspects

represent those parts of a diagram which forms the main structure and therefore

stable. Example- Component diagram, Class diagram.

UML diagrams are not only made for developers but also for business users, common

people and anybody interested to understand the system. The system can be a software or non-

software.

Activity diagram. Activity diagrams are graphical representations of workflow of

stepwise activities and actions with support for choice, iteration and concurrency. In the Unified

modelling language activity diagrams are intended to model both computational and

organizational processes (i.e. workflows). Activity diagram describes the flow of control in a

system. So it consists of activities and links. The flow can be sequential, concurrent or

branched. Activities are nothing but the functions of a system. Numbers of activity diagrams are

prepared to capture the entire flow in a system. Activity diagrams are used to visualize the flow

of controls in a system. This is prepared to have an idea of how the system will work when

executed.

Activity diagram given below depicts the flow of activities in claim management

system.

activity

diagram.vsdx


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Component diagram. In the Unified Modelling Language, a Component diagram

explains how components are wired together to form larger components and or software

systems. They are used to illustrate the structure of arbitrarily complex systems. A component is

something required to execute a stereotype function like documents, database tables, files, and

library files. This diagram is very important because without it the application cannot be

implemented efficiently. A well prepared component diagram is also important for other aspects

like application performance, maintenance etc. Component diagrams are useful communication

tools for various groups. Component diagrams can generally put stakeholders at ease because

the diagram presents an early understanding of the overall system that is being built. Developers

find the component diagram useful because it provides them with a high-level, architectural

view of the system that they will be building. Broadly, the main function of a component

diagram is to show the structural relationship between different components in a system.

Component Diagram for Claim process show the different component involved for the

Claim process system and their relationship.

component

diagram (1).vsdx

Class diagram. The class diagram is defined as a static diagram in Unified modelling

language, it explains the structure of the system, its classes, attributes, methods, and relationship

among objects. Class diagram is not only used for visualizing, describing and documenting

different aspects of a system but also for constructing executable code of the software

application. Class diagrams are arguably the most used UML diagram type. The class diagrams


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are referred as a main building block in object oriented modeling system systems as they can

directly mapped with the same. The class diagram comprises of classes (which represent both

the main elements, interactions in the application, and the classes to be programmed), interfaces,

associations, collaborations and constraints. It is also known as a structural diagram.

Class diagram is different from Activity, Sequence diagram though it also provide sequence

flow of application but it’s different because it serve following other purposes as:

Analysis and design of the static view of an application.

Describe responsibilities of a system.

Base for component and deployment diagrams.

Forward and reverse engineering.

The Claim system class diagram describing its classes with sub classes attributes and

methods and their relationship among them is under mentioned.

Sequence diagram. Sequence diagrams, along with class diagrams are th most important

design-level models for modern business application development. A Sequence diagram is

defined as an interaction diagram that shows how processes operate with one another and in


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what order. It is a construct of message sequence chart. A sequence diagram shows object

interactions arranged in time sequence. It depicts the objects and classes involved in the

scenario and the sequence of messages exchanged between the objects needed to carry out the

functionality of the scenario. Sequence diagrams are typically associated with use case

realizations in the Logical View of the system under development. Sequence diagrams are

sometimes called event diagram or event scenarios.

A sequence diagram shows, as parallel vertical lines (lifelines), different processes or

objects that live simultaneously, and, as horizontal arrows, the messages exchanged between

them, in the order in which they occur. This allows the specification of simple runtime scenarios

in a graphical manner. Sequence diagram are used to model following:

Usage Scenario

Logic of methods

Logic of services

Under mentioned sequence diagram for claim processing explains about the sequence of

events for happy path: Happy path (default scenario, error free path) where sequence of

activities as everything moves as expected.

SEQUENCE

DIAGRAM.vsdx

Use case diagram. The use case diagram in UML is to demonstrate the different ways

that a user might interact with a system A Use case diagram is a representation of a user's


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interaction with the system that shows the relationship between the user and the different use

cases in which the user is involved. A use case diagram can identify the different types of users

of a system and the different use cases and will often be accompanied by other types of

diagrams as well. Use Case diagrams show the various activities the users can perform on the

system. There are following benefits of Use case they are as follows:

Use cases are a mature model to capture software requirements.

Use case modeling is regarded as an excellent technique for capturing the

functional requirements of a system.

Use cases discourage premature design.

Use cases are traceable.

Use cases can serve as the basis for the estimating, scheduling, and validating

effort.

Use cases are reusable within a project.

Use case alternative paths capture additional behavior that can improve system

robustness.

Use cases enables to tell stories.

Use case diagram depicts the interaction of Users (medical provider and insurance

company) with the system in claim management process., Use case index in the below

document, explains about details of selected four use case such as name, description and actor to


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whom the requirement belongs to, whether requirement is with in scope and

Use Case Diagram

1.vsdx

Use case index and

description.doc

Deployment

The major objective involves is deploying the new system in its target

environment. It comprises following task to cover up the objective.

The work is segregated in different modules for coding, completed the rounds of

successful coding.

Further followed by testing (unit testing and Quality assurance testing) the code

was ready for production deployment. Testing enable to be sure of the

outcome/product which justify and addresses the gathered requirement. After

successful testing the product is delivered / deployed to the customer for their

use.

After this phase, the system enters the Operations and Maintenance Phase for the

remainder of the system’s operational life.

References

Activity diagrams. (n.d). Retrieved from http://agilebench.com/blog/the-product-backlog-for-

agile-teams

Dareen, Levy.,. (2014).The best way to manage your product requirements. Retrieved from

http://www.gatherspace.com/static/use_case_example.html

Donald,Bell,.(2004).UMLbasic:the.sequence.diagrams.Retrieved.from

http://www.ibm.com/developerworks/rational/library/3101.html

http://agilebench.com/blog/the-product-backlog-for-agile-teams

http://agilebench.com/blog/the-product-backlog-for-agile-teams

http://www.gatherspace.com/static/use_case_example.html

http://www.ibm.com/developerworks/rational/library/3101.html


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Happy path,.(n.d). In Wikipedia. The Free Encyclopedia Retrieved May10, 2016 from

https://en.wikipedia.org/wiki/Happy_path

Nishadha,. (2012). The complete guide to uml diagrams types with examples. Retrieved from

https://en.wikipedia.org/wiki/Unified_Modeling_Language

Project on claim management (2012). Retrieved from http://www.docfoc.com/project-on-

claims-management-in-life-insurance-55845333308b8

Scruminc (n.d). Retrieved from https://www.scruminc.com/product-backlog/

Unified modelling language. (n.d). In Wikipedia The Free Encyclopedia Retrieved May10, 2016

from https://en.wikipedia.org/wiki/Unified_Modeling_Language

https://en.wikipedia.org/wiki/Happy_path

http://www.docfoc.com/project-on-

http://www.docfoc.com/project-on-

https://www.scruminc.com/product-backlog/

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