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Automation of Disability Claims Handling at Insureit

The document describes a disability claims handling process that is to be automated using Bizagi BPM Suite. Key steps in the process include a customer submitting a claim, the claim being verified for policy validity and completeness by junior and senior claims handlers, assessment of the claim by a senior handler, communication of the decision to the customer, and potential renewal of long-term disability claims. Students are asked to implement this process in Bizagi and submit screenshots of the process diagram, data model, decision rules, resource allocation rules, and task forms rather than a full project export.

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Rahul Aryan
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
452 views

Automation of Disability Claims Handling at Insureit

The document describes a disability claims handling process that is to be automated using Bizagi BPM Suite. Key steps in the process include a customer submitting a claim, the claim being verified for policy validity and completeness by junior and senior claims handlers, assessment of the claim by a senior handler, communication of the decision to the customer, and potential renewal of long-term disability claims. Students are asked to implement this process in Bizagi and submit screenshots of the process diagram, data model, decision rules, resource allocation rules, and task forms rather than a full project export.

Uploaded by

Rahul Aryan
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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MTAT.03.

231 – Business Process Management

Homework 4: Process Automation

 Worth 5 points
 To be completed individually or in pairs

Your task is to Implement the following process for disability claims handling using
Bizagi BPM Suite.

Automation of Disability Claims Handling at InsureIT


The disability claims handling process is started by a customer, who submits a claim
via InsureIT's claims handling system and attaches a medical report to the claim. The
claimant has to then print and sign the claim and send it (together with the original
copy of the medical report) by post to InsureIT. The checks and assessment of the
claim can start even if the signed claim and original medical report have not arrived.
The junior claims handler verifies the validity of the policy. If the junior claims
handler finds that the policy is invalid or does not cover the disability reported in the
claim, the claim is escalated to the senior claims handler. The senior claims handler
must then double-check the policy. If the senior claims handler confirms that the
policy is invalid or does not cover the disability reported in the claim, he/she
communicates this issue to the customer (via phone and/or e-mail) and marks the
claim as "rejected". In some cases, the senior claims handler may determine that the
policy is in fact valid. In this case the senior claims handler returns the claim to the
junior claims handler for further processing.
Next, the junior claims handler verifies the completeness of the claim. If any items are
incomplete or missing, he/she writes down some remarks and returns the claim to the
customer, who must then re-submit a completed claim. If the application is complete,
the claim is moved on for further processing by the senior claims handler. The junior
claims handler may add some free-text "Notes" to the claim if they wish to make the
senior claims handler aware of some particular points in relation to the claim (e.g. if
they notice any particular anomaly in the application that may be relevant to its
assessment).
A senior claims handler then assesses the claim and records his/her decision (positive
or negative). In case of positive decision, the senior claims handler enters the amount
of the monthly entitlement, the starting date and the duration of the entitlement (in
months). In case of long-term disability, the senior claims handler marks the
entitlement as being "long-term". In this case, the duration of the entitlement is
automatically 3 months from the entitlement's start date. In case of a negative
decision, the senior claims handler must enter a justification. If the decision is
positive, a justification is optional. The senior claims handler is responsible of
communicating the decision to the customer (via e-mail).
No entitlement is paid until the sign copy of the claim and original copy of medical
report has been received by InsureIT. Documents related to insurance claims are
received by the junior claims handler. Upon receiving the documents related to a
claim, the junior claims handler retrieves the claim in the system and records that the
documents have been received.
In case an entitlement needs to be paid for a given claim, and once the original
documents of the claim have been received, a finance officer triggers the first
entitlement payment and schedules any additional payment(s).
In case of long-term disability, the case is automatically put back for renewal 2
months from the date of the start of the entitlement.1 When an entitlement is due for
renewal, the customer needs to re-submit the application (but all data from the initial
claim is copied to the new renewal claim), to attach a new medical report.
A junior claims handler then checks the completeness of the renewal claim (mainly
that the required report is attached). The claim is then assigned to the same senior
claims handler who made the initial claim assessment. The claims handler makes an
assessment in the same way they did in the first iteration. Note that in the case of
renewal requests, the insurance policy should not be checked again.
A disability claims form includes the following questions:
 Type of insurance policy (Accident disability insurance, short-term disability
insurance, full disability insurance)
 Insurance policy number
 Given names and surname of insured person
 Address
 E-mail
 Telephone
 Occupation
 Length of time in occupation
 Name of employer
 Contact person at employer
 Phone number of employer
 Current base salary
 A medical report to be uploaded as a separate file

What to submit?
Exporting a fully executable dump of your Bizagi project is quite cumbersome. It
requires some database administration skills, which not all of you have. It would also
be highly time-consuming to grade.
Therefore, you should not submit a full Bizagi project.
Instead, you should submit as a zip file containing the following:

1
For the purposes of this exercise, we will replace 2 months by 60 seconds, to make it possible for one
to observe the renewal without waiting an unreasonably long period of time.
 A screenshot showing your process diagram (if it does not fit in one
screenshot, make it 2 or 3 pieces, as needed).
 A screenshot showing your data model
 A screenshot for each of the decision rules you defined
 A screenshot of each of the resource allocation rules you defined (in the
Performers window)
 One screenshot for each task in your process showing how the execution of
that task looks like (the Web form of the task). In other words, you should
execute the process in the Bizagi portal (multiple executions so that all tasks
appear at least once), and you should take a screenshot of the Web form of
each task (one Web form screenshot per task).

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