Sample case: Insurance claim
Jackie Zhu 1100007DBS firstname.lastname@example.org | | Tags:  manager icm insurance ecmredbooks case claim
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Brian Benoit is the Technical Consultant for Pyramid Solutions' ECM practice. He has responsibility for pre-sales support, Pyramid Product offerings and support for the Pyramid relationship with IBM's ECM development groups. Brian joined Pyramid Solutions in 2003 and has over 20 years experience in the IT industry. Brian is an IBM Certified Specialist and Solution Design Technical Professional in Content Manager, Business Process Manager and Case Manager. He is recognized for developing Case Manager solutions in financial, insurance and government industries.
When looking at difference processes with the variety of industries that can be supported by a Case solution, one of the examples that stands out is an Insurance Claim.
Why a Claim is a Case
In many ways, people may look at processing a claim as a simple process where the claimant provides a Notice of Loss and the insurer, is reviewed and gets paid. This will often lead people to trying to build a Business Process Management (BPM) or workflow based solution. When a claim is examined in more detail we will see exactly how it is better handled by the Case approach.
I will examine two claim scenarios to show both how the tasks can change within a claim and how the unpredictable and varied nature of a claim makes IBM Case Manager a perfect fit for building claim solutions.
First, I’m going to examine a simple auto insurance claim. Let’s examine the scenario where we have a simple fender bender type of accident where the insured driver ran into a tree.
In this simple example the claim would be processed by gathering the required information. This content would include the Loss Notice, Police Report and estimate for repair. This could be processed in a very straightforward manner where the Claim Processor would work with the Support personnel to gather the content and once the claim is approved it would be forwarded for payment.
When examining a claim like this one there would be the tendency to look at claim processing as a workflow since the required activities are easily defined and fairly consistent. The problem is that this is only one example of a claim and a simple one at that. Now we will examine how a more complex claim will be processed.
Expanding the example previously provided, I will add a few new wrinkles to this claim. Instead of hitting a tree, our claimant hit another car. Immediately we now have new people involved and an additional claimant. Just adding this simple change to the claim will result in new tasks required to gather information about the other claimant in the accident.
If we were to examine some other possible scenarios we would see how quickly the tasks and activities would quickly outgrow the ability to a basic workflow. Take the following questions for instance and think about the new activities and tasks that would have to happen if any are answered yes.
These questions could go on and on making it easy to see how there would be many people and activities/tasks needed to be able to successfully process this claim. The real question to examine is how many of these questions can be answered when the Notice of Loss is filed? The fact that many of the required tasks are not known at the beginning of the claim process and, more importantly, can change as the claim goes through its lifecycle make it a perfect fit for an IBM Case Manager solution.
The task based approach to work within IBM Case Manager allows a solution to be built that enforces the required tasks (through preconditions) while providing the flexibility to react to changes in the case and launch tasks for any of the actions or additional information that may occur while processing the claim.
For IBM Case Manager V5.2 related blog posts, see:
For IBM Case Manager V5.2 Redbooks publication, see: