Success stories
Healthcare Industry: Policy Processing
Health insurance provider improves customer satisfaction and reduces costs by implementing workflow-management system
Scenario:
A leading insurance provider needed to improve customer satisfaction and reduce costs. The company also wanted tools to measure product sales, claims- and correspondence-processing productivity and employee utilization.
Objectives:
Develop an application-processing workflow-management system that would allow imaged mail to be electronically routed for real-time, online processing. Install a reporting system that would use customizable performance measures to provide appropriate management controls.
IBM WebSphere Business Integration Modeler solution:
IBM WebSphere® Business Integration Modeler proposed a workflow and management system that automatically routes policy-application and support- information images to business teams and individuals. WebSphere Business Integration Modeler provided expert support and conducted a series of Business Process Modeling (BPM) Workshops that focused on BPM, workflow integration, and development monitoring.
Overview and results:
Our client was faced with the challenges of improving customer service by reducing both work-item turnaround times and total processing costs. The client also needed a reporting capability that would get information to managers in time for them to prevent a problem from becoming a major issue.
We assisted in developing a model of the client's current process to determine the specific processing time and cost metrics for each task. Once the current process was understood and metrics compiled for benchmarking, the customer reviewed the process and streamlined it to meet the company's goals. These goals included reducing processing cost and improving customer satisfaction with accurate processing and reduced turn-around time.
WebSphere Business Integration Modeler assisted in developing consensus among the regional business units on how the process worked. All participants recognized that each unit needed flexibility to deal with its unit-specific exceptional cases. The participants addressed legal-compliance issues in order to ensure that all legal and business requirements were met. They considered numerous quality issues and covered a wide list of issues, from inaccurate processing and rework to out-the-door customer mishaps.
The regional business units used a corporate business team to oversee the project and to serve as their project contacts. WebSphere Business Integration Modeler worked with the corporate team and subject-matter experts to build a business process model that the team used to design and develop a proposed process model.
The new To-Be process model used workflow and information technology that routed correspondence to the appropriate business team or individual. Once the correspondence was either scanned and indexed in an imaging system or received electronically from WebSphere Business Integration Workbench's Xform Designer helped the subject-matter experts to visualize both the WebSphere MQ Workflow system and its associated monitoring interfaces.
The company then used the WebSphere Business Integration Monitor to generate historical and real-time reports for their front-line supervisors and management. This information was also available in real time to area management and other support personnel in appropriate formats for in-process items.
Implemented technology:
The WebSphere Business Integration Workbench, including Xform Designer, and WebSphere Business Integration Workbench Server Web Publisher tools provided solid process modeling and analysis capabilities and a method for sharing and distributing these capabilities and the results they provided. The project's implementation phase used WebSphere MQ Workflow and the WebSphere Business Integration Monitor.
Customer benefits:
A savings of approximately $300,000 annually is projected from using the new system. These costs include standard estimates for the working times of employees performing the tasks. These savings allowed the customer to validate the decision to use a workflow solution. The tools, expertise and training that WebSphere Business Integration Modeler provided allowed the implementation of an effective customized system. The new system met all the client's needs for much less cost and time than would have been possible with an alternative "homegrown" system.
