Scenario: Automobile insurance claims
IBM® Business Process Manager can provide an application for creating and managing automobile insurance claims. With the case management system, you can associate the data about the claim and the submitter with the supporting documentation as it is submitted. The business analyst can quickly process any required changes to the automobile claim solution. By configuring an application in IBM Business Process Manager, you can ensure that claims are processed completely and accurately.
Case management functions are only available if you have IBM BPM Advanced with the Basic Case Management feature installed.
Problem
Automobile insurance claims can involve input and supporting documentation from many sources. The sources include the claim submitter, the repair shop, the police, and other official sources of information about vehicle value or road conditions. In addition, different analysts are often required to evaluate and add information to an insurance claim during processing. All documentation and claim information must be available and easily accessible to enable adjustors to properly evaluate and resolve the claim.
Individual claims can vary greatly. This variability can require case workers to start discretionary processes and to involve new teams. The variability can also change how and when tasks are completed as the claim is routed through the organization.
Solution to problem
Javier, a business analyst at the automobile insurance company, is working on making the automobile claims process more consistent. Javier uses IBM Business Process Manager to design an application with activities that involve multiple human services. Javier creates teams for each step in the claims process. Javier assigns permission to the teams for the groups of employees who do the activities at each stage in the process.
- Claim properties, such as policy number and accident details
- Teams, such as claims adjustor or fraud investigator
- Case types, such as general claims, claims with injury, or major loss claims.
In addition, IBM Business Process Manager enables Javier to create a flexible solution. Javier can quickly change teams, processing, or add activities when they are needed.
Scenario
Carly is driving on a roadway when Carly's car strikes a large object. Although Carly is not hurt, the car is too damaged to drive. The police arrive, and a tow truck is dispatched. When Carly calls the insurance company, customer service representative Chris opens a case for the claim. Chris uses a First Notice of Loss (FNOL) form to record the information. When Chris enters Carly's home phone number, many of the form fields are automatically populated with data that is retrieved from the system.
Chris asks about Carly's location, and tells Carly to have the tow truck driver take the damaged car to a specific nearby repair shop. The case information is forwarded to the car repair shop. Chris tells Carly how to use a PDF form that is available on the insurance company's website to provide details about the accident. Chris gives Carly the case number that was generated when Chris opened Carly's case. Carly is told to include the case number on the form.
Chris recalls a memorandum about recent fraudulent claims that involve collisions with roadway debris. Chris creates a discretionary task to involve a fraud investigator in the claim.
Later, Carly downloads the PDF form from the insurance company's website and enters the accident details and the case number. Carly mails the form back to the insurance company. Because this action is set as a precondition on Chris's task to review the claim, Chris is notified when the form is added to the case. Also, on the company website, Carly uses the case number to access a tool for uploading photographs of the damaged car.
John, the agent at the car repair shop, receives notification about the case. John creates a task to provide an estimate for repairs. John makes sure that the $4500 estimate for repair does not exceed the value of the car and submits the estimate to the insurance company. John uses Carly's contact information to notify Carly that the estimate was submitted.
The case is routed to Lisa, an adjustor. Lisa reviews the case and the supporting documents, including the police report and the photographs of the damage. The estimate is below the threshold for investigation, and the fraud investigator set the flag for possible fraud to false. Lisa approves the claim.
After the case is closed, the insurance company receives a report from the police. The report says that a freight company was charged with dropping the object that caused Carly's accident. Lisa reopens Carly's case. Lisa contacts Javier, who adds a team to the system called recovery expert. The recovery expert creates new tasks to attempt to reclaim the cost of the repairs from the freight company.
Because of the flexibility of this case management system, case workers can resolve problems more quickly and efficiently, and customers can close their claims more easily.
Case management overview