Developing A BPMN Model For Insurance Claim Handling Process

Task and Gateway Requirements

1.

Figure 1: BPMN Model for Finance Bank Co Internal Procedure Manual Change Of Details Process

(Source: Created by Author)

The process starts when processing staff member will search for other similar requests has been done on the main queue. The staff load the form in image view. The missing filled are requested from the customers. The case is closed through sending PDA or updates are available. If all the required fields are not filled, then the customer is contacted. Otherwise, the filled data are validated. To validate the data supporting documents are needed. The staff check if those documents are present. If the documents are missing then again the customer is contacted and 2 weeks are waited to re-start the process. After data is validated, staff open CustomerBDcrm. If the customer is not present in the system then PDS is sent to the customer. If for changing data additional data is required then contact centre is instructed to collect those required data. The organization strongly focuses on storing all the data. Changing data does not mean old data must be deleted. Along with changing data, the old data is stored in audit log. If the change is related to pension payment then re-indexed to pension queue done. After all the data are properly validated and all data are present then data are stored.

1. Check if critical fields are empty (Process: Check if all fields are filled)
2. Check and fill all the data (Process: Contact customer and fill fields)
3. Supported by appropriate documents (Process: Validate data)

3.

Figure 2: The Insurance Claim Process Model

(Source: Created by Author)

The process starts when a claim handler receives a claim. If the policy is not valid then request is cancelled. Otherwise, claim request data is entered into the system. The assessor service CTR evaluate the claim request. If the incident is not covered then request is cancelled. Otherwise, preliminary estimation of claim is done. If the primary estimate exceeds $3000 then on-site investigation is authorized by Assessor Headquarter. If the report says that incident was covered then price damage is calculated. Otherwise, the request is cancelled. The case is approved and forward to Senior Assessor. The senior assessor check claim case for both approved case and preliminary estimate under $3000. The senior assessor approved the claim forward the request to Document Control Department. The payment is sent to client. The case is finally closed and file is claimed by the document control office. The claim handling is completely managed by internal staff. For investigation, organization can hire third party but that is seen in very rare cases.

Sources for Developing the Process Model

3.The process mining aims for discovering the significant information through an event log very easily. The collected information through process mining can be later utilized to implement an organization wide system or analytical method that assists in auditing. The existing business process will then improve significantly and provide better chance for business growth (Van der Aalst 2016). The collected information are objectively compiled in process mining. At the end of the day, process mining procedures are useful on the grounds that they accumulate data about what is really occurring as per an event log of a business, and not what individuals believe is going on in this company.

Figure 3: Process Mining Application Scenarios

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The figure 3 illustrates the scenarios for using the process mining technologies. The process mining can be employed through either before or after the deployment of organization wide ICT system (Van der Aalst 2015). In the primary situation, the event logs are gathered physically. Process mining can be utilized to mine a process model, (for example, process perception) from a given log and think about the practices of the mined model with the given log, (for example, conformance testing). In the second situation, process mining can be utilized also aside from that the event logs are recorded by data systems naturally. Additionally, we can contrast the mined process model and the predefined one to discover the inconsistencies between them, (for example, delta examination).

Process mining is helpful for no less than two reasons. As a matter of first importance, it could be utilized as a device to discover how individuals or potentially methodology truly function. Taken as an example, business processes supported by an ERP ICT system such as SAP (like a purchase procedure). These kind of systems logs entire exchanges yet as a rule does not implement a particular method for functioning (Rosemann and vom Brocke 2015). Within like a domain, process mining may be utilized for picking up understanding within the authenticated procedure. Alternative situation would be the number of patients in a Hospital or Health Care Organization. It is to be noted that, taken as an instance, condition entire exercises are logged however, data regarding the fundamental procedure is regularly absent. Within this setting pressure that database administration systems give information regarding key functioning pointers like asset usage, stream periods and management levels (Partington et al. 2015). However, does not concern about the unknown business processes, taken as an instance, fundamental relations, demanding of functions and that is only the bottom of the concerned topic. Second, process mining may be employed regarding Delta Investigation, taken as an instance, contrasting the real process and few of the predefined procedures. A model this determines the functioning capability of individuals and associations based on various anticipated factors. By looking at the inflexible or unique process model with the freshly developed BPMN model, contradictions among both can be recognized and utilized for improving the procedure (Nguyen et al. 2014). Taken for instance, the developed reference models with regards to SAP. The developed models represent the utilization of the system. Utilizing process mining it is conceivable to check whether this is the situation. Truth be told, process mining could likewise be utilized to look at changed offices/associations utilizing the same ERP system. In the context of business process intelligence or BPI, the process mining is considered as one of the crucial tools.

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