Real World Process Examples: BPM For Insurance – Claims Management

Business Problem: Our Lotus Notes-based system for managing our contractor network was inflexible, provided little visibility into claims management processes, and lacked an interface to our AS 400 financial system. Contractor enrollment and KPI management was difficult to monitor. Client satisfaction was negatively impacted by claims completion process delays.

Process Players: Customers, contractors, Claims Management department, Finance department

Process Steps: Claims are now entered into a BPM-based extranet and routed to appropriate stakeholders for review. When approved, the claim goes through the extranet to our contractor network. The right contractor for the work is assigned, and throughout the repair process, they organize audits to check workflow, quality, and resources to ensure standards are maintained. Contractor reporting from the field is done through mobile Tablet PCs, with information going directly into the BPM system, which sends appropriate status alerts to our internal departments and to customers. Upon job completion, all data is sent to Finance for invoicing and to close out the claim.

Process Benefits: With BPM, we now have the process visibility and control needed to guarantee that the right contractor is assigned, that the repair workflow proceeds smoothly, that service quality meets our high standards, and that proper internal and customer reporting occurs at every stage. Because our BPM solution is web-based, it is integrated with the mobile devices used by contractors in the field, and interfaces to our backend AS 400 financial systems, increasing overall efficiency and profitability.

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