Automated Claim handling via a BPM framework
Kari Laine / Jan Winbrant
External Talk, Oslo18.11.2014
218.11.2014Kari Laine / Jan Winbrant Version 1.0
Classic claims handling in If, early 200X
User Interface
Insurance
System
User Interface
Claims
Systems
User Interface
Customer
System
Insurance
Database
Customer
Database
Claims
Databases
User Interface
External
Systems
External
Databases
318.11.2014Kari Laine / Jan Winbrant Version 1.0
Scanning and document management
User Interface
Insurance
System
User Interface
Claims
Systems
User Interface
Customer
System
Insurance
Database
Customer
Database
Claims
Databases
User Interface
External
Systems
External
Databases
Document
Database
418.11.2014Kari Laine / Jan Winbrant Version 1.0
Mental business process with claims
Registration
Decision
Payment
Recourse…
Closing
518.11.2014Kari Laine / Jan Winbrant Version 1.0
Service-enabling the legacy core systems
Insurance
Services
Claims
Services
Customer
Services
Insurance
Database
Customer
Database
Claims
Databases
External
Services
External
Databases
Document
Database
Process Management Solution
618.11.2014Kari Laine / Jan Winbrant Version 1.0
Business process management
Insurance
Database
Customer
Database
Claims
Databases
External
Databases
Customer
Services
Insurance
Services
Claims
Services
External
Services
Registration Decision Payment Recourse… Closing
Human Task
Management
Document
Database
Process Management Solution
718.11.2014Kari Laine / Jan Winbrant Version 1.0
Common integration layer a.k.a. ESB
Insurance
Database
Customer
Database
Claims
Databases
External
Databases
Registration Decision Payment Recourse… Closing
Human Task
Management
Common Integration Layer (ESB)
Customer
Services
Insurance
Services
Claims
Services
External
Services
Document
Database
Process Management Solution
818.11.2014Kari Laine / Jan Winbrant Version 1.0
Decision management and predictive analytics
Customer
Database
Claims
Databases
External
Databases
Registration Decision Payment Recourse… Closing
Common Integration Layer (ESB)
External
Services
Human Task
Management
Customer
Services
Insurance
Services
Insurance
Database
Analytics
Databases
Decision and
Analytics
Services
Claims
Services
Document
Database
Process Management Solution
918.11.2014Kari Laine / Jan Winbrant Version 1.0
Claims handling as it should be!
Customer
Database
Claims
Databases
External
Databases
Registration Decision Payment Recourse… Closing
Common Integration Layer (ESB)
External
Services
Human Task
Management
and “Scripting”
Customer
Services
Insurance
Services
Insurance
Database
Analytics
Databases
Decision and
Analytics
Services
Claims
Services
Document
Database
“Relax, we’ll help you …”
1018.11.2014Kari Laine / Jan Winbrant Version 1.0
Automated claims process – result I
1118.11.2014Kari Laine / Jan Winbrant Version 1.0
Automated claims process – result II
Overall result
1218.11.2014Kari Laine / Jan Winbrant Version 1.0
Same money out
to happier customers
with much less work!
Behind the business view: walk through the disciplines
1318.11.2014Kari Laine / Jan Winbrant Version 1.0
Initial planning
Production
Requirements/analyse/design: Model driven approach
1418.11.2014Kari Laine / Jan Winbrant Version 1.0
FOUNDATION MODELS
BUSINESS TERMS
BUSINESS MODEL
COMMON DOMAINMODEL
PROCESS MODELS
ANALYSIS PROCESS MODEL
If Waypoint
IMPLEMENTATION PROCESS MODEL
Requirements/analyse/design: Process design
1518.11.2014Kari Laine / Jan Winbrant Version 1.0
15
Main Statefull Long Running (Implementation of Common Use Case for all Claims)
Decsion_Travel/Motor_NO/SE/FI
Registration_NO/SE/FIClosing_NO/SE/FI
Payment_NO/SE/FI
Dec_Compensation_Common
Requirements/analyse/design: Use Case Spec
1618.11.2014Kari Laine / Jan Winbrant Version 1.0
1.1 Identify customerand defineclaim type
1.4 Validatecoverage
1.5 Check multiclaims
internal
1.6 Registerclaim
1.7 Check multi
claims external
Registeredclaim
1.2 Retrieve and
present questions
1.3 Collect answers
1.1 Claims Use Case Specification: REG1: Identify customer and define claim type
1.1.1 Claims Use Case Specification: REG1-HT: Identify customer
1.4 Claims Use Case Specification: REG2 :Validate Coverage
1.5 Claims Use Case Specification: REG3: Check multi claims internal
1.6 Claims Use Case Specification: REG5: Register claim
1.7 Claims Use Case Specification: REG6: Check multi claims external
“Relax, we’ll help you …”
Implementation: Framework Logical View
1718.11.2014Kari Laine / Jan Winbrant Version 1.0
Core systems
Automated claims process
Decision Payment Recourse… ClosingRegistration
Human tasks
Documentum External systems
Content
services
External
services
External dataCustomer
documentsCore data
JRules & AutoScoreProcess data (CDM)
Rules and
analytics data
Common Data
Storage
Decision and
analytics services
Process data
servicesCore services
Task queues“Scripting”
Claim
handlers managers
Claim
managersCustomers
Customer
Communication
Business activity
monitoring
Partners
Partner
Communication
Claim notification
data
E-invoice data
Invoicing Invoicing
firms
E-invoicing
Web Forms
Engine
Customers
Preparation
Core System
Core services
Implementation: Integration Layer
1818.11.2014
Kari Laine / Jan Winbrant Version 1.0
Integration Layer / Services / Common Domain Model (ESB)
Party Policy Claim
Core System
Core services
Entity Service
Conversion
Common
Domain
ObjectsEntity Service
Conversion
Common
Domain
Objects
Core System
Core services
Core System
Core services
Entity Service
Conversion
Common
Domain
ObjectsEntity Service
Conversion
Common
Domain
Objects
Core System
Core services
Core System
Entity Service
Conversion
Common
Domain
ObjectsEntity Service
Conversion
Common
Domain
Objects
Any System
Entity Service
Some
Proprietary
Format
Other
Core services Service
Implementation: Configuration
1918.11.2014Kari Laine / Jan Winbrant Version 1.0
Node1: BPM EngineRule Engine
Node2: BPM EngineRule Engine
Node1 ESB Node2 ESB
Cluster 1
Cluster 2
UI Forms
UI TaskHandler
UI Monitor
UI Cluster
Implementation / Test: Continius Integration
2018.11.2014Kari Laine / Jan Winbrant Version 1.0
Build Server(JUnit/Maven/Ant/Gradle)
SVN
Nexus
Integration Tests(SoapUI)
Deploy(DeployIT)
PROD
ITEST
ATEST
STEST
Evaluation:
2118.11.2014Kari Laine / Jan Winbrant Version 1.0
Some claims volumes in 2013:
• 1,5 million claims, over one third of which reported via Internet
• Two thirds of claim notifications from Finnish Private customers reported
in Internet
• Over 200 million Euros paid for house or other property damages
• Over 400 000 damaged cars handled
• Thousands of stolen or damaged mobile phones compensated
Questions, comments?
2218.11.2014Kari Laine / Jan Winbrant Version 1.0
Sampo / If video presentation