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The client in this case was a Croatian insurance company, with it’s centralized organizational structure, spanning multiple branches with branch offices, employing multiples of employees working on multiple processes.

One of the key processes is claims notice and settlement (Process in later text).

Process involves different levels of operation and interaction, results of which needed to be integrated and processed.

Key parts of the Process (As-is):

1.Claim notice (first step) - can take place in branch office, starting with direct contact with one of the claimers (participants), or in central office over a telephone call

During this step agents collect basic data about participants and events (personal data, documentation). Collected data is then sent to the Administrator office, where the second step takes place

2.Entry in WinCubis registry (second step) - data is entered into centralized LOB application used to manage claims.

Administrator enters claim data and receives a claim ID, then forwards it to Control (step three).

3.Claim control (third step) - collected data and documentation is being reviewed and corrected by the controller; additional documentation can be requested from branch office; various forms are being filled and printed; authorized settlement agent is being chosen.

At this point multiple persons can manage the same claim.

After evaluating the collected data, controller makes decisions whether evaluation is needed (step four) and notifies the next in chain - settlement agent.

4.Evaluation (fourth step) - if needed, settlement agent sends emails containing collected relevant documentation to evaluation and estimate company and therefore engages in two-way mail communication that can take place over considerable period of time (mail sent - wait for answer - no answer - hurry mail sent - wait - answer negative (more data required or data invalid).. )

After the evaluation is complete, settlement agent begins step five..

5.Settlement (fifth step) - during this phase agent reviews all collected data, documentation, financial details, and makes futrher decisions - can request additional documentation; can review and manage claims reserve; can review and manage settlement; can notify involved parties using memos etc.

If a settlement is reached, Process can end at this step, untill further notice.

If decided upon, process can enter recourse action.

6.Recourse (sixth step) - additional data is being collected, recourse settlement is being negotiated.

7.Reopening of settlement (seventh step) - if needed, a settlement case can be reopened and process can return to step five.

 

Some key aspects of the Process that needed optimizing:

  • Large number of documents of different types are being collected, copied, emailed as attachments, and kept in hardcopy form

-> proposed solution: DMS (Document Management System)

  • All communication takes place via email or voice (some documents are being sent by mail). Tracking emails and phonecalls over considerable periods of time becomes a task unto itself. Also, scheduled notifications require manual actions (maintaining schedulers, calenders, keeping records..)

-> proposed solution: built-in integrated mailing, tracking and alarms system

  • Tracking time estimated for each task and job, response times in communication and actual work hours for those tasks can become frustrating - it becomes nearly impossible to track down weak links, cloggs and stalled processes, as well as measure organization working efficiency.

-> proposed solution: BPM (Business Process Management) with reporting

  • In a growing organization such as the one in question, migrating people and processes across organization, with ever changing roles and responsibility, requires special attention - new job functions being opened and new employees assigned to existing processes daily.

-> proposed solution: OrgStruct (Organization structure) integrated with BPM

  • Large number of memos being manually created using copy-paste from existing memos, then sent via email or mail, and printed and stored as hardcopies, or saved on local hard drives.

-> proposed solution: built-in memo creator and editor integrated with DMS and BPM

 

Solutions implemented

All solutions were developed and built on Microsoft .NET and SQL Server platforms, making a robust and easy scalable platform for an enterprise framework. Using web technologies (ASP.NET MVC, JavaScript) for client side that work equally well in all current web browsers enabled effortless maintainance and deployment.

 

1.DMS (Document Management System)

Self-developed DMS was implemented as a SaaS web application. Some key features included uploading, downloading, editing, versioning, searching, combining multiple documents etc.

 

2.CMS (Content Management System)

Self-developed CMS was implemented as a platform for both hosting various content and self-developed modules: OrgStruct, BPM (Client and Admin), Address book

 

3.OrgStruct (Organization structure)

Self-developed module for CMS, taking care of the whole organization structure - org. Chart with entities such as branches, job functions, roles, employees, with all required relations and personal data. Integrated with other modules, it’s easy to administer changes across organization or changes in BPM processes

 

4.BPM (Business Process Management)

Self-developed module for CMS, serving as a platform for modelling, building and managing business processes. Processes are divided into steps, each represented with a different form, containing other subtasks and integrated with utility platform functions. Process management is done in BPM Admin module, where processes and steps are created, linked, integrated with OrgStruct entitites and process variables defined using decision scripts for routing between steps.

BPM performs like a reactive application, meaning it saves states of all step variables with each save, proceed or retun operation, so any process variable in any step can be tracked and it’s value/state compared with other state instances, allowing easy monitoring of changes. Specially designed previews and history forms are available at every step, so the user can quickly access process instance data from anywhere.

Central module for BPM Client is inbox - a special grid containing all info on current and past process instances. After login, user lands on the inbox page that shows his current tasks, tasks that can be assigned to him, tasks that he can pick up, his completed task and processes.. From there, user can work on his tasks (process steps), monitor his alerts, search, track documents and perform other activities.

 

5.Utility layer modules - alarms system, mailing system, memo editor

Self-developed modules serving as integration modules, solving the problem of ‘keeping everything in one place’.

6.Interfaces to other systems (WinCubis, HUO)