An insurance company is considering some process improvement options for their claims processing department. Below is a narrative of their current process.
The process begins when a Claimant creates & submits a Claim. When a new claim is received, a Claims Officer (CO) first checks if the Claimant is insured by the company. If the Claimant is NOT insured by the company, the Claimant is sent a claim rejection letter and the process ends. If the Claimant is insured by the company, the Claims Officer evaluates the severity of the claim to be either Simple or Complex. If the claim is determined to be ‘Simple’, the Claims Officer processes the claim and the ends the process with a resolution letter to the Claimant.
If the claim is determined to be Complex, the claim is assigned a ‘Claims Specialist’ who then contacts the claimant to complete additional forms and to collect additional materials. The Claims Specialist then sends a ‘Findings Report’ to the Claims Officer who reviews the findings report. The Claims Officer either approves the claim ending the process with a resolution letter sent to the Claimant or denies the claim. If the claim is denied, the Claims Officer sends the Denial back to the Claims Specialist who has to draft a denial letter and send it to the claimant thus ending the process.
Create a BPMN model of the process.