Draw out bpmn process
BPMN elements:
- Pools and lanes
- Tasks
- Gateway
- Sequence flows
- events
When a claim is received, a junior claims officer first enters the claim details into the insurance information system. The same junior claims officer performs an eligibility check. If the claim is not eligible it is rejected and the junior claim officer notifies the customer and the process ends. Otherwise the claim is marked as “eligible” and moves forward in the process. Next, the claim is sent to a senior claims officer who then receives it, performs an in-depth assessment of the reported disability and estimates the monthly benefit entitlement (i.e. how much monthly compensation is the claimant entitled to, and for what period of time). At this point of time he decides if the customer is eligible for short-term disability or long term disability benefits.
In the case of short-term disability benefits, the senior claims handler can perform the benefit assessment without requiring further documentation. Once a decision is made, the senior claims handler registers the entitlement on the insurance information system and informs the customer of the outcome via e-mail or postal mail. The process ends.
However, in the case of long-term disability claims (more than three months), the senior claims handler requests a full medical report. Senior claims handlers perceive that these medical reports are essential in order to assess the claims accurately and to avoid fraud. Once the senior claims handler has received the medical report he assesses it and compares it with the claim. Afterwards the process continues as normal and he performs the benefit assessment. The entitlement is registered in the insurance information system. Afterwards the senior claims handler informs the customer of the outcome via e-mail or postal mail. This is when the process ends.