Claims management touches many systems, involves multiple stakeholders, and requires constant monitoring. Business Process Management can help make all the pieces fit together seamlessly and efficiently. Read how in this brief diagnostic white paper.

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1. Claims with incomplete data
make it to the agent’s desk
…and the agent spends valuable time chasing down the
missing information –chasing after the client or hunting
through other data systems to find it.
When a client makes a claim, your claims management
system should make sure the form is complete. Online
forms can be designed to alert the user when
information is missing or incorrect, and prompt the user
to add or change it.
A BPM solution can prevent improper data – for
example, input that does not follow proper naming
conventions, is in the wrong format, or in the wrong
category – by guiding the user to select from only
…that your claims correct options.
2. Full customer data is not
management process available to agents who need it,
can’t “claim” when they need it
Even when claims data is complete, there may be other
to be efficient relevant customer information in the system that should
be available to the claims handler. Is the customer’s
history, the claim history, or any other information
Claims management touches about the customer, relevant to the current claim? If the
many systems, involves agent doesn’t have access to this information, how
would they know?
multiple stakeholders, and
requires constant monitoring. The claims management system clearly needs to be
integrated with other existing systems so agents can
access information beyond the current claim.
Business Process Management
can help make all the pieces fit
together seamlessly and efficiently. 3. Some claims agents are
overloaded even while others are
available
Accurate prioritization and appropriate routing of claims
helps delegate workload evenly. Proper delegation
streamlines the entire process by ensuring that each
claim is sent to the available individual most qualified to
resolve it. Claims can be routed by BPM based on the
following criteria, for example:
 Agent availability
 Agent profile
 Escalation to specifically qualified agents
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processes. Use monitoring dashboards to see what is
4. Your customers keep asking, happening, and to spot inefficiencies that can lead to
“What’s happening?” improvements.
Customer satisfaction improves when a client has
information about the progress of a claim through the 7. Policies and procedures are
process. The claims management system can send
automated updates regarding the progress of a claim to not being consistently applied
the customer, and can also be used to remind the client Legal policies may vary depending on where your claims
when they need to take additional action or provide are being processed. And like company policies, they are
more information. highly susceptible to change.
A claims management system implemented with BPM
5. Confidential information isn’t can support electronic implementation of new policies
and procedures – changes to processes can be made
available to the agents who need easily and implemented quickly.
it – or visible to those who don’t
Confidentiality and legal requirements may mean that Insurance claim…after-sales service…support
some information about a claim is restricted and
ticket…similar under the skin?
accessible only to certain employees. A BPM‐based
claims management system can have a rights For insurers, a claim is a claim is a claim.
management mechanism to ensure that sensitive data is But how different is the insurance claims process from
provided only to authorized people. BPM “information other types of after‐sales service or technical support?
assurance” governs security and identity management.
Accepting data input from a client or customer,
And BPM “information accessibility” allows integration prioritizing and routing, appropriate escalations,
with your existing security and verification systems, communication with the customer and collaboration
restricted knowledge management systems, and so on. among employees assigned to respond…the names may
change, but the processes are similar.
6. You don’t know how many or For a look at how claims management applies to
technical support, see Seven Signs Your Help Desk
what kinds of claims are being Needs Help.
processed
Or how long it is taking to settle claims! RECLAIM EFFICIENCY WITH
Claim processing time – the time between the claim BUSINESS PROCESS MANAGEMENT
capture and the claim settlement – is highly affected by
wait time. Customer and handler delays and un‐ Developing a claims handling process with BPM is
availability of specialized resources (claims adjusters, straightforward and rapid, and the result is flexible
appraisers, examiners, and so on) can significantly add to enough to change easily as your company’s needs
claims processing time. change. Give your employees the support they need to
do their jobs well, give your customers the support they
Cost of settling the claim – the cumulative cost to the
deserve, and reduce loss due to inefficiency.
company from receipt of a claim through payout – is
affected by individual and department productivity, laws
and regulations, and the overall efficiency of the claims
management system. For more information, visit our web site
BPM gives you the means to measure and monitor these http://www.bonitasoft.com/solutions/quality‐
and other indicators by gathering data from your actual management
BonitaSoft is the leading provider of open source business process management (BPM) software.
Created in 2009 by the founders of the original Bonita project, BonitaSoft is democratizing the use of
BPM in companies of all sizes with an intuitive and powerful solution at an optimum cost. Bonita Open
Solution has been downloaded more than 1 ½ million times by organizations worldwide.
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