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http://fundamentals-of-bpm.org/wp-content/uploads/2013/11/SampleExam1.doc

a scenario of business process and its questions
I want to know the issue register analysis and root cause analysis for following issues
1-InsureIT's sales department estimates that the extreme delays in handling disability claims costs EUR 50K per year to InsureIT in lost sales of insurance policies due to unsatisfied customers and the resulting negative publicity.


2-The insurance company receives 2000 disability claims per year, out of which 20% are for short-term disability and 80% for long-term disability.


3-The company employs two full-time junior claims handler and two full-time senior claims handler dedicated to disability insurance.




thank you hello here is


http://fundamentals-of-bpm.org/wp-content/uploads/2013/11/SampleExam1.doc

a scenario of business process and its questions
I want to know the issue register analysis and root cause analysis for following issues
1-InsureIT's sales department estimates that the extreme delays in handling disability claims costs EUR 50K per year to InsureIT in lost sales of insurance policies due to unsatisfied customers and the resulting negative publicity.


2-The insurance company receives 2000 disability claims per year, out of which 20% are for short-term disability and 80% for long-term disability.


3-The company employs two full-time junior claims handler and two full-time senior claims handler dedicated to disability insurance.




thank you hello here is


http://fundamentals-of-bpm.org/wp-content/uploads/2013/11/SampleExam1.doc

a scenario of business process and its questions
I want to know the issue register analysis and root cause analysis for following issues
1-InsureIT's sales department estimates that the extreme delays in handling disability claims costs EUR 50K per year to InsureIT in lost sales of insurance policies due to unsatisfied customers and the resulting negative publicity.


2-The insurance company receives 2000 disability claims per year, out of which 20% are for short-term disability and 80% for long-term disability.


3-The company employs two full-time junior claims handler and two full-time senior claims handler dedicated to disability insurance.




thank you

Explanation / Answer

1. Firstlythe process starts when a customer lodges a disability claim

Here the customer fills a form for disability claim

The form will be submitted by the customer interaction he form of email or through post

Once the form has been submitted then here we are having two resources like junior claim officer and senior claim officer

Once the form has been submitted then the junior claim officer will receive the form and enters the data in insurance information system

We are having two types of disability one is short term and the other one is long term

Short term doesn't require any documents

Long term will be down by the senior officer and requires docents to process further and it takes more than three months to close the case

Documents should be provides inorder to check the he customer is not fraud

Once they receive the medical report and they start processing for further assessment

Then the finance officer will trigger the customer for the first payment after receiving the medical report

The junior claim will handle the contacts of the customer and when he receives a signed acknowledgement from the customer then it will be handled to senior officer

If the customer was not willing to submit the medical report in time this may cause a negative feedback with the officer and they will not process further

2. Here the insurance company performances are calculated called as combined ratio i.e., which is the sum of claim payouts plus operational expenses for every year divided by the sum of insurance paid by the customer

A good customer for the insurance they will retreat the customers as their patients and they will not delta their work

If a customer wants a medical report from so and so date then they need to provide a valid reason so that they can process it more fast

3. For each disability insurance they will be two full time junior claims.and two full time senior claim

Junior claim will receive all the requests from the customer and if all the details are correct and they will process further and by which the senior will handle the request

Senior claim decides that it is a short term disability or long term disability

For short term disability it doesnt require any documents and for long term disability they require documents like medical report and once they receive a report from the customer then a senior claim will send a mail to the insurance officer

If all the reports are genuine then the senior claim provides a benefit assessment and that the medical reports are essential inorder to access the claim accurately without any fraud

Here he thinks that the customer was genuine and he is not fraud

Once a medical report has been received by the junior claim and he will be handling to senior claim and they start enquiring about where the patient has brought the report like the hospital enquiry will be started

Depending upon the medical report then the insurance company will be paid as per the rules signed by the customer

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