Claims Processing Demo User Guide
Overview
This sample demonstrates how Web Services and human workflow can be used together within a single business process orchestration. The demo interfaces with JBoss Drools and leverages ActiveVOS Central for working with human tasks. Complex Event Processing (CEP), working with attachments and custom reports are highlighted.
Scenario
Title: Claims Processing
Actors
Tony: Customer
JoAnn: Claims Processor
Brian: Claims Examiner
Richard: Claims Adjuster
Margaret: VP Auto Claims
Description
VOSton Mutual is a fictitious insurance company
specializing in
personal property lines of insurance. As the company has
grown,
so too have the number of claims. As a first step
in streamlining the claims
process, VOSton Mutual will now allow customers to submit new
automobile / collision claims through their website, and is using
ActiveVOS to assist in the orchestration and coordination of the
overall claims process.
Process Steps
The Automobile Claims Process is the first process to be
automated by VOSton Mutual. The process contains the
following high-level activities:
- Tony submits a claim for repairs to be done on his automobile. He is encouraged to submit attachments along with the claim (picture of the car, estimates from body shops, etc.)
- The claim request is validated using a rules engine
- An acknowledgement email is sent to Tony
- JoAnn is notified that a new claim has been submitted
- JoAnn reviews the claim and can either deny it immediately, or pass it on for further analysis.
- Richard, a member of the 'claims adjuster' group will provide the fair market value of the car
- Brian, a member of the 'claims examiner' group will be assigned to assess the damage and provide an estimate of the cost to repair the car.
- JoAnn reviews the input from Brian and Richard and makes a final decision as to the amount (if any) the customer will be reimbursed.
- An email is automatically generated an sent to the customer with the final decision of the claim.
- Margaret, the VP of Auto Claims, is the 'Business Administrator' of each of the tasks in the process. As such, she can work on or delegate tasks as needed. She alone has access to will also be automatically notified if claims are taking too long to process.
Benefits of Automation
Using ActiveVOS to automate this process gives greater control
and visibility:
- Customers of VOSton Mutual can enter and review status of their claims at any time online.
- Employees of VOSton Mutual are automatically notified when new tasks need to be addressed
- Task deadlines and escalations can be automated
- Email is automatically generated and sent to the customer, allowing employees to focus on more important things within the business
- Managers can view work queues and reassign tasks as needed
- Managers and IT can create custom reports to analyze active and completed processes
Running the Demo
The demo application takes you through the automobile claims process from the viewpoint of the customer and several roles within VOSton Mutual Insurance. With those roles in mind, and assuming the setup instructions have been carried out, the following links are used for the demo:
| Actor(s) / Action | URL | ID & Password (same value for both) |
| Tony: Enters a new claim request from the VOSton Mutual website | http://samples.activevos.com/AVClaimClient/claimRequest.html | No credentials required |
| JoAnn: Reviews the initial request and performs the final review using ActiveVOS Central | http://samples.activevos.com/activevos-central/login.jsp | processor |
| Richard: Determines the 'write-off' amount of the automobile and submits the information using ActiveVOS Central | http://samples.activevos.com/activevos-central/login.jsp | adjuster |
| Brian: Tasked with contacting the customer and arranging an on-site evaluation of the damage. Using ActiveVOS Central he provides a list of parts and labour that VOSton Mutual would cover as part of the repair work. | http://samples.activevos.com/activevos-central/login.jsp | examiner |
| Margaret: Views business reports and work queues from ActiveVOS Central. She can also re-assign tasks and is notified when claims take too long to be processed. | http://samples.activevos.com/activevos-central/login.jsp | claimsmgr |
Tony: Submits a new claim request
1) From within a browser, navigate to the VOSton Mutual homepage and click on 'New Claim'
2) Submit information about yourself and your car. Reqired fields are:
- Policy
- First Name
- Last Name
- Your email address (must be a valid address)
- Make
- Model
- Style
- Year
- Condition
Note: We’ve implemented validation of input data in two places.
- Name and email validation are handled within the form, resulting in a warning that appears in the browser and the request is not sent to the server.
- Car information is validated as part of the process orchestration. A rules engine is invoked to ensure data is complete. For instance, based on the year of the car a Vehicle Identification Number (VIN) may be required for the claim to be processed.
3) A response is returned to the browser containing a Reference Number, date and status of the request that was just entered.
- A status of 'pending' indicates the following has happened:
- A process instance was created (the reference number generated is the process instance ID)
- A web service call to a Java-based rules engine was made to validate the request and assign a quote time-to-live
- An email was sent to the email address provided
- A task was created for the 'processor' to review the claim
- An ActiveVOS process is in a 'running' state, waiting for the initial review to be carried out
- A status of “QuoteRequestFault� indicates the following:
- A process instance was created (process ID = reference number displayed)
- The rules engine determined that the car information was incomplete or in error
- The process is now in a 'faulted' state
JoAnn: Review the claim request
The ActiveVOS task management system creates a new claim task for the JoAnn, a claims processor. She is notified of new requests from the ActiveVOS Central task list, or subscribes to it using RSS so she can be notified by other means.1) Log into the ActiveVOS Central task list with the credentials of processor / processor
2) By default, you should be placed in the 'open / unclaimed' task list view. If not, select it from the tree view on the left navigation pane.
3) Select the task you generated in the task list by identifying the Reference Number in the subject line.
4) Click the claim button
to
claim and start the task. 
- Information about the request is displayed in the ‘Claim Request’ tab.
- Results from the call to the rules engine can be seen in the ‘Pre-Analysis’ tab
- The ‘Liability Review’ tab is where Roger will provide the estimate details.
5) From the ‘Liability Review’ tab JoAnn can:
- Deny the task herself
- Select the 'Denied' radio-button to immediately deny the claim
- Complete the task by clicking on the
button
- Advance the claim to the next steps of the workflow
- Select the 'Further Review' radio-button
- Check either (or both) the Adjuster and Examiner to review the claim and provide additional information
- Complete the task by clicking on the button
Richard: Provide a write-off amount for the automobile
1) Log Out of ActiveVOS Central as the processor
2) Log into ActiveVOS Central as the claims adjuster (adjuster / adjuster)
3) Select the task from the task list
4) Select the 'claim' button to claim the task
5) Select the 'Adjuster Thresholds' tab in the task form and enter the market value of the automobile.
6) Complete the task by selecting the 'Complete' button
Brian: Provide covered costs to repair damage caused by the accident
1) Log Out of ActiveVOS Central as the adjuster
2) Log into ActiveVOS Central as the claims examiner (examiner / examiner)
3) Select and claim the task
4) Select the 'Estimate of Repairs' tab in the task form
6) Select a category from the Parts List tree-view by clicking on a folder (interior / exterior / power / misc)
7) Select the 'Add' button next to part(s) required to repair the car
8) For each part selected, provide the following in the 'Parts and Labor' detail section of the task form
- Parts Qty
- Labor Hours
- Hourly Rate (labor rate per hour)
- Total Cost is automatically calculated (as is the 'Estimated Cost' at the top of the form
8) Complete the task by selecting the 'Complete' button
JoAnn: Final review of the claim
1) Log Out of ActiveVOS Central as the examiner
2) Log into ActiveVOS Central as the claims processor (processor / processor)
3) Select and claim the task
4) Select the 'Background Research' tab in the task form to review input from the adjuster and field examiner
5) From the ‘Final Adjudication’ tab JoAnn can:
- Deny the task
- Select the 'Denied' radio-button
- Complete the task by clicking on the button
- Approve the claim
- Select the 'Approved' radio-button
- Select an 'Adjudication Date' using the date-picker control
- Enter a 'Loss Amount' - representing the amount the customer will be re-imbursed
6) Complete the task
Upon completion of this task, an email is automatically sent to the customer detailing the outcome of their claim request.
Operations Dept (VOSton Mutual): Check process status on the ActiveVOS Console
The ActiveVOS Console provides a wealth of information for both business users and IT personnel. For security reasons, access to various pages within the console can be restricted from use.Process instance information and data logs are persisted to a database. By using the console, it is possible to view details about processes in any state (running, completed, suspended, faulted, etc.). It is also possible for administrators to suspend or terminate running processes. If a process is suspended, process variables can be modified and the process can be resumed – allowing owners or administrators the ability to 'fix' a process that may be in trouble.
A typical use case for looking at the details of a process instance is to debug a process that has faulted. Root-cause analysis is a case for examining a process that completed normally - for instance an auditor may need to determine exactly what happened to cause the outcome of a specific process instance.
1) Log into the ActiveVOS Console at http://samples.activevos.com/activevos/home.action
If your Console
has been secured, you will be prompted to log-in as a user with admin
priveleges (as seen here):
3) Click on either the Process ID or Name to display instance details
- The process graph is annotated with intuitive markers to display activities that completed, faulted or were skipped
- From the Outline view (shown above) you can:
- Select process variables, activities and objects – details are displayed directly under the process graph
- Suspend or terminate running processes, and resume a
process if it’s been suspended
- From the Log view
- You’re presented with a sequential log of activity and data change events. You’ll notice that by running your mouse over items in the log synchronizes to the corresponding activity in the graph.
- Double clicking on a log entry will basically 'freeze'
all variables at that exact point in time. When the
'execution point' is frozen, if you go back to the outline view and
select a variable, you will see the value of the variable at the time
of the execution point – even if the variable was within a loop.
Margaret: Viewing Reports and CEP Notifications From ActiveVOS Central
The management team at VOSton Mutual has decided that if the average response time to close a claim request exceeds 30 minutes (for purposes of the demo), Margaret a VP of automobile claims should be notified so she can immediately check to see if it's a sysem issue or simply a matter of delegating work to others within the organization.1) Log into ActiveVOS Central as claimsmgr / claimsmgr
2) Select the Open category in the Task List
- If in the past 1 hour window, the average response time of completing a claim request has exceeded the 'allowable threshold' of 30 minutes, Margaret will be assigned an open task to research why claims are taking longer than expected to process
3) To see how much work is in each persons work-queue, she can either run a standard or custom report. The standard work queue reports can be found in the Task Management folder, while custom reports that deal only with the 'automobile claims' process can be found in the 'Claim Reporting' category.
- Select the Reports category from the left navigation pane in ActiveVOS Central
- Select the Claim Reporting folder, then the 'Claim Status' Report
- When a report is selected in the list, a preview is provided (the preview is a static image)
- To run the report, double click on the report name in the list or choose the 'Open in Tab' button
- Because Margaret is defined as a 'Business Administrator' of each of the claims process tasks, she can reassign the task to someone else's work quque by selecting the task in the task list and selecting the Reassign button
About Active Endpoints
Active Endpoints (www.activevos.com) is the leading developer of visual orchestration systems. ActiveVOS empowers line of business project teams to create applications using services and industry standards, making their businesses more agile and effective. Active Endpoints’ ActiveVOS promotes mass adoption of SOA-enabled applications by focusing on accelerating project delivery time with a standards-based, easy to use system. Active Endpoints is headquartered in Waltham, MA with development facilities in Shelton, CT.
To find out how Active Endpoints can help your business, visit www.activevos.com, call +1 781 547 2948, or email us at info@activevos.com.