Claims Processing sometimes involves collating and sharing large amounts of information among multiple parties involved in a claim—from body shops to adjusters to investigators to lawyers and doctors to claimants and regulators. And it involves the knowledge of experienced adjusters to determine the fair and appropriate outcome of a claim. In fact, losses and loss expenses absorb 80% of premium dollars collected by carriers.

Key Solutions and Services

To deliver optimum results, Hexaware combines proven methodologies with best practice custom claims applications development, legacy and third party systems integration, claims search integration and leading Vendor technology (FileNet) and application products.

Claims solution components that Hexaware delivers include:

HexSOACF

HexSOACF is an Auto Claims workflow application that handles the complete workflow of an Auto Claims system from First Notice of Loss (FNOL) to Claims Settlement. The entire process has been modeled using Web Sphere Business Modeler.

The exported Model to WebSphere Integration Developer was used for both Component development as well as for the actual ‘wiring’ of Services using IBM’s SCA architecture.

The Work flow integrates different components like

• Human Tasks
• Java Components
• Business Rule Components

The work flow is initiated from a Web based application titled HexFNOL, which captures the critical information pertaining to the Loss.



The above diagram shows the components, participating applications, Roles & Phases in a Swim Lane Diagram.

High lights of HexSOACF Application Framework

• Ability to process various sub claims under one master claim
• Automatic allocation of CM or CH to a claim request as well as allocation of SU or LA during claim investigation
• Service interface to other Systems like PAS, GL, WLS
• Flexibility to deploy service components as Java or Local or Web Service
• Usage of Business Rule components resulting in ‘agile ‘ systems to respond to changes in business rules , without changing any logic in the application
• Role Based security implemented for CM & CH with the result the user only sees the work queues pertaining to his role & only his work items ‘filtered’ out from the relevant Queue
• ISO standards compliant
• Built using IBM’s SOA Design Principles

Considerations in our Optimized Process Flow

Much like how the Service Granularity is a consideration during SOA design, granularity of the human tasks at the modeling stage have been addressed based on the following considerations, so that the application can meet the exacting performance standards of a production system.

• If all tasks are to be achieved in a single interaction with the user (Combined into one human task)
• The longevity of the task duration to complete(Which can result in possibly in separate logical human tasks, each one accomplishing related tasks together)
• Whether the tasks will be performed by the same or a different role (Resulting in separate Queues for these roles)
• Optimum no of Queues for a role (Too many resulting in cumbersome user experience, too few may result in coarse grained human tasks)

Additional Features planned for Future Release

• Integration with WebSphere Portal, UDB & Web Service call to .Net for obtaining Policy details
• Integration with Fraud Management System
• Integrating Investigators as active participants in the Workflow
• Intelligent Creation of Claim Reserve leading to accurate estimation of Reserve
• Content Management for Artifacts (Using BLOB attributes for columns)
• Dashboards for Key Stakeholders for better decision making
  • Define KPIs using WebSphere Business Modeler
  • Measure KPIs using WebSphere Business Monitor
  • Present KPIs using WebSphere Portal

FileNet Acenza P&C Claims 4.0

Acenza P&C comes with pre-configured workflows that are built on industry best practices. Since the Acenza P&C workflow maps are part of the solution, in-depth process design and implementation activities are not required. Business processes that are included with Acenza P&C are:

• Claims File Creation and Assignment
• Coverage Verification and Claims Maintenance
• Review for Salvage and Subrogation
• Special Investigations Processing
• Supporting Document Processing

Implementation of Document Management Tools

Document management tools are those that automatically generate, organize, and print correspondence to comply with service and regulatory requirements. Hexaware provides services around FileNet Enterprise Content Management (ECM) platform to implement these tools and integrate with the Legacy and Web based Claims applications.

Fraud Management

Fraudulent Claims is a significant and costly area of concern for property and casualty insurance companies. Hexaware has helped its clients in developing a multipurpose Insurance fraud alerts system to detect fraud and improve the Productivity of Claims officers. This system (Acenza ClaimsSearch Connect) works in the FileNet Acenza environment providing a comprehensive solution for Claims Automation.

Key benefits include:

• Reduction of loss due to fraudulent claims by quickly verifying the claims against the historical claims data before payment is made. ACSC eliminates the batch mode interface and provides real-time interaction with ClaimsSearch databases. This results in elimination of manually intensive batch mode file transmission and collation of the search results
• ACSC web interface provides intranet based tool for claims information query during processing
• Faster claims processing and loss reduction will result in customer retention and improved customer satisfaction. The carrier can control the costs better leading to competitive rates
• The solution implemented on industry standards is platform independent and scalable
• Hexaware technology (Legacy and new) and business expertise with offshore based development/customization resources will enable faster customization and implementation at reduced overall cost