Reference no: EM133213693

Scenario- Insurance claim process

The insurance claims process starts when a Customer submits an insurance claim to the Claims Office. Each insurance claim goes through a two-stage evaluation process. The Claims Office sends the insurance claim to the next available Claims Handler. The role of the Claims Handler is to determine if the Customer is duly insured and if the Customer is liable for the loss described in the claim. In case of that the customer is not insured or not liable, The claims handler should send rejection notification to the customer and end the process. In the other case, the claim is assessed in order to determine if the insurance company has to cover this liability and to what extent. If the amount of the claim is greater than 10000 dollars, the assessment of the claim must be forwarded to and performed by a Senior Claims Handler. If the claimed amount is less than or equal to 10000 dollars, the assessment can be performed by a Claims Handler. The claims handler should send emails and call the relevant parties to check and assess the claim. When a handler or a senior handler has completed their assessment, they send their assessment back to the Claims Office.

The Claims Office then notifies the Customer of the outcome of their claim. If the outcome is positive, the Claims Office informs the Customer of the amount they are to be reimbursed. The Claims Office then sends the Customer's claim and assessment to the Finance Department for payment. The Finance Department prepares a payment (cheque) and sends it to the Customer via the mail service. The Finance Department then sends the Customers claim and assessment to the Records Department. The Records Department stores the Customers claim and assessment onto the company's database system.

If a claim is rejected, the Claims Office notifies the Customer and then sends the Customer's Claim and assessment to the Records Department. The Records Department stores the Customers claim and assessment onto the company's database system.

Students are required to develop a process model using the swim lane approach for the Insurance claim process described in the above scenario.