GENERAL INSTRUCTIONS

• 1.      The student must work within the parameters of the assignment only (individually – students may not consult other students; partners or groups – students must complete the work assigned equally and fairly within the group created).

• All assignments are due on the date and at the time indicated above. All times are eastern standard time (depicted by EST).
• By submitting the assignment, the student acknowledges that the assignment reflects the work of the individuals listed on the submission only. If the Professor deems the submission to be contradictory to cited academic integrity policies listed in section eight of the academic policies, further disciplinary action appropriate to the infraction may ensure.
• The student understands that through the act of submission of the assignment, they have all read the assignment thoroughly and acknowledge it to adhere to the policies listed in section five of this assignment’s general instructions.

SPECIFIC ASSIGNMENT INSTRUCTIONS

You will need to create an account on a modeling tool. List of recommended free modeling apps

Recommended application: https://camunda.com/

ASSIGNMENT

As a process analyst working for a car insurer, you are engaged in a project that aims at improving the company’s insurance claim registration process. The first step is to model the as-is process. You have interviewed a few representatives for three key roles participating in this process: a customer service representative from the customer service department, a claims handler from the claims handling department, and a claims manager. The relevant parts of the interview transcripts for each role are provided below.

Customer service representative:

“When I receive a claim from a customer, I first check it for completeness. If it is not complete, I ask the customer to complete the missing information and resubmit the claim. When receiving a complete claim, I register it and send it to the claims handling department. I then wait for a notification from the claims manager that a decision has been taken. After receiving this notification, I send a customer satisfaction survey to the customer. If the customer sends back a completed survey, I first add it to our customer satisfaction database. I then have a closer look at it to evaluate if the overall satisfaction indicated by that customer is at least 5 on a scale from 1 to 10. If it is, my job is done. If it is not, all that is left for me to do is to notify the claims manager. If, after sending out the survey to the customer I do not get a response within two months, I make a no reply entry in the customer satisfaction

database”.

Claims handler:

“When I receive a claim from the customer service department, I first check whether the claimant has a valid insurance policy. If not, I inform the claimant that the claim is rejected due to an invalid policy. Otherwise, I evaluate the severity of the claim. Based on the outcome of this evaluation, I send relevant forms to the claimant. I also check whether the form is complete. Only if the form is complete, I register the claim in the claims management system. Otherwise, I ask the claimant to update and complete the form. Upon receiving the updated form, I check it again for completeness. After the claim is registered, I start evaluating it as either simple (for minor car accidents) or complex (for major car accidents). When a claim is complex, I need to additionally retrieve the corresponding car accident report from a police reports database. Based on the claim, and on the police report if required, I calculate an initial claim estimate and create an action plan. Finally, I send both the initial claim estimate and the action plan to the claims manager”.

Claims manager:

“After receiving an initial claim estimate and action plan from the claims handling department, I make a final decision. Depending on the outcome of the decision (accept or reject), I notify the customer about my decision. I then update the claim file to record this decision and notify the customer service that a decision has been taken. After that, there are two possibilities:

• I receive a notification from the customer service that the results of a customer satisfaction survey indicate that the overall satisfaction of the customer is very low (i.e., less than 5). In this case, I retrieve the corresponding survey and claim from our databases. I analyze them thoroughly to identify whether our internal operations could have been done differently, or could be improved in the future to better satisfy our customers. Finally, I send a letter to the claimant to apologise and promise to provide better services in the future.
• I do not hear back from the customer service within two months. In this case, no further action is required from me.”

Claimant:

The claimant completes a claims form and submit it to the customer service of the car insurer. Then the claimant has to wait for a response, which can be either of the following:

• Notification from customer service of the approval of my claim; in this case the claimant does not have to do anything further.

·        Request from customer service to provide missing information on the forms, in which case the claimant updates the form and resends it to claims handling.

• Rejection from claims handling; in this case the claimant does not proceed any further with his or her claim.

Final decision about the claim. After that, the claimant receives a customer satisfaction survey from the customer service. The claimant may choose to simply ignore this form. He or she may also choose to fill it out (typically the claimant does so when he or she is not satisfied with the service) and sends it back to the customer service. In this case, the claimant may receive a letter of apology from the claims manager within two months; otherwise the claimant is done.

Using the information above, create a draft BPMN model of the as-is claim registration process. This draft will then be validated with the people that have been interviewed before sign-off by the process owner. Make appropriate assumptions.

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