Introduction to IBM Case Manager and the solution templates
There are many types of case management applications. For the purposes of this tutorial, let's focus on case management solutions that are more human-centric in nature and require the coordination of different services throughout an organization, such as health, legal, or financial, in order to provide a business service for a customer or party. Typically, this includes creating a case file and following a process (or collection of processes) to ensure the delivery of the business service. Case-related information is used by case managers or members of a case team who collaborate to resolve and close a case. After the case is completed, information about the case is typically retained for compliance or in support of longer-term business processes.
These case management scenarios require highly collaborative, dynamic, and event-driven work. Often, cases and the processes that support them can have significant life cycles, and can be closed, suspended, and reopened.
An example case management solution is auto claims management in insurance services. In this scenario, a customer calls in to file a claim, and a case is opened to track this claim. Resolving the claim requires collaborative work between multiple teams, inside and outside of the organization. There are regulatory and company service-level agreements (SLAs) that dictate timelines and interactions with the customer.
Delivering this type of solution requires the effective integration and leveraging of a broad set of capabilities as illustrated in Figure 2.
Figure 2. Artifacts in advanced case management
Case content must be gathered and maintained in a single, secure location and passed seamlessly between all individuals working on the case. Context must be complete and consistent across all users. Events, business rules, and workflow help to automate elements of the process to reduce errors, ease the burden on the user, and increase efficiency. Efficient collaboration between team members is critical. Providing transparency into the process is important, not only for operational purposes but also for assessing the impact of the solution on the overall business.
IBM Case Manager provides a platform that leverages capabilities from across IBM Software Group to deliver the advanced requirements needed to drive better case outcomes. The platform combines enterprise content management and business process management, along with integrated rules, events, collaboration, and analytics to deliver a comprehensive case management product. On top of this platform, IBM Case Manager provides a set of tooling that enables business analysts to quickly define solutions, and then collaborate with customers and IT to deliver them.
There are case management solutions in virtually every industry. Figure 3 illustrates some of these case management solutions.
Figure 3. Different types of cases across industries
Most of these case types are vertical in nature, solving a specific problem in a specific industry. But some are more horizontal, addressing a challenge that occurs in many industries.
To aid in the deployment and delivery of these solutions, IBM Case Manager supports the notion of a solution template. A solution template contains case management assets that are applicable to a particular business problem, and can be easily customized and extended to deliver a complete solution.
To illustrate the concept of a template and demonstrate how the features of IBM Case Manager can be used to deliver a solution, IBM has provided two sample solution templates coincident with the first release of the product. The first sample is Credit Card Dispute Management in financial services. This template is discussed in Part 1 of this series.
The second template is Auto Claims Management in the insurance industry. The remainder of this tutorial introduces this template and the assets it contains, and describes some details of how the template was built. Finally, this tutorial shows you how to create a template and how you can deploy the Auto Claims Management template in your environment.
Successfully managing auto claims requires efficient interactions among customers, damage assessors, medical and legal experts, and the insurance company. The expertise required for a claim will vary, depending on the details of the claim. Most insurance companies have well-defined processes for auto claims. Errors or inefficiencies in the interactions among experts, customers, and the insurance company can result in additional costs, delays, and unresolved claims disputes.
IBM Case Manager provides capabilities that allow collaboration and flexibility in the business process, while recording the events. The Auto Claims Sample Solution Template is a good starting point for building your Auto Claims solution.
The diagram in Figure 4 provides a high-level view of the case flow.
Figure 4. High-level process flow for managing an auto claim
The process typically starts with a customer involved in an accident calling the insurance company. A customer service representative takes the call and works with the customer to complete a First Notice of Loss (FNOL) form. In addition to details about the customer and the accident, the form will allow the customer service representative to specify additional steps, such as whether a rental car is required, or whether a third party might be responsible for part or all of the damage. If the customer has any supporting documents, such as pictures or the police report, she will send those in, and the customer service representative will include those with the case.
At this point, a claims adjuster takes ownership of the case and works with third-party agents to gather estimates and arrange repairs. She will also approve the claim and work with other insurance companies, if necessary, to pay for the repairs.
Underlying this process are workflows and rules systems that route work and inspect the case data to determine if particular steps need to be taken, such as a fraud investigation.