Implementing the Auto Claims Management template
IBM Case Manager enables the business analyst to design, build, test, and deploy a solution using a tool called IBM Case Manager Builder. The Case Manager Builder provides an easy-to-use environment that allows the analyst to describe the solution using familiar terminology, while abstracting away the underlying complexities of the technical implementation. (Throughout this tutorial, you will see numerous screenshots of the Case Builder tool.)
In describing the implementation of the Auto Claims Management sample, this tutorial starts with the assets defined using the Case Builder tool. It then describes some places where we extended the template using the IBM FileNet P8 Process Designer and discusses how we implemented two rules that we built with ILOG® JRules.
Finally, the tutorial inspects some UI assets contained in the template.
The artifacts of a case management solution are organized into an object model, as illustrated in Figure 5.
Figure 5. The IBM Case Manager object model
Each solution includes a unique, user-provided descriptor that will be used as a prefix on all assets within the solution. The solution also contains one or more properties, document types, roles, and case types. Document types, properties, and roles are defined at the solution level and are used across the defined case types. There is one personal in-basket defined for all users of the solution.
Within a case type are properties, case property views, folders, and tasks. All properties defined at the case-type level are mapped up to the solution level so they can be reused in other case types. Case types also contain user pages. These pages can be customized, and new pages can be created to meet the needs of the case workers.
This section discusses all of the assets defined and implemented using the IBM Case Manager Builder tool. Collectively, they provide the definition and high-level structure of the template.
There are a significant number of properties defined in the template. Most of them are self-explanatory; they store and display details about the customer's policy and the claim being worked. Figure 6 shows the details defined for three types of properties.
Figure 6. Details of three types of properties
Other properties help drive the solution in a variety of ways:
- Setting a precondition for a task — Note that a
property can be used as a precondition for the instantiation of a
new task. In the Auto Claims sample, there are a number of Boolean
properties that the case workers can set to start new tasks. When
the case worker sets one of them to true, a new work stream is
created to complete that piece of work. As an example, when the
claims adjuster sets the Boolean property Request Estimate to
TRUE, the create estimate task will automatically
Request Estimate = TRUEis a precondition for that task.
- Specifying the purpose of a work item — The property Work Item is used to indicate what the purpose of each work item is in a case worker's inbox.
- Indicating the current state of the case — The property Claim Status is used to indicate the case's current state.
There are a number of roles defined for the solution. See Table 1 for a list of them.
Table 1. Roles used in the Auto Claims template
|CSR||Customer service representative|
|Agent||Third-party investigating/assessing damage|
|Supervisor||Supervisor for team of adjusters|
|Recovery Expert||Expert for recovering the cost of losses|
|Fraud Investigator||Investigates potential fraud cases|
|Administrative Clerk||Performs back-office activities, like assisting with the generation of letters|
As Figure 7 shows, each role has an associated in-basket.
Figure 7. Details of a role
In addition, the template defines a simple personal inbox for handling work items directed at individuals or workgroups.
Throughout the auto claims process, there are documents that may be included with the case. Figure 8 shows that properties can be assigned to describe the document type.
Figure 8. Details of a document type
Table 2 lists the document types that categorize these documents.
Table 2. Document types used in the Auto Claims template
|FNOL||First Notice of Loss (PDF version only)|
|Adjudication report||Report of the decisions made in the legal adjudication process|
|Form of arbitration|
|Expertise form||A form that an external specialist can provide to indicate his qualifications|
|Subrogation form||Agreement when multiple parties share liability for a loss|
|Proposal of liability share|
|Piece of evidence||Example: Photos taken at the scene of the loss|
|Claim form||The claim form that the claimant has downloaded and filled out|
There are three case types defined within the template. The first is general claim, which defines the processes for simple claims with material damage only (approximately 80 percent of all claims). This is the case type discussed in detail in this tutorial and that has been implemented with a set of tasks.
The two other case types, claim including bodily injury and major loss claim, are provided solely for the purpose to illustrate that the case worker who initiates the case has a choice to select different claim types. IBM Case Manager offers the capability to define multiple case types, which may involve different roles, different tasks, and different UIs for the execution of these tasks.
As an example, when the company receives a bodily injury claim, the claims adjuster will be the central figure in the case and will ask numerous questions during the process. The claims adjuster will be surrounded by legal and medical specialists. There will be hospital and other medical bills (consider the ambulance ride and emergency room visit).
Other types of auto claims that may require a different case type are property damage claims, windshield claims, or third-party insurance claims, where the claimant is not the policy holder, but somebody filing a claim against the policy holder.
Figure 9. Folder structure for the general claim case type
During the execution of the claims process, documents are being added to the case and organized into a folder structure. For this template, three folders have been created:
- Correspondence — To capture all correspondence with the customer and other third parties.
- Evidence — To capture pictures the customer has taken of the scene of the accident and potential additional evidence material gathered by the agent who assesses and estimates the damage or the claims adjuster.
- Police report — To file the police report.
To help organize the case information for the case worker, the Case Builder allows the business analyst to create a view of the properties in the case. For the Auto Claims template, the case information is organized into three groups:
- Policy details, which includes information such as policy number, name, address, cars insured, etc.
- Claim details, which includes properties about the claim itself.
- Tasks work actions that the case worker can initiate as he learns more about the case.
Figure 10 shows the data view with each group expanded.
Figure 10. The views of the properties in the general claim case type
The general claim case type contains a number of tasks, as shown in Figure 11.
Figure 11. The tasks in the general claim case type
For Auto Claims, there are two required tasks: record claim and close case. Within the record claim task, the CSR gathers all the information required to process the claim. Depending on the information gathered in the record claim task, a number of other optional tasks will be instantiated.
All of the optional tasks in the Auto Claims template are automatic, instantiated when certain preconditions are met. The preconditions can be set programmatically in a workflow or by a background process, such as an ILOG rules system. They can also be set manually by the case worker.
There are two user-created tasks defined in the template. Request letter enables a case worker to request a particular type of letter be sent. Involve recovery expert would be invoked by the claims adjuster when additional assistance from this role is required to resolve the claim.