A Customer Service Representative can execute the Claim Status Solution Scenario in Business Space by logging on to Business Space, initiating a request, providing details using forms, and submitting the data for processing. While submitting the data, you can close the claim inquiry or you can transfer the Auto claim inquiry to an Auto LOB Specialist and the Home claim inquiry to a Home LOB Specialist. A supervisor can then use Business Space to view and analyze information using the various graphs and diagrams displayed in the reports generated.
The fields in which data is required are labeled with a * and have a different color. The Submit button in the form is disabled until you provide a value in all such fields in a form.
You can start the Solution Scenario in Business Space to view the Getting Started Widget. The Getting Started Widget lists the assets and the steps for using the Solution Scenario.
Roles | Inquiry | Claim Query | All dashboards | Process instance |
---|---|---|---|---|
Customer Service Representative | Yes | N/A | N/A | N/A |
Specialist | N/A | Yes | Yes | N/A |
LOB Manager | N/A | N/A | Yes | N/A |
Process Owner | N/A | N/A | N/A | Yes |
The Solution Scenario provided with the WebSphere Insurance Content Pack includes different pages that are customized to display reports. These reports can be used for further analysis.
After you submit the request, you can log on using the User ID and password of an agent to analysis the information about the following pages.
The Claim Status Dashboard page contains widgets that provide information about alerts, instances, total claims overview, and so on related to the benefits eligibility request raised.
The details for the widgets displayed on the Claim Status Dashboard page are given in the following table.
Widget | Description |
---|---|
Nationwide Distribution of Total Submitted Claims | The map displays the total number of claims submitted for 50 states. |
Claim Amount Overview - Current Month | The full gauge diagram displays an overview of the claim amount for the current month. |
Total Claims Overview - Current Month | The widget displays an overview of the total claims for the current month. |
Instances | The widget displays the claim duration, claim key, and so on. |
Alerts | The widget displays the business measure alerts. |
The Performance page can be used to view widgets. This page displays a bar graph and gauge diagrams that you can use to analyze the claim status.
The details for the widgets displayed on the Performance page are given in the following table.
Widget | Description |
---|---|
Total Submitted Claims on Different LOBs - Current Month | The bar graph displays a total of the claims submitted for each line of business in the current month. |
Claim Summary for Different LOBs - Current Month | The half gauge diagrams display the claim summary for each line of business. |
Total Paid Claims on Different LOBs - Current Month | The full gauge diagrams display the claims paid for each line of business. |
The Analysis page contains widgets that provide information about LOB distribution, total claims paid, and so on, related to the claim inquiry request raised.
The details for the widgets displayed on the Analysis page are given in the following table.
Widget | Description |
---|---|
LOB Distribution | The pie chart displays the number of claims for the line of business. |
Claim Status Distribution | The pie chart displays the claim distribution grouped by the line of business. |
Total Claim Amount Paid per LOB | The bar graph displays the total claim amount paid for each line of business. |
The Report page contains widgets that provide information about the trend of submitted claims and the trend of claims amount related to the claim inquiry request raised.
The details for the widgets displayed on the Report page are given in the following table.
Widget | Description |
---|---|
Trend of Submitted Claims | The 3D-line graph displays a trend for the claims submitted. |
Trend of Claims Amount | The 3D-line graph displays a trend for the claim amounts. |
The Claim Status process flow can be viewed as published using WebSphere Business Compass or as an inflight process that displays the services used and the sequence in which they are processed.
View the Claims Status process flow on the following pages.
The artifacts, users, and roles used in the Solution Scenario can be viewed in the Claim Status Process page.
The details for the widget displayed on the Claim Status Process page is given in the following table.
Widget | Description |
---|---|
Draft Artifacts | Navigate and view the artifacts used in the Solution Scenario. |
Publishing Server Access Control | Navigate and view the users and roles provided for the Solution Scenario. |
The details for the widgets displayed on the Claim Status Process Check page are given in the following table.
Widget | Description |
---|---|
Diagrams | This dynamic process flow diagram displays the state of the transaction. Select an item from the Instances widget to view the run time transaction flow in this widget. |
Instances | The instances of the requests and responses created can be viewed in this widget. |