Executing the Claim Status Solution Scenario using Business Space

The Claim Status Solution Scenario provides access to the system of the insurance carrier to close the claim or to transfer the claim to an agent. This Claim Status Solution Scenario can be executed in Business Space using the procedure provided here.

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.

Note: Some of the fields, used in the forms, for this Solution Scenario are programmed using basic validations. You can verify the validation for the field by moving the mouse pointer over the field.

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.

Table 1. Widgets to roles mapping
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
Before you begin
Ensure that the following prerequisites are complete before you execute the Solution Scenario.
  • Add and configure users and groups.
  • Verify that the Claim Status Solution Scenario artifacts are successfully installed in WebSphere® Process Server.
About this task
Execute the Claim Status Solution Scenario in the Business Space using the following steps.

Accessing the Claim Status Business Space

When using Business Space to view the Solution Scenario execution, you need to log in to the Business Space. This involves providing login details and viewing various pages that are part of the Claim Status space.

Procedure
  1. Open the Business Space portal.
  2. Log on to Business Space with the User ID as admin.
  3. Open the Claim Status space and verify that the following pages are displayed.
    • Getting Started
    • My Tasks
    • Claim Status Process
    • Claim Status Process Check
    • Claim Status Dashboard
    • Performance
    • Analysis
    • Reports
    Note: This Solution Scenario is configured to display the Claim Status space by default.

Accepting claim inquiry details

After logging to the Claim Status space, a Submit Claim Inquiry request can be created. The claim number, if available, can be provided in the Submit Claim Inquiry Request form.

Procedure
  1. Open the My Tasks page.
    Note: The Task Management page is displayed by default the first time you log on to the Business Space.
  2. In the Task Definitions List widget, select the Submit Claim Inquiry check box and click the Create an instance from this task template icon Create an instance from this task template icon. The Submit Claim Inquiry Request form is displayed in the Task Information widget.
  3. Provide the required information in the form and click Submit. The View Claim Status task is displayed in the Tasks List widget.
    Note:

    Select the All - Assess and work on tasks option from the list that is displayed in the Tasks List widget to view the task.

    The scope of this Solution Scenario is limited. You must select and specify the customer details from the following table.
    Table 2. Customer details for the Solution Scenario
    Claim type Name Last name Zip Claim number
    Home Craig Adams 12321 650832105
    Auto n6 s6 330389 287904305

Transferring the claim to a claim specialist

After a claim inquiry request is initiated, it can be accepted by the agent. The Claim Status form displays the information related to the claim and gives the agent an option to transfer the claim to a specialist.

Procedure
  1. Select the View Claim Status check box from the Tasks List widget, and select Accept from the Actions list. The Claim Status form is displayed in the Task Information widget.
  2. Review the information displayed in the Claim Status form.
  3. Click Transfer To Specialist and click Submit.
    Note: You can click Close and then click Submit to close the claim inquiry.

Closing the claim inquiry

If the claim inquiry is transferred to a specialist, the specialist can either close the request or provide comments about the claim.

Procedure
  1. Log on to Business Space as a Claim Specialist, open the Claim Status space, and then open the My Tasks page.
    Table 3. Claim specialist login information
    Specialist User ID
    Auto Peter
    Home Susan
  2. In the My Tasks widget, select the Claim Status Issue check box and click Edit from the Actions list. The Claim Status form is displayed in the Task Information widget.
  3. Specify a comment in the text box provided and click Update Status.
    Note: The scope of this Solution Scenario is limited and the comments that you enter in the text box are not stored in any database. You need to click Submit after you click Update Status to submit the form.

Viewing reports

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.

Claim Status Dashboard

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.

Table 4. Claim Status Dashboard page - widgets
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.
Note: You can drill down to view and further analyze the attributes of report values. To drill down, double-click a drillable field on the graph or diagram that you want to analyze. To return to the previous level, right-click a value and click Drill Up. You can also click Display menu icon from the Instances widget title bar, and click Refresh.

Performance

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.

Table 5. Performance page - widgets
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.
Note: You can drill down to view and further analyze the attributes of report values. To drill down, double-click a drillable field on the graph or diagram that you want to analyze. To return to the previous level, right-click a value and click Drill Up. You can also click Display menu icon from the Instances widget title bar, and click Refresh.

Analysis

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.

Table 6. Analysis page - widgets
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.
Note: You can drill down to view and further analyze the attributes of report values. To drill down, double-click a drillable field on the graph or diagram that you want to analyze. To return to the previous level, right-click a value and click Drill Up. You can also click Display menu icon from the Instances widget title bar, and click Refresh.

Report

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.

Table 7. Report page - widgets
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.
Note: You can drill down to view and further analyze the attributes of report values. To drill down, double-click a drillable field on the graph or diagram that you want to analyze. To return to the previous level, right-click a value and click Drill Up. You can also click Display menu icon from the Instances widget title bar, and click Refresh.

Viewing the Claim Status process flow

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.

Claim Status Process

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.

Table 8. Claim Status Process page - widgets
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.

Claim Status Process Check

The Claim Status Process Check page contains a process flow that shows the sequence of the services executed for every claim inquiry request raised using the Solution Scenario. The human tasks that show the order flow for this process are displayed in green on this page.

The details for the widgets displayed on the Claim Status Process Check page are given in the following table.

Table 9. Claim Status Process Check page - widgets
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.