Smart Case Management. Emily V. Burns

Transcription

1 Smart Case Management Emily V. Burns

2 Agenda Case Elements The Relationship of Case to Process One-to-Many Nested & Heterogeneous Pega Smart Case Management: Supporting Cases and their Related People and Processes 2 Pegasystems 2009

3 Case Management: A Mammoth Process Problem Looks like a Bodily Injury claim to me I think it s actually just a customer inquiry No, it s a Vehicle Damage Claim Looks like a pretty tricky exception to me No, you re wrong, it s a Fraud Investigation 3 Pegasystems 2009

4 Case Management: Defined Case Management is the coordination of multiple tasks planned or unplanned and associated content, towards a concrete objective or goal. The nature of the work, means that cases are subject to change based on events, and generate events themselves. 4 Pegasystems 2009

5 Content/ Attachments Police Report Example: Auto Claim Channels Subjects Physician Statement Interview transcripts Damage assessment and repair estimate Phone Online Mail Fax In-Person Case: Policy holder submits claim in at-fault accident Related Cases Prior Claim A Prior Claim B Prior Claim C Insured 3 rd Party Tasks and Subcases Obtain police report Subcase 1: Bodily injury to insured Subcase 2: Vehicle Damage Claim for 3 rd party Subcase 3: Vehicle Damage Claim Site visit for verification Interview parties Request submission of hospital bills Obtain physician statement Site visit for initial assessment of damage Obtain damage estimate from repair shop Case Workers Interview Insured Interview witnesses 5 Pegasystems 2009 Bodily Injury 3 rd Party s Insurance Vehicle Damage Assessment Representative

6 Content/ Attachments Police Report Example: Auto Claim Channels Subjects Physician Statement Interview transcripts Damage assessment and repair estimate Phone Online Mail Fax In-Person Case: Policy holder submits claim in at-fault accident Related Cases Prior Claim A Prior Claim B Prior Claim C Insured 3 rd Party Tasks and Subcases Obtain police report Subcase 1: Bodily injury to insured Subcase 2: Vehicle Damage Claim for 3 rd party Vehicle is a Total Loss Subcase 3: Vehicle Damage Claim Site visit for verification Interview parties Request submission of hospital bills Obtain physician statement Site visit for initial assessment of damage Obtain damage estimate from repair shop Case Workers Interview Insured Interview witnesses 6 Pegasystems 2009 Bodily Injury 3 rd Party s Insurance Vehicle Damage Assessment Representative

7 Content/ Attachments Police Report Example: Auto Claim Channels Subjects Physician Statement Interview transcripts Damage assessment and repair estimate Phone Online Mail Fax In-Person Case: Policy holder submits claim in at-fault accident Related Cases Prior Claim A Prior Claim B Prior Claim C Insured 3 rd Party Tasks and Subcases Obtain police report Subcase 1: Bodily injury to insured Subcase 2: Vehicle Damage Claim for 3 rd party Vehicle is a Total Loss Subcase 3: Vehicle Damage Claim Site visit for verification Interview parties Request submission of hospital bills Obtain physician statement Site visit for initial assessment of damage Obtain damage estimate from repair shop Case Workers Interview Insured Interview witnesses 7 Pegasystems 2009 Bodily Injury 3 rd Party s Insurance Vehicle Damage Assessment Representative

8 Content/ Attachments Police Report Example: Auto Claim Channels Subjects Physician Statement Interview transcripts Damage assessment and repair estimate Phone Online Mail Fax In-Person Case: Policy holder submits claim in at-fault accident Related Cases Prior Claim A Prior Claim B Prior Claim C Insured 3 rd Party Tasks and Subcases Obtain police report Subcase 1: Bodily injury to insured Subcase 2: Vehicle Damage Claim for 3 rd party Vehicle is a Total Loss Subcase 3: Vehicle Damage Claim Site visit for verification Interview parties Request submission of hospital bills Obtain physician statement Site visit for initial assessment of damage Obtain Assess damage Fair estimate Value from of repair Vehicle shop Case Workers Interview Insured Interview witnesses 8 Pegasystems 2009 Bodily Injury 3 rd Party s Insurance Vehicle Damage Assessment Representative

9 Content/ Attachments Police Report Example: Auto Claim Channels Subjects Physician Statement Interview transcripts Damage assessment and repair estimate Phone Online Mail Fax In-Person Case: Policy holder submits claim in at-fault accident Related Cases Prior Claim A Prior Claim B Prior Claim C Insured 3 rd Party Tasks and Subcases Obtain police report Subcase 1: Bodily injury to insured Subcase 2: Vehicle Damage Claim for 3 rd party Subcase 3: Vehicle Damage Claim Site visit for verification Interview parties Request submission of hospital bills Obtain physician statement Site visit for initial assessment of damage Obtain Assess damage Fair estimate Value from of repair Vehicle shop Case Workers Interview Insured Interview witnesses 9 Pegasystems 2009 Bodily Injury 3 rd Party s Insurance Vehicle Damage Assessment Representative

11 Relationship of Case to Process: One to Many 11 Pegasystems 2009

12 Case Processes: Nested and Heterogeneous 12 Pegasystems 2009

17 Case Processes: Dynamic & Event-Driven Something 17 Pegasystems 2009

20 Three Over-Arching Case Types Source: Forrester Research 20 Pegasystems 2009

21 Cases Change Throughout Their Lifecycles Request: Reimburse for Lost Item Source: Forrester Research 21 Pegasystems 2009

22 Cases Change Throughout Their Lifecycles Request: Reimburse for Lost Item Source: Forrester Research 22 Pegasystems 2009

23 Cases Change Throughout Their Lifecycles Request: Reimburse for Lost Item Exception: Item type typically not covered Source: Forrester Research 23 Pegasystems 2009

24 Cases Change Throughout Their Lifecycles Request: Reimburse for Lost Item Exception: Item type typically not covered Source: Forrester Research 24 Pegasystems 2009

25 Cases Change Throughout Their Lifecycles Fraud Investigation: Possible fraud Request: Reimburse for Lost Item Exception: Item type typically not covered Source: Forrester Research 25 Pegasystems 2009

26 And the Processes Needed to Resolve Them Change, Too Fraud Investigation: Possible fraud Request: Reimburse for Lost Item Exception: Item type typically not covered Source: Forrester Research 26 Pegasystems 2009

27 Poll What type of cases are you managing predominantly? A. Service Request Cases B. Incident Management/Exception Cases C. Investigative Cases D. Our cases go through multiple phases and types E. Not captured in these three case types 27 Pegasystems 2009

28 Cases Must Interact with Other Cases Throughout their Lifecycles Principal Case & Nested Subcases Possible Related Cases Re-Open Associate as Related Case Associate as Subcase Close/ Consolidate Other work related to Case Subject X X Prior Cases (Closed) X X X Duplicate X 28 Pegasystems 2009

29 Key Process Traits in Case Mgmt Context-Driven The context of a case, and the associated business policies dictate how the case is handled Nested/Hierarchical & Heterogeneous Nested Cases Nested Processes Event-Driven Respond to and generate events Dynamic Cases & their processes differ based on context Cases & their processes change in response to events Ad Hoc Must support ad hoc changes and additions to processes and case Collaborative Multiple workers, multiple skill-sets, multiple channels Content-intensive Content generated Content can drive the case & its processes 29 Pegasystems 2009

31 Enterprise Case Management Means Supporting All Types of Cases Supporting All Roles Support All Case Processes Service Request Incident Management Investigative Worker Manager C-Level External User Simple, Highly structured Complex, Highly structured Totally Ad Hoc Hybrids 31 Pegasystems 2009

32 Pega Smart Case Management: Supporting all Types of Cases Graphic Source: 32 Pegasystems 2009 Forrester Research

33 Pega Smart Case Management: Supporting all Types of Cases Customer Service Requests Claims Management Graphic Source: 33 Pegasystems 2009 Forrester Research

34 Pega Smart Case Management: Supporting all Types of Cases Customer Service Requests Claims Management Care Management Dispute Resolution Graphic Source: 34 Pegasystems 2009 Forrester Research

35 Pega Smart Case Management: Supporting all Types of Cases Customer Service Requests Claims Management Financial Crimes Management Care Management Dispute Resolution Graphic Source: 35 Pegasystems 2009 Forrester Research

36 Pega Smart Case Management: All Roles & All Case Processes Structured Case Predictable Workflow/BPM Short Duration Semi- Structured Case Dynamic Case Unstructured Collaborative Long Duration Knowledge Worker Knowledge Assisted Worker Clerical / Manufacturing Worker 36 Pegasystems 2009

37 PegasystemsTHE Leader in Business Process Management Gartner Magic Quadrant, for Business Process Management Suites, February 2009 The Forrester Wave TM, Human-Centric Business Process Management Suites for Java platforms, Pegasystems 2009

38 BAA BAA: Aircraft A Case Turn-around Mgmt Approach Case Mgmt to Aircraft Turn-Around Business Objective: Departing Aircraft Punctuality Results: Airport Running at 98.7% Capacity On-time departures up from 68% to 83% Case Subject: Aircraft Turn-Around Case workers Related Subjects Channels Content/ Attachments Air-to-Air Case 1578 Stand planners Airline Operations Staff Airport Staff Passenger(s) Bags Radar Min Target Turn-Around Time Passenger Info Flight Update Message Inbound Subcase Flight A Activities Landing T Taxiing Outbound Subcase Flight B Activities CDM Portal Cleaning Bags Refuelling Passenger Mgmt Departure Scheduling Mobile Phone f Events: External, Internal Related Cases Inbound Flight Outbound Flight Match Bags to Passengers Board Passengers Handheld Devices Weather Security Alert Mechanical Delay Baggage Reconciliation 38 Pegasystems 2009

39 Thank you! Emily Burns: Pegasystems 2009

40 Question & Answer 40 Pegasystems 2009