Smart Case Management Emily V. Burns
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
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
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
Content/ Attachments Police Report Example: Auto Claim Channels Subjects Physician Statement Interview transcripts Damage assessment and repair estimate Phone Online Mail Fax In-Person Email 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
Content/ Attachments Police Report Example: Auto Claim Channels Subjects Physician Statement Interview transcripts Damage assessment and repair estimate Phone Online Mail Fax In-Person Email 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
Content/ Attachments Police Report Example: Auto Claim Channels Subjects Physician Statement Interview transcripts Damage assessment and repair estimate Phone Online Mail Fax In-Person Email 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
Content/ Attachments Police Report Example: Auto Claim Channels Subjects Physician Statement Interview transcripts Damage assessment and repair estimate Phone Online Mail Fax In-Person Email 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
Content/ Attachments Police Report Example: Auto Claim Channels Subjects Physician Statement Interview transcripts Damage assessment and repair estimate Phone Online Mail Fax In-Person Email 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
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 10 Pegasystems 2009
Relationship of Case to Process: One to Many 11 Pegasystems 2009
Case Processes: Nested and Heterogeneous 12 Pegasystems 2009
Case Processes: Nested and Heterogeneous 13 Pegasystems 2009
Case Processes: Nested and Heterogeneous 14 Pegasystems 2009
Case Processes: Nested and Heterogeneous 15 Pegasystems 2009
Case Processes: Nested and Heterogeneous 16 Pegasystems 2009
Case Processes: Dynamic & Event-Driven Something 17 Pegasystems 2009
Case Processes: Dynamic & Event-Driven Something 18 Pegasystems 2009
Case Processes: Dynamic & Event-Driven Something 19 Pegasystems 2009
Three Over-Arching Case Types Source: Forrester Research 20 Pegasystems 2009
Cases Change Throughout Their Lifecycles Request: Reimburse for Lost Item Source: Forrester Research 21 Pegasystems 2009
Cases Change Throughout Their Lifecycles Request: Reimburse for Lost Item Source: Forrester Research 22 Pegasystems 2009
Cases Change Throughout Their Lifecycles Request: Reimburse for Lost Item Exception: Item type typically not covered Source: Forrester Research 23 Pegasystems 2009
Cases Change Throughout Their Lifecycles Request: Reimburse for Lost Item Exception: Item type typically not covered Source: Forrester Research 24 Pegasystems 2009
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
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
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
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
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
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 30 Pegasystems 2009
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
Pega Smart Case Management: Supporting all Types of Cases Graphic Source: 32 Pegasystems 2009 Forrester Research
Pega Smart Case Management: Supporting all Types of Cases Customer Service Requests Claims Management Graphic Source: 33 Pegasystems 2009 Forrester Research
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
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
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
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, 2007 37 Pegasystems 2009
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
Thank you! Emily Burns: Emily.Burns@pega.com 617-866-6327 39 Pegasystems 2009
Question & Answer 40 Pegasystems 2009