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Automated health insurance
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Transcript of Automated health insurance
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Automated Health InsuranceBusiness Rules automation with ILOG JRules
Annette Ibsen
Tieto, SSZ Sales / SSX Sales Excellence /[email protected]
© 2011 Tieto Corporation
Agenda• Tieto BPM services
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Tieto BPM
© 2011 Tieto Corporation
Business performance
TOP-DOWN BOTTOM-UPPlanning & Controlling
Strategy
KPI’s
Corporateperformance management
Skills
Operative and process development
Ongoing process instances management
Process instance E2E management
Individual measures
MANAGEMENT
TEAM
EMPLOYEEMy Performance
- Determining the company’s competitiveness
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© 2011 Tieto Corporation
Business Processes driving Business Performance
5 2011-02-19
Agility
Business Sourcing
EfficiencyBusiness Execution
EffectivenessBusiness Performance Control
Collaboration
Business Unit
Role
© 2011 Tieto Corporation
BPM Conceptual Environment- Dividing content for enhancing Business Performance
6 2011-03-03
© 2011 Tieto Corporation
Tieto BPM Services
• Business back in control• Collaboration, Communication and Skills
• Improvement of Business Performance• Visibility, Effective Resources, Efficient Processes
• Enablement of Business Sourcing• Across and holistic view on business
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The right product - In the right time - Meeting the right demand
© 2011 Tieto Corporation
Process GovernanceSustainability of cross process perspective consisting of guidelines, KPIs and roles.
Business Process AnalysisModelling and mapping of business processes, with
focus on analysing and optimisation.
Business Process AutomationOperational execution through SOA and Legacy Integration.
Business Activity MonitoringReal-time measurement and analysis of the performance of managerial activities
TietoBusiness Process
ManagementLife-Cycle
Tieto Business Process Management Life-cycleThe Disciplines and Phases of Business Process Management
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ModelAnalyze
Monitor Op
timize
Execute
© 2011 Tieto Corporation
Tieto BPM ServicesCovering a wide area of BPM related challenges
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Implementation
Strategic Advisory
Transformation planning
Technology
specific
consulting
implementation
management
Process
Integration and
Optimization
Process
Automation &
EA/SOA
Consultancy Implementation
© 2011 Tieto Corporation
Tools Support
• BPM technology specific consulting and Process implementation offerings often includes technology-specific know-how
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• In Tieto, we have technology-specific and certified competences covering • IBM Websphere Blue Works Live• IBM Websphere Lombardi Edition• IBM WebSphere ILOG Jrules• IBM Cognos and SPSS
2011-04-08Tieto / IBM Partnership
Technology
specific
consulting
Process
Automation &
EA/SOA
Process
Integration and
Optimization
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Automated Health DeclarationCustomer Case
© 2011 Tieto Corporation
Case summary: VHF
• Knowledge Centre for Health and Insurance (VHF) is an independent organization that advises insurance companies and pension funds around the medical assessment of health in connection with the subscription of personal insurance
• One of their main activities is to handle Health Declarations
• The health declaration is a generic health questionnaire with 12 primary questions and 19 underlying forms covering close to 1000 questions in total
© 2011 Tieto Corporation
Health Declaration
• Today the declaration is sent by mail and when received from the client treated manually.
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• The business idea is to automate the declaration so the customer can fill out an electronic version of the form, sign it digitally through NemID and return the form to the insurance company that stores it together with the digital signature.
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Some HEFO customer
© 2011 Tieto Corporation
Expected benefits
• Reduced handling of "inbound" schemes in companies
• Faster and uniform case management of clients with health problems
• Better assessment overview
• VHF estimates that approx. 20% of medical declarations will be processed automatically rather than manually on the basis of Tieto's delivery, which will help to reduce insurance costs significantly.
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Rule flowsImplementation in ILOG
© 2011 Tieto Corporation
IT architecture
17 IBM Smarter Business dag 11.oktober 2011 2011-10-06
© 2011 Tieto Corporation18 IBM Smarter Business dag 11.oktober 2011 2011-10-06
© 2011 Tieto Corporation
Ruleflows• There is developed an electronic copy of
the declaration which means transferring the questions to ILOG JRules ruleflows (in ILOG you use rules to automate one or more processes).
Note that 1i is just one of several supplementary questionsto Question 1, if you cannot answer "no".
A "gray" button will trick an underlyingworkflow.
© 2011 Tieto Corporation
Submit Health Decleartion PDF
Adobe Server
Parts of system delivered by Tieto and IBM
ILOG Server
Webservice Call
Applicant
Insurance Company A
Healt DeclarationEvaluation report
Ger HealthDeclearation
Webservice Response
Serve InsuaranceCompany A’s
healt declearation
The System• VHF develops health forms in PDF format, that
insurance applicants needs to fill out and submit, to get health insurance. VHF provides this service to a number of insurance companies, and maintains a set of health forms customized for each insurance provider, but all based on a standard set of questions.
• The form (the PDf file) is downloaded by applicants form the insurance companies server, and filled out by the user. When filled out, the user can click a submit button, and the form is submitted to VHF’s adobe server. On the adobe server data is extracted from the form, and submitted as web service call to the ILOG server for evaluation. The ILOG server processes the form data, and sends back an evaluation, containing both general ratings, and explanations to how this rating was found. In some cases, the evaluation result, will be the need for further investigation, either by the insurance company, VHF, a third party specialist.
The solution is based on ILOG Business Rules Management System
© 2011 Tieto Corporation
The delivery
1)Consulting
2)BRMS Server environment setup
3)Rules Governance • Rule Lifecycle flow and configuration
This includes configuration and setup of the necessary security roles on Rule Team Server, to enable a simple rule lifecycle, including a simple flow for moving a new or modified rule through validation and test stages, and on to production and eventually retirement.
• Procedures for versioning including schema changes (Both in and out).This includes documented procedures for handling additions and changes to the basic questionnaire, and corresponding business rules and XML schemes for the rule webs services. It also includes procedures for handling customized questionnaire and rules that apply only to individual insurance companies.
• Test procedures for unit and regression testingThis includes setting up Decision Validation Service to executing specific test suites to be run as part of a unit and regression testing procedure, as well as configuring deployment to test environment, as part of an overall test plan.
4)Expert guidance in the following areas• BOM (Business Object Model) design including verbalization.• Rule organization.
This include organization of rules to ensure easy maintenance, and the ability to handle business rules that a specific to individual insurance companies
• Review complex rules.This includes review on complex rules and rule flows, to ensure efficient and easy maintainable rules, that can be extended in the future