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


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

4


Business Processes driving Business Performance

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Agility

Business Sourcing

EfficiencyBusiness Execution

EffectivenessBusiness Performance Control

Collaboration

Business Unit

Role


BPM Conceptual Environment- Dividing content for enhancing Business Performance

6 2011-03-03


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

7 2011-02-20

The right product - In the right time - Meeting the right demand


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

8 2011-02-20

ModelAnalyze

Monitor Op

timize

Execute


Tieto BPM ServicesCovering a wide area of BPM related challenges

9

Implementation

Strategic Advisory

Transformation planning

Technology

specific

consulting

implementation

management

Process

Integration and

Optimization

Process

Automation &

EA/SOA

Consultancy Implementation


Tools Support

• BPM technology specific consulting and Process implementation offerings often includes technology-specific know-how

10

• 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


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


Health Declaration

• Today the declaration is sent by mail and when received from the client treated manually.

.

• 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.


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.


IT architecture

17 IBM Smarter Business dag 11.oktober 2011 2011-10-06


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.


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

PDF

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


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