Insurance Claim Settlement

Claims officer examines and writes settlement recommendation reviewed by senior officer with rework loop.


Process Description

After a claim is registered, it is examined by a claims officer. The claims officer then writes a settlement recommendation. This recommendation is then checked by a senior claims officer who may mark the claim as OK or Not OK. If the claim is marked as Not OK, it is sent back to the claims officer and the recommendation is repeated. If the claim is OK, the claim handling process proceeds.

Structure

Zoom and pan enabled · Source: PET Dataset (Bellan et al., 2022)

Elements

ActivityActor
Examine ClaimClaims Officer
Write RecommendationClaims Officer
Review RecommendationSenior Claims Officer
Proceed with ClaimClaims Officer