Question

Case: Disability Insurance Claims Handling at InsureIT Identify at least 3 issues in the above process. Analyze these issues by means of an issue register, root cause analysis (why-why diagram or Fishbone) and/or Pareto analysis. If you need to make assumptions to fill in the issue register, please write them down in an "Assumptions" column. If you find that there are more than three issues, you can focus on the three issues that have the highest impact.

Answer 1

For the above case:

Three issues are:

When a customer lodges a claim against disability and fill the forms describing the disability and submit the form at any branch of insureIt, post box, mail etc.

1. Junior Claim Manager, first enters the claim details into the information system of the insurance company.After, filling details he gives a basic check to the details claimed by the custoemr and varifies whether these claims are covered under the policies or not.If the claim is set to be eligible, he forwards the claim to the senior claim manager.

2. Senior Claim Manager performs a indept check and verification and describes the monthly benefit or compensation need to give to customer.If the case is considered under the short term disability benefits, then Senior Claim Manager, does not require any further documentation and informs the customer about result and benefits he will avail.

3. If the case in found to be under Long term disability benefit (more than 3 months), the senior calim manager request for the deep medical report and any essential process to verify that the claim is accurate and does not come under any fraud case. Once, the report seems fine, senior claim manager files the report in information system and anounce the outcome to the customer.

Then, finance manager sends the first payment and schedule the rest payment to the customer.This process takes 20 min for finance manager to take care of.

1. Issue Register

Assumptions: Name of Customer: Sanket, Junior Manager: Ravi, Sr. Manager: Shiv, issue Id: A1278

Issue Id	Issue Date	Raised By	Report Author	Issue Type	Description	Priority	Severity	Status	Update Date	Closure Date
A1	08/06/2018	Sanket	Ravi	Problem	Benefit of health insurance	Low	Junior Level	Ongoing	08/06/2018	20/08/2018
A1	08/06/2018	Sanket	Ravi	Problem	Benefit of health insurance	High	Sr. Manager	Ongoing	10/08/2018	20/08/201
A1	08/06/2018	Sanket	Ravi	Problem	Benefit of health insurance	High	Finance Manager	Complete	15/08/2018	20/08/2018

2. FISHBONE ANALYSIS:

Find the attached sheet.