Case Study: Insurance Claim Registration & Validation through HWA

This will be the first of a four-part blog series on how HCL Workload Automation can mimic end-to-end processes on the insurance business side.

In this first blog, we’ll be looking at the process below and trying to mimic it end-to-end via HCL Workload Automation.

An Insurance Claim when submitted via a Manual Form or Online with all the enclosed Documentation would need to be validated for completeness both with respect to the details in the Claim Form, also with respect to all the Documentation attached.

The completeness check would need Scanning the Application Form in case of a Manual Submission along with the Scanning of the attached Document Set submitted.

In this Blog, we are using Docusumo APIs for the Scan Process, one could also substitute this with an equivalent product like IBM Discovery API, Google Cloud Vision API etc.

The Scanned Data along with the Documents are uploaded as a Document on Mongo DB.

The Insurance Company in this case has a developed APIs in Python for the Upload to the Mongo DB.

All Data Validations and Conditionally branching logic to carry out the Business Process is handled by HWA.

Scan Insurance Data:
The First step of this elaborate process involves Scanning the Insurance Data sent over form from the Customer Side. This would be carried out through an HWA Job where we would employ a RESTFUL Get Job to directly Scan the Document by calling the Docusumo Extract Data API:

The call on HWA Side with a RESTFUL Get Job:

The response on HWA Side returned would be as follows:

As noticed from the Form, all details Scanned like the Address of the Claimant, Date, Hospitalization Claim, Insurance Claim Number, Medical Bills Amount, OPD Bills Amount, SSN Number, Tax Identification Number, Total Claimed Amount, Type, ID etc. are extracted successfully.

Upload Insurance Form Data:
To Upload the Insurance Data, the company employs a job in the flow which uploads this data via a RESTFUL Job into an Internal Mongo DB storing Customer Data.

An API developed by the company for CRUD Operations is leveraged for the Upload into Mongo DB.

RESTFUL call from HWA:

Upload into Mongo DB through HWA Job:

Scan Images from Documentation Set:
The Documentation images are scanned via the same Docusumo “Extract Data API” and the data is extracted from the Documentation Set capturing all data in the Documentation proofs in JSON Format.

Upload Images from the Documentation Set:
A RESTFUL Post Job to call the API would upload all Data captured from the Documentation set into the Mongo DB as desired, here the job makes a call such as:

Completeness Check on Documentation Data:
The completeness Check on Form Data can be made by making a RESTFUL GET Call via a HWA Job into the same MongoDB serviced via an Internal API running in the background :

As noticed, details like Address, Hospital Bill No, Hospitalization Charges, Medical Bill Charges, Medical Bill No, Name, OPD Bill No, OPD Charges, Phone Number, SSN Number, Type, id etc are captured, some of the fields captured are Blank here like the Medical Bill Charges Field, Medical Bill No etc. are captured as N/A indicating a problem on Completeness.

This Particular job has a Conditional Dependency check for the characters N/A Returned in a field to translate as a Condition called “NOT COMPLETE”

This would in turn call another Mailing Job to send an Email intimating that the Documentation is not complete, so that Customer is intimated that the Claim is on Hold for now:

Insurance Data Completeness Check:
The Completeness Check of Insurance Data is also made via a RESTFUL GET Job whereby any misses in the Form Completeness can be captured readily and the same can be intimated in real time via an Email.

A Similar conditional Dependency on the job ensures that in case should any Data return N/A, the same is captured and the condition satisfied, all details like “Address of the Claimant”, “Date”, “Hospitalization Claim”, “Insurance Claim Number”, “Medical Bills”, “OPD”, “SSN Number”, “Tax ID no”, “Total Amount Claimed”, “Type” are captured.

As the Capture is complete, the Mail Notification job is supressed in this case:

Further we have Conditional Dependencies from these Mail Intimation jobs also to mark the Claim as Registered in “COMPLETE” State which would only happen when both the Mailing Jobs go to SUPRESS State.

Whole Flow as it looks at HWA Side:

Learn more about HCL Workload Automation here or drop us a line at HWAinfo@hcl.com