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draw a BPM and Use pools and lanes . When a claim is received, a claims officer first checks if the claimant is insured. If
draw a BPM and Use pools and lanes .
When a claim is received, a claims officer first checks if the claimant is insured. If not, the claimant is informed that the claim must be rejected by
sending an automatic notification via an SAP system. Otherwise, a senior claims officer evaluates the severity of the claim. Based on the outcome
(simple or complex claims), the relevant forms are sent to the claimant, again using the SAP system. Once the forms are returned, they are checked for
completeness by the claims officer. If the forms provide all relevant details, the claim is registered in the claims management system, and the process
ends. Otherwise, the claimant is informed to update the forms via the SAP system. Upon reception of the updated forms, they are checked again by the
claims officer to see if the details have been provided.
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