Smart Case Management

Emily V. Burns

Agenda
Case Elements
The Relationship of Case to Process
One-to-Many
Nested & Heterogeneous

Pega Smart Case Management:

Supporting Cases and their Related People and
Processes

Pegasystems 2009

Case Management:
A Mammoth Process Problem
Looks like a
Bodily Injury claim to me

I think its actually

just a customer inquiry

No, its a Vehicle Damage Claim

Looks like a pretty tricky

exception to me

No, youre wrong,

its a Fraud Investigation

Pegasystems 2009

Case Management: Defined

Case Management is the coordination

of multiple tasksplanned or unplanned
and associated content, towards a
concrete objective or goal.
The nature of the work, means that
cases are subject to change based on
events, and generate events
themselves.

Pegasystems 2009

Example: Auto Claim

Content/
Attachments

Channels

Subjects

Police Report
Physician
Statement

Phone

Interview
transcripts

Online

Mail

Fax

In-Person

Related Cases

Email

Insured

3rd Party

Prior Claim A

Damage
assessment
and repair
estimate

Prior Claim B

Case:

Prior Claim C

Policy holder submits claim

in at-fault accident

Tasks and
Subcases

Subcase 1:
Bodily injury to
insured

Obtain police
report

Site visit for

verification

Interview
parties

Request
submission of
hospital bills

Subcase 2:
Vehicle
Damage Claim
for 3rd party

Obtain
physician
statement

Subcase 3:
Vehicle
Damage Claim

Site visit for

initial
assessment of
damage

Obtain damage
estimate from
repair shop

Case Workers
Interview
Insured

Interview
witnesses

Bodily Injury
5

Pegasystems 2009

3rd Partys Vehicle Damage

Insurance
Assessment
Representative

Example: Auto Claim

Content/
Attachments

Channels

Subjects

Police Report
Physician
Statement

Phone

Interview
transcripts

Online

Mail

Fax

In-Person

Related Cases

Email

Insured

3rd Party

Prior Claim A

Damage
assessment
and repair
estimate

Prior Claim B

Case:

Prior Claim C

Policy holder submits claim

in at-fault accident

Tasks and
Subcases

Subcase 1:
Bodily injury to
insured

Obtain police
report

Site visit for

verification

Interview
parties

Request
submission of
hospital bills

Subcase 2:
Vehicle
Damage Claim
for 3rd party

Obtain
physician
statement

Vehicle is a
Total Loss

Subcase 3:
Vehicle
Damage Claim

Site visit for

initial
assessment of
damage

Obtain damage
estimate from
repair shop

Case Workers
Interview
Insured

Interview
witnesses

Bodily Injury
6

Pegasystems 2009

3rd Partys Vehicle Damage

Insurance
Assessment
Representative

Example: Auto Claim

Content/
Attachments

Channels

Subjects

Police Report
Physician
Statement

Phone

Interview
transcripts

Online

Mail

Fax

In-Person

Related Cases

Email

Insured

3rd Party

Prior Claim A

Damage
assessment
and repair
estimate

Prior Claim B

Case:

Prior Claim C

Policy holder submits claim

in at-fault accident

Tasks and
Subcases

Subcase 1:
Bodily injury to
insured

Obtain police
report

Site visit for

verification

Interview
parties

Request
submission of
hospital bills

Subcase 2:
Vehicle
Damage Claim
for 3rd party

Obtain
physician
statement

Vehicle is a
Total Loss

Subcase 3:
Vehicle
Damage Claim

Site visit for

initial
assessment of
damage

Obtain damage
estimate from
repair shop

Case Workers
Interview
Insured

Interview
witnesses

Bodily Injury
7

Pegasystems 2009

3rd Partys Vehicle Damage

Insurance
Assessment
Representative

Example: Auto Claim

Content/
Attachments

Channels

Subjects

Police Report
Physician
Statement

Phone

Interview
transcripts

Online

Mail

Fax

In-Person

Related Cases

Email

Insured

3rd Party

Prior Claim A

Damage
assessment
and repair
estimate

Prior Claim B

Case:

Prior Claim C

Policy holder submits claim

in at-fault accident

Tasks and
Subcases

Subcase 1:
Bodily injury to
insured

Obtain police
report

Site visit for

verification

Interview
parties

Request
submission of
hospital bills

Subcase 2:
Vehicle
Damage Claim
for 3rd party

Obtain
physician
statement

Vehicle is a
Total Loss

Subcase 3:
Vehicle
Damage Claim

Site visit for

initial
assessment of
damage

Obtain
damage
Assess
Fair
estimate
Value from
of
repair
shop
Vehicle

Case Workers
Interview
Insured

Interview
witnesses

Bodily Injury
8

Pegasystems 2009

3rd Partys Vehicle Damage

Insurance
Assessment
Representative

Example: Auto Claim

Content/
Attachments

Channels

Subjects

Police Report
Physician
Statement

Phone

Interview
transcripts

Online

Mail

Fax

In-Person

Related Cases

Email

Insured

3rd Party

Prior Claim A

Damage
assessment
and repair
estimate

Prior Claim B

Case:

Prior Claim C

Policy holder submits claim

in at-fault accident

Tasks and
Subcases

Subcase 1:
Bodily injury to
insured

Obtain police
report

Site visit for

verification

Interview
parties

Request
submission of
hospital bills

Subcase 2:
Vehicle
Damage Claim
for 3rd party

Obtain
physician
statement

Subcase 3:
Vehicle
Damage Claim

Site visit for

initial
assessment of
damage

Obtain
damage
Assess
Fair
estimate
Value from
of
repair
shop
Vehicle

Case Workers
Interview
Insured

Interview
witnesses

Bodily Injury
9

Pegasystems 2009

3rd Partys Vehicle Damage

Insurance
Assessment
Representative

Agenda
Case Elements
The Relationship of Case to Process
One-to-Many
Nested & Heterogeneous

Pega Smart Case Management:

Supporting Cases and their Related People and
Processes

10

Pegasystems 2009

Relationship of Case to Process:

One to Many

11

Pegasystems 2009

Case Processes: Nested and Heterogeneous

12

Pegasystems 2009

Case Processes: Nested and Heterogeneous

13

Pegasystems 2009

Case Processes: Nested and Heterogeneous

14

Pegasystems 2009

Case Processes: Nested and Heterogeneous

15

Pegasystems 2009

Case Processes: Nested and Heterogeneous

16

Pegasystems 2009

Case Processes: Dynamic & Event-Driven

Something

17

Pegasystems 2009

Case Processes: Dynamic & Event-Driven

Something

18

Pegasystems 2009

Case Processes: Dynamic & Event-Driven

Something

19

Pegasystems 2009

Three Over-Arching Case Types

Source: Forrester Research

20

Pegasystems 2009

Cases Change Throughout Their Lifecycles

Request:
Reimburse for
Lost Item

Source: Forrester Research

21

Pegasystems 2009

Cases Change Throughout Their Lifecycles

Request:
Reimburse for
Lost Item

Source: Forrester Research

22

Pegasystems 2009

Cases Change Throughout Their Lifecycles

Request:
Reimburse for
Lost Item

Exception:
Item type
typically not
covered

Source: Forrester Research

23

Pegasystems 2009

Cases Change Throughout Their Lifecycles

Request:
Reimburse for
Lost Item

Exception:
Item type
typically not
covered

Source: Forrester Research

24

Pegasystems 2009

Cases Change Throughout Their Lifecycles

Request:
Reimburse for
Lost Item

Fraud
Investigation:
Possible fraud

Exception:
Item type
typically not
covered

Source: Forrester Research

25

Pegasystems 2009

And the Processes

Needed to Resolve Them Change, Too

Request:
Reimburse for
Lost Item

Fraud
Investigation:
Possible fraud

Exception:
Item type
typically not
covered

Source: Forrester Research

26

Pegasystems 2009

Poll
What type of cases are you managing
predominantly?
A.
B.
C.
D.

Service Request Cases

Incident Management/Exception Cases
Investigative Cases
Our cases go through multiple phases and
types
E. Not captured in these three case types

27

Pegasystems 2009

Cases Must Interact with Other Cases

Throughout their Lifecycles
Principal Case &
Nested Subcases

Possible
Related Cases

Re-Open

Other work
related to
Case Subject

Prior Cases
(Closed)

Duplicate

28

Pegasystems 2009

Associate
as Related
Case

Associate
as Subcase

Close/
Consolidate

Key Process Traits in Case Mgmt

Context-Driven
The context of a case, and the associated business policies
dictate how the case is handled
Nested/Hierarchical & Heterogeneous
Nested Cases
Nested Processes
Event-Driven
Respond to and generate events
Dynamic
Cases & their processes differ based on context
Cases & their processes change in response to events
Ad Hoc
Must support ad hoc changes and additions to processes and
case
Collaborative
Multiple workers, multiple skill-sets, multiple channels
Content-intensive
Content generated
Content can drive the case & its processes
29

Pegasystems 2009

Agenda
Case Elements
The Relationship of Case to Process
One-to-Many
Nested & Heterogeneous

Pega Smart Case Management:

Supporting Cases and their Related People and
Processes

30

Pegasystems 2009

Enterprise Case Management Means

Supporting All
Types of Cases
Service Request
Incident
Management
Investigative

31

Supporting All
Roles

Support All
Case Processes

Worker
Manager
C-Level
External User

Simple, Highly
structured
Complex,
Highly
structured
Totally Ad Hoc
Hybrids

Pegasystems 2009

Pega Smart Case Management:

Supporting all Types of Cases

Graphic Source:
32
Forrester Research

Pegasystems 2009

Pega Smart Case Management:

Supporting all Types of Cases

Customer
Service Requests
Claims
Management

Graphic Source:
33
Forrester Research

Pegasystems 2009

Pega Smart Case Management:

Supporting all Types of Cases

Customer
Service Requests
Claims
Management

Care
Management

Dispute Resolution
Graphic Source:
34
Forrester Research

Pegasystems 2009

Pega Smart Case Management:

Supporting all Types of Cases

Customer
Service Requests
Claims
Management

Financial
Crimes
Management

Care
Management

Dispute Resolution
Graphic Source:
35
Forrester Research

Pegasystems 2009

Pega Smart Case Management:

All Roles & All Case Processes
Structured Case
Predictable
Workflow/BPM
Short Duration

Knowledge
Worker

Knowledge
Assisted
Worker

Clerical /

Manufacturing

Worker

36

Pegasystems 2009

SemiStructured
Case

Dynamic Case
Unstructured
Collaborative
Long Duration

PegasystemsTHE Leader in
Business Process Management

The Forrester WaveTM, Human-Centric Business Process

Management Suites for Java platforms, 2007
Gartner Magic Quadrant, for Business Process
Management Suites, February 2009

37

Pegasystems 2009

BAA:
A Case
Mgmt Approach
BAA
Aircraft
Turn-around
Case Mgmt
to Aircraft Turn-Around
Results:

Business
Objective:

Airport Running at 98.7%

Capacity
On-time departures up
from 68% to 83%

Departing Aircraft Punctuality

Case Subject:
Aircraft Turn-Around

Caseworkers

Related Subjects

Channels
Content/
Attachments

Radar

Air-to-Air
Case
1578

Min Target
Turn-Around
Time
Passenger
Info
Flight Update
Message

Inbound
Flight
Subcase
Activities

Cleaning

CDM Portal

Events:
External, Internal

Mobile Phone

Handheld
Devices
38

Bags

Security
Alert

Mechanical
Delay

Taxiing
T

Refuelling

Related Cases

Inbound
Flight

f
Weather

Landing

Airline
Stand
Operations
planners
Staff

Outbound
Flight

Baggage
Reconciliation

Pegasystems 2009

Passenger(s)

Airport
Staff

Bags

Outbound
Flight
Subcase
Activities
B

Passenger
Mgmt

Match Bags
to
Passengers

Departure
Scheduling

Board
Passengers

Thank you!
Emily Burns:
Emily.Burns@pega.com
617-866-6327

39

Pegasystems 2009

Question & Answer

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Pegasystems 2009