Notes From the Field: Pet Insurance Claim Automation Solution

Capture, Workflow, ECM and ERP: Recipe for Automation

I had a great call with one of our customers the other day, a major pet insurance organization.   Keeping on my theme from my previous post (Capture+BPM: Pre, Midstream, Post), I wanted to share some details.  They have built an amazing solution to automate their inbound claims process.  Here is the lay of the land, pre-solution:

  • They provide pet insurance for their clients
  • Clients file claims that include invoices from vets, etc
  • They receive 6,000-8,000 claims per week.
  • Before the solution, everything was manual, received by fax, email and inbound paper mail
  • Data was being entered manually into their ERP
  • Documents were being saved manually, one-by-one into their ECM system
  • They have stringent regulatory SLAs for claim turnaround and response
  • New regulations required detail down to the line items on invoices filed for claims
  • It was taking 60-70 business days once a claim was received to process

Ah, the pain of manual processing.  Here is the teaser, after implementing the solution, they are now down to a 20 day turn around, and believe through further tuning they can get to 7.  So, they have taken the time to process down to a third or their pre-solution burden, and create an overall electronic system for claims processing.

Claims Workflow Queue
Processors Now Have a Digital Queue

The solution has made the process remarkably efficient, taking us from 70 days down to 20 to process a claim.

The Solution Architect

So, here are the components of the solution:

Ephesoft (Capture)Ephesoft’s intelligent document capture solution is used to capture and classify claims from inbound fax, email and paper files.  Through its advanced learning engine, it auto-identifies the type of document, splits multi-invoice PDFs, and then extracts the invoice information down to the line item data.  The documents and XML are then passed to the workflow engine.

extract claim data
Ephesoft Classifies and Extracts Inbound Invoice Data

There is quite a bit more that happens within the front-end capture.   This organization has enabled review and validation where they can actually review questionable documents before they get passed to the workflow.  This prevents bad data and documents from entering, and allows a checkpoint for insuring a complete claim package.  Rejected claims are passed back to the customer, with a note about what is required to complete the claim.

insurance claims validation
Ephesoft Automated Validation and Rejection of Claims

Finally, they have also implemented capture through Ephesoft web services.  Through a web portal, the customer can upload claim documents, and they are passed via web service to the capture engine to be classified and have data extracted.

document capture and OCR web services
Web Page Front-end For Ephesoft Web Services

You can learn more about web services for OCR and document capture here:  Web Services for OCR, Capture, Classification and Data Extraction

BPLogix (Workflow) – The Ephesoft data package is ingested into the BPLogix workflow engine, and then presented to claims processors for review and extensive validation.  With the new regulatory requirement on-line item invoice detail, this is a critical step.

workflow for claims
The Workflow Engine Receives the Extracted Data

Microsoft Dynamics AX (ERP)– once all the data is verified and validated, all the claim data is placed into the ERP for final processing and payment.

capture to dynamics
Ephesoft Data in AX

Alfresco (ECM) – Once all is complete, the claim documents are placed into their end resting place, and can be accessed at a later date if an issue arises, or there is a need for further review.

Alfresco is The End Resting Place 

Great use of multiple technologies to automate a painful business problem.  Shows off the true value of document capture within workflow to add another dimension of process efficiency.  What do you think?  Any success stories to share?  Please comment.

BPA Platform Value: The During (Part II)

BPA ROI and Value

Direct and Indirect Benefits from No/Low-code Platforms

This is part II of a series on the value, benefits and ROI of Business Process Application platforms, and the first post can be found here: BPA Platform Value – The Before.

In the previous post, we discussed the advantages to using a low/no-code platform to deliver apps faster to business users, and reduce the IT backlog.  Once the apps get into production, there is a huge impact on business performance, and this is where typical value is associated with efficiency and productivity.   There are two types of benefits that are provided in this phase, direct and indirect.  Below is a summary of both:

Direct and Measurable Benefits of BPA/BPM


Indirect Benefits of BPA/BPM

Return on investment for BPM
Examples of BPM/BPA ROI

In the above image, there are a few examples of some hard numbers on savings through process efficiency.  You can read more here:  BPM/BPA Case Studies.

BPM ROI Presentation: The Before, During and After

I built this out for a prospect that requested a summary of the benefits, value and ROI for a Business Process Management (BPM) and Business Process Application (BPA) platform.

Great Fortune Article: Business is Slowing Down

Business process management and agility

Regulations, Technology Overuse and Over-process Lead to Slow Downs

Great article from Fortune:

The Hard Evidence: Business is Slowing Down

Financial Services: Top 5 Reasons to Modernize Your Processes

Business Process Management for Banks

BPM for Efficiency, Risk Reduction and Improved Security


…Gartner estimated that financial services firms spend between six and seven percent of revenue on IT. Yet on average, they only realize 43 percent of their
technology’s potential. This lag in technology is often due to size, complexity and legacy systems that limit agility.

See the whole article here:  Top 5 Reasons for BPM and Process Improvement in Financial Services and Banking

The CIO’s Quandry: Build, Buy or BPM?

Benefits of BPM over Custom Development

Choosing the Right Application Strategy Path

I have the privilege just about every day to be involved in one of the most complex decisions on the IT Strategy front:

What is the most effective way for our organization to introduce new applications or rebuild old ones?

These discussions are always bound by key options:

  1. Build a custom application.
  2. Buy an off the shelf commercial application.
  3. Buy a BPM/BPA Suite.
  4. A hybrid approach.

My position gives me the unique advantage of being an “outside” observer, and seeing how each choice is viewed.  Along with gaining insight into the minds of IT professionals, and how they view the application landscape, I also make a conscious effort to identify what works and what doesn’t (historically).   Below is a summary of my experience, and a compilation of opinions on each option.


Ah, the custom application.  The promised land, everything you want, built exactly to requirements ;).  My favorite CIO quote in my time in BPM is: “I am so tired of being a custom software development house.”  The Build option has historically been the de facto path to meeting the exact business needs of a desired application, and truly tailoring functionality.  But building comes with unique resource requirements, longer timelines, and rigid change management that prevents agility.  Add in the standard requirement of Line of Business (LOB) System integration, and even small applications can require large teams with diverse skill sets to deliver.  For this reason, many organizations leverage 3rd party partners to help with development, which adds to overall project complexity.  The benefit?  If managed correctly, you get exactly what you want.  Some great info on Build vs Buy here:  Build Versus Buy Whitepaper


Whether its Safety, HR, Accounting, or any other core business function, there are focused commercial applications to meet business needs.  Most of these applications will meet about 80% of an organization’s requirements, but what I find is that missing 20% is the true gold.  Many applications offer APIs to extend and add functionality, but this requires custom development or hiring the 3rd party’s services team to extend.  I am seeing more and more organizations that are trying to get their app “bloat” under control, and reduce the number of niche applications in use by their business.  There are some key questions to ask when evaluating focused apps:

  • How easy is it to integrate with my LOBs?  Code or configuration?
  • Is the system overkill for what we are trying to accomplish?
  • How difficult is it to administer?  Will I require certified staff?
  • What is missing and what will it cost to extend and maintain?

I find many organizations “settle” when it comes to off the shelf applications, and adjust their business to the application.  The key benefit, in most cases, is you get up and running quite quickly, and can glean advantages and ROI without waiting for dev or build time.


The Business Process Management/Business Process Application suites are just about always in the mix, but I find there is always some deep education required on capabilities.  There is quite often core resistance to them, especially from the development teams.  No/Low Code platforms can be perceived as a threat, but smart dev managers see them as powerful tools that can lead to reduced delivery time, increased agility and quite frankly, a driver for accomplishing more with less.  The benefits are shorter dev times, agility when it comes to modifying the applications, and creating process centric applications that map to the business.  These platforms have evolved into a true “swiss army knife” of IT, and can be used as a plugin to provide solutions around all types of requirements.  More on No/Low Code here:  No/Low Code Platforms


The hybrid approach seems to be quite common, and many of the inquiries I see today involve organizations looking for BPM/BPA platforms to round out their existing inventory.  Maybe they have a custom dev project where they need a workflow engine, or a data integration layer, and see the platform as a way to provide core capabilities.  Perhaps they purchased an off the shelf app, and need to extend it, or wrap it with a more capable forms or reporting engine.  To see how a hybrid strategy including BPM/BPA can impact an organization, see this post:  BPM Benefits  The true benefit of this hybrid strategy is that you can have all the benefits of the core BPM engine, and use extended capabilities through the APIs to add value to other existing apps or projects.

Just a quick overview of App Strategy observations.  Comments?





Process Automation Gauge: How Many Processes?

How much process automation

Poll Of 500 Executives: How Much of Your Workflow is Automated?

Process Automation for Business
Just how automated are your processes?

This Cognizant poll was very interesting, and see the below stats:

  • Execs believe 25-40% of their processes are automated
  • 50%+ believe that business process automation will have a significant impact on business operations within the next 3-5 years.
  • 1/5 reported greater than 15% cost savings through process automation.
  • Banking and Healthcare led the way in cost savings through automation.

To see the full article, click here:  Intelligent Process Automation – The Study

More info on process automation: BPM and BPA Software



BPM + ROI: Video Testimonials


Cost Savings and ROI with Business Process Management

Continuing on the ROI theme for Business Process Management/Automation, here are some great video testimonials about the cost and time savings these types of solutions (Business Process Applications) can provide.


BPM ROI Part Deux: Choose Wisely


The Whale or the Sardine? Fastest Way to a BPM/BPA ROI

Continuing on the groundwork set by my initial BPM ROI post (ROI and Benefits of BPM/BPA), this post will take a peek at where companies should focus out of the gate to maximize the impact of the BPM/BPA suite they purchase, and where they can find hidden treasure.

In meeting with prospects, it is typically the same story:  They have a critical business process that needs to be automated.  It is that single core use case that typically drives them to research, seeking to find a way to drive efficiency and automation, and all the key direct and indirect benefits that business process automation can provide.   But during discovery, demos and conversations, they quickly find that there are so many ancillary processes within their business that can be automated, and it is in these areas that the trail to ROI can be significantly shortened.

The Whale

Ah, the critical business process.  Usually a cross departmental, fluctuating beast that drives profit and keeps the lights on.  Maybe for your organization, it is a complex contract process that touches sales, legal, accounting and execs, and ultimately leads to revenue.  For another, maybe the management of the product life-cycle, tying together sales, artwork. legal and production lines to ultimately get a product out the door.  These processes are easy to identify, and high on management’s list of targets for improvement.  Although in the end, automating these processes can have a huge impact on the bottom line, the road to a positive ROI is typically longer.  Take for example this Real Estate Company in California that automated contracting, and estimates $216,000 in savings per year: Real Estate and BPM Case Study

The Sardine

Every business has painful, time-consuming processes that touch many, if not all employees.  I was in a meeting with a client, discussing a critical business process, and we started a conversation around justifying the purchase.   There was clearly a justification in the core use case, but they wanted more ammunition.  We talked about ancillary processes, and it became apparent that vacation/sick day management was a major pain.  It was currently a paper process that involved forms that were filled out every month by all employees, and involved management, processing of scanned forms, and manual data input.  With 700 employees, and taking into account the time to fill out forms, management approval, etc., this was an easy choice as a first process (in parallel with the larger process project).  Many BPM/BPA vendors have realized the power of automating many small processes that touch large users bases, and have built out ROI accelerators.  These accelerators are pre-packaged applications, including forms, workflow, reports and data, that can be deployed immediately.  K2 has built out a series of these, including leave approval, expense reimbursement, incident management and more.  An example would be Kimberly-Clark, who automated hundreds of processes: BPM Process Automation

Combining the quick value of smaller processes in parallel with the core return on automating larger ones can result in a faster return on investment, and all the benefits that can be gleaned from digital processes.  Thoughts?


BPM and ROI: Direct and In-direct Benefits

The ROI on BPM

Just What Is The ROI on BPM?

It is a topic in all the conversations on BPM, and one of the most difficult to address.  Just what is the ROI on BPM/BPA implementation?  This will be a first in a series of posts to address the Return on Investment question, and make the justification process an easy task.

So, to start, let’s get this out of the way right now:

There is no clear, exact, repeatable way to build out an ROI model for a BPM implementation.

Why?  The benefits are multi-dimensional and can be dependent on process, number of people involved, the department, the industry and on and on.  So, to begin with, let’s address the two types of benefits gleaned from any BPM implementation: Direct and In-direct.

Direct Benefits of BPM:

  • Improvements in efficiency and productivity
  • Reduction in rework, errors and process failure (Quality Improvement)
  • Reduction in required staffing through automation and process tuning
  • Risk mitigation
  • Insight for continuous process improvement and analysis

In-direct Benefits of BPM:

  • Centralized control and management of all business processes
  • Enhanced compliance
  • Simplified and centralized audit capabilities
  • Improved collaboration
  • Greater alignment of IT with business requirements

It is the combination of all these benefits that can help you compile an ROI model focused on your business and the processes you automate.  Anything I missed?  Thoughts?

In the next post, I will discuss more on ROI, and where to focus out of the gate.  Want some other posts on the topic?  See below:

5 Things to Know About BPM ROI

Insider’s Guide to BPM ROI