Question

Model the following business process. Use pools/lanes where needed.

----------->Sketch on Paper BPMN MODEL with POOLS/LANES<-----------------

You can draw on paper Gateways/Pools/Lanes. Thanks

Question 1: 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, and so on.

Answer 1

A claim refers to the act of making claims or demands that usually occur when one party to a contract alleges that the other party contravenes the contract. For example, if a contract that entitles a person or legal entity to own a particular property such as land is infringed, the complaining party will have to raise s claim.

Explanation :

Once a claim is received, if the claimant is insured a claim officer first checks.

If not, the claimant is informed by sending an automatic notification via an SAP system that the claim must be rejected.

Otherwise the severity of the claim is assessed by a senior claims officer. The relevant forms are sent to the claimant on the basis of the result (simple or complex claims) and again using the SAP.

Once the forms are returned, the claims officer verifies that they are complete. If all relevant details are provided in the forms, the claim will be registered in the claims management system, and the process will end.

Otherwise, the claimant will be informed via the SAP system to update the forms. Upon receipt of the updated forms, the claims officer checks them again to see if the details were provided, and so forth.

To conclude, if the claimant is insured and has provided all the updated forms in the correct manner, the claims officer critically analyzes the case and if the claimant is proved to be the property's rightful owner, then the defendant will be liable for charges for the breach.

Please note that the claimant is the complainant or the claimant, the SAP system is an enterprise resource planning, as well as the data management program that the claim offices are applying in cases such as this one.

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