Claims Process Research Articles

Improving the Process of Disruption Claims: Identification of the Difficulties and Expectations

Improving the Process of Disruption Claims: Identification of the Difficulties and Expectations

Financial Performance of Logistics Companies: Liquidity, Solvency and Profitability Ratios at PT. Jet-Logistik in Yogyakarta

The aims of this research are: a) to empirically test the liquidity ratio of PT. Jet-Logistik do Yogyakarta; To empirically test the solvency and profitability ratio of PT. Jet-Logistik do Yogyakarta; Apart from that, during the pre-survey, problem a) was discovered. Difficulty Checking Delivery Receipts; b). Goods Not Arrived; c). Error in information on shipping method; d). Damaged Goods on the Road; e). Confusing Claims Process. This research method uses a mixed method. The research results show: a). PT. Jet-Logistik shows that the company is illiquid because the company is unable to cover the company’s current liabilities; b). PT, JetLogistik is not solvable because the capital owned by the company is not able to cover debts to external parties and when measured using the debt to asset ratio it shows that the company is solvable because the total assets owned by the company are able to cover its debts. company; c). PT. JetLogistik shows that the company is not profitable because the profits obtained from the capital used for operations have not produced profits that are lower than the company’s internal average.

Event-based Smart Contracts for Automated Claims Processing and Payouts in Smart Insurance

Event-based Smart Contracts for Automated Claims Processing and Payouts in Smart Insurance

Administrative Burden of the Compensation Claim System - Physicians and Union Compensation Representatives’ Views

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. Cigarettes are the leading cause of this disease. However, workplace exposures, including those in the mining industry, may also lead to COPD. These exposures include dust and fumes that can be higher for mineral industry workers who work in confined areas. As a result, workers in the minerals industry may submit compensation claims. Sadly, work-related COPD is not well compensated or recognized by the Ontario Workplace Safety and Insurance Board (WSIB). Physicians and union representatives struggle to complete forms and have claims approved, and because of this, workers can struggle with money, family, and mental health problems. This qualitative narrative study used in-depth telephone interviews (eight) to collect information. The information collected from physicians (four) and union representatives (four) was analyzed to understand their perspectives and experiences when assisting workers with compensation claims. This is the first study to examine how COPD could affect underground mineral workers in Northeastern Ontario. Themes identified in this study include 1) additional administrative and human support resources are required, 2) smoking cessation is essential, 3) COPD is a crippling disease, 4) education is required to support documenting an occupational illness, 5) the compensation claim process is challenging; 6) occupational diseases are challenging to prove, 7) occupational COPD is costly. This study may help with compensation services and provide support for physicians and union representatives involved with an underground mineral worker diagnosed with occupational COPD.

“You didn't ask, so you don't know”: Information and administrative burden in social benefit claims

AbstractEncounters with welfare state bureaucracy are often burdensome and might even result in administrative exclusion and non‐take up. With the growing scholarly interest in administrative burden experiences, a particular focus has been on learning costs, with evidence suggesting that difficulty obtaining reliable and useful information is one of their most fundamental aspects. We still lack a systematic conceptualization of bureaucratic information and its various dimensions. In this non‐representative exploratory study, we draw on interviews with 15 Israeli social benefit claimants to delve deeper into the nature of the information required in encounters with welfare state bureaucracy. Using thematic analysis, we identify five dimensions of such information: primary information on the existence of the benefit, as opposed to secondary procedural information on the claiming process; universal, wide‐ranging available information, in contrast to personalized information; one‐ versus two‐directional information transfer; covert, informal and dynamic, as opposed to overt, publicly available information; and finally, online versus offline information. We suggest that this exploratory conceptual framework can serve as a starting point for future studies to develop deeper understanding of the information citizens need in their encounters with welfare state bureaucracy.

Navigating the Medical Disability Assessment and Personal Injury Claims Landscape in Malaysia

Introduction Individuals who have sustained permanent residual disabilities due to injuries or illnesses and relevant stakeholders engaged in the adjudication process persistently encounter obstacles in accessing equitable and just systems for assessment, support, and facilitation. These systems enable such individuals to secure appropriate compensation and lead fulfilling lives within their communities. Objective This stakeholder engagement process explores the lived experiences of individuals with disabilities and their journey through the claims processes, understanding their concerns and expectations. Results A total of 152 participants participated in the seminar. Thirty-nine participants with extensive experience in medical disability assessment and the claims process were purposefully surveyed, and in-depth interviews were conducted. Several themes emerged from the interview: awareness and education, the legal and judicial system and processes, expert opinion, and reports. Conclusion The findings concluded that expert opinion and report emerged as a critical theme, with participants stressing the need for guidelines, professionalism, and accreditation for expert witnesses. Establishing a multidisciplinary regulatory body to design and develop an educational program for court experts is suggested, as is creating and maintaining a public register of court experts. Such measures will promote transparency, accountability, and quality in expert testimony and reporting

Gerber-Shiu Metrics for a Bivariate Perturbed Risk Process

We consider a two-dimensional risk model with simultaneous Poisson arrivals of claims. Each claim of the first input process is at least as large as the corresponding claim of the second input process. In addition, the two net cumulative claim processes share a common Brownian motion component. For this model we determine the Gerber–Shiu metrics, covering the probability of ruin of each of the two reserve processes before an exponentially distributed time along with the ruin times and the undershoots and overshoots at ruin.

Pertanggungjawaban Hukum Atas Kehilangan Barang Pengguna Jasa di PT. Pos Indonesia (Persero) Kecamatan Sirah Pulau Padang dan Kota Kayuagung

The purpose of this article is to understand and analyze the legal liability of PT. Pos Indonesia (Persero) Sirah Pulau Padang District and Kayuagung City regarding loss of goods of service users. normative legal research, which focuses on the analysis of applicable legal theories and regulations. The research method used is empirical juridical with primary and secondary data sources. The research results showed that there were several cases of lost goods at PT. Pos Indonesia area. PT. Pos Indonesia, based on its internal regulations and policies, has an obligation to provide compensation to service users in the event of loss of goods. However, the compensation claim process often experiences obstacles and often causes customer dissatisfaction. The recommendation from this research is the need to improve the compensation claim mechanism and increase the quality of service so that public trust in PT. Pos Indonesia can be maintained.

Perlindungan Hukum Klaim Asuransi Pemegang Polis Asuransi

Life insurance has become integral to individual and family finances in the modern era, providing financial protection and peace of mind. Life insurance claims involve complexities that require in-depth understanding from both the policyholder and the insurance company. Legal protection in insurance claims is important to ensure policyholder rights are protected. This article investigates legal protection for life insurance policyholders during the claims process, analyzing regulations, dispute resolution mechanisms, and how legal protection ensures policyholder rights are safeguarded. The research method uses a juridical-normative approach with literature study, applying analytical descriptive analysis. The results illustrate the importance of understanding statutory provisions, consumer protection, and dispute resolution.

Online Perspectives of Workers Navigating Workers' Compensation Systems: A Content Analysis of the Reddit Social Media Platform.

Social media platforms are increasingly used by the general public as a source of information on health-related and legal concerns, among other topics. Reddit.com, one of the top 10 most visited websites in the United States, is a popular social media platform that allows users to anonymously discuss various topics, including workers' compensation (WC). Understanding the candid concerns of workers who are navigating WC systems will allow for the development of more effective educational resources that are tailored to the needs of this population. Methods: In January-March 2023, a cross-sectional review of anonymous public posts submitted to the r/WorkersComp section of the Reddit social media website between December 2021 and December 2022 was performed. Post content was extracted from a systematic random sample and coded into themes/sub-themes and emotional tones by two independent reviewers. A third reviewer resolved any discrepancies in coding in order to reach consensus prior to data analysis. The data were analyzed using Microsoft Excel 2019 (Microsoft Corporation, Redmond, WA, USA). Content from 200 original posts submitted to r/WorkersComp was reviewed and analyzed. Nearly 94.0% of posts (n =187) specified a state of residence, with posters most frequently residing within the United States in California (32.0%), New York (7.0%), Pennsylvania (5.0%), and Florida (5.0%). The most common primary theme was "medical" (27.0%, n = 54), with questions and comments related to provider complaints, medical care access, referral denials, maximum medical improvement, and independent medical examinations being the most frequent within this category. The second most common primary theme was "legal" (26.5%, n = 53), with questions and comments related to lawyer retainment and settlements being the most frequent within this category. The third most common primary theme was "general" (18.5%, n = 37), with questions and comments related to the general claims process, eligibility for WC, claim denial, and communication issues with claims adjusters being the most frequent within this category. The fourth most common primary theme was "employer" (14.0%, n = 28), with questions and comments related to employer retaliation, job security, and work restrictions being most frequent within this category. Only 37.0% of posts (n = 74) expressed a clear emotional tone, with frustration (13.5%, n = 10), fear (13.5%, n = 10), and confusion (13.5%, n = 10) being the most frequent tones observed in this sample of posts. Our findings indicate that there are workers who are navigating WC systems who use social media platforms such as Reddit to obtain information and advice on various aspects of WC, including medical issues, legal advice, and employer concerns. These findings may be used to address the information and education needs of workers who are navigating WC systems, which may help attenuate some of the frustrations surrounding the WC claims process.

A Design Study on the Design of Customer Claims Management System for Qinghai Electric Power Company

Abstract This paper utilizes the SOA framework to realize the system structure design, combined with the total flow of the claim processing, the design of the acceptance and audit processing, responsibility determination and reminder management of 4 modules, constituting the customer claim management system as a whole. The improved LEACH algorithm is utilized to control the network topology, and the cluster tree combined with data fusion is used to reduce the energy loss of the nodes in the network. Based on the weighted queuing scheduling algorithm, the feedback processing module is designed to determine the grouping rules and calculation methods, and the decision tree algorithm is used to build the demand management prediction model. The accuracy of the prediction of the decision tree algorithm is verified to realize the case information management statistics. Analyze the utility of the improved LEACH algorithm and test the system’s performance. The experimental results show that the improved LEACH algorithm is more balanced in the range of [0,100] dead nodes, and the energy consumption is well balanced. The total delay is 16.13-time slots, which is the lowest delay among the four algorithms. The node death time is 1045 rounds, having the longest network life cycle. The system performance is tested using IO and memory-intensive loads. Before writing a file of 16GB, the system time responsiveness stays around 80%, and the system CPU utilization and disk IO utilization increase as the file is written. The system performance is good.

DEVELOPMENT OF A BPJS HOSPITAL CLAIMS MONITORING SYSTEMS VIA BRIDGING DASHBOARD

Enhancing efficiency in the management of claims by the Social Security Organizing Agency (BPJS) at hospitals is a paramount issue in the healthcare sector. This research endeavors to address this challenge by proposing the implementation of Dashboard Bridging, a technology-based solution capable of integrating data from various information sources within hospitals. This system generates comprehensive real-time information and enables more precise decision-making in the management of BPJS claims. Through a structured development approach, the Dashboard Bridging system is designed and implemented to ensure accuracy and optimal performance in BPJS claim analysis. Its objectives include reducing claim processing time, improving healthcare service quality, and potentially enhancing hospital operational efficiency. Furthermore, it aims to serve as a reference for the development of similar solutions in various public service sectors.

A Blockchain and IPFS-Based Anticounterfeit Traceable Functionality of Car Insurance Claims System

Due to frequent traffic accidents around the world, people often take out car insurance to mitigate their losses and receive compensation in a traffic accident. However, in the existing car insurance claims process, there are problems such as insurance fraud, inability to effectively track and transmit insurance data, cumbersome insurance procedures, and high insurance data storage costs. Since the immutability and traceability features of blockchain technology can prevent data manipulation and trace past data, we have used the Elliptic Curve Digital Signature Algorithm (ECDSA) to sign and encrypt car insurance data, ensuring both data integrity and security. We propose a blockchain and IPFS-based anticounterfeiting and traceable car insurance claims system to improve the above problems. We incorporate the Interplanetary File System (IPFS) to reduce the cost of storing insurance data. This study also attempts to propose an arbitration mechanism in the event of a car insurance dispute.

Optimizing Goods Claims Processing Time in Logistics Operations Through Website-Based Applications with the DMAIC Approach

PT XYZ is an e-commerce company which offers an electronic buying and selling platform for a wide variety of products from many sellers to buyers. As an industry engaged in the commercial sector, logistics has a vital role in shipping goods from upstream to downstream to meet consumer desires. However, conditions in the field are not always in accordance with the plans. Lost or damaged goods during delivery or at the Warehouse are a frequent problem. PT XYZ, through its XYZ Logistics team, implements a claims system for replacing items lost or damaged during the operational process. Currently, the claim submission system is done manually via email. This manual claim system creates many problems due to the lack of proper coordination between stakeholders. Therefore, this study proposed a solution with a lean six sigma approach using the DMAIC (Define, Measure, Analyze, Improve and Control) method. The solution offered to improve PT XYZ's claim system is to design an automated claim system using a website-based application. After implementing a website-based application to automate the XYZ logistics claim process, it was proved that the company was able to reduce lead time by up to 60% from initial conditions, up to 33% of stakeholder workload, and improve data security and real-time supervision.

Critical Review of Digital Entrepreneurship and Performance of Insurance Companies in Nigeria

This study critically reviewed digital entrepreneurship and the performance of Insurance companies in Nigeria. Digital products and mobile technology were used to explore their effects on innovation and public trust in insurance. The adoption of digital tools eliminates brokers paperwork and claims process, it has the capabilities to minimize fraud - leading to reduced time, effort, and costs. The scope of the study comprises all the InsurTech insurance companies in Nigeria. This study describes the desktop and structured research method used in attaining the stated research objectives. Findings revealed that the company’s product, digital services, and novel services influence the performance of insurance companies in Nigeria. Further, Mobile technology has a positive and significant influence on public trust in Nigerian insurance. Findings revealed that more effective and efficient, smooth communication influences the performance of insurance companies in Nigeria. This study concludes that digital products and mobile technology have a positive and significant influence on innovation and public trust in Nigerian insurance. This study recommends that more company products need to be designed to be digital according to client’s preferences. And mobile technology can be utilized to reach out to millions of insurance clients. It makes the insurance business more effective and efficient. Proper utilization of mobile technology can improve the communication between the insurer and the insured.

Web3 enhanced Insurance System using Ethereum Smart Contract

Abstract:-The traditional insurance industry has long struggled with inefficiencies, too much paperwork, and complex processes for handling policies and claims. This often means waiting a long time for claims to be sorted out because of all the go-betweens involved. To solve these issues, we're putting forward a new web3 solution that uses Blockchain technology. Our plan uses smart contracts to make managing policies and processing claims simpler, and we don't need all those middlemen. This change has lots of good points like stopping fraud, making everything more transparent and trustworthy, and making things happen faster. Instead of sticking with the old ways of doing insurance, we're bringing Blockchain into the mix and keeping track of policies and transactions using smart contracts. This shift means fewer middlemen and a much more efficient system overall. We've tested our idea with an experimental model in the web3 framework, and it's shown that our plan works and is cost-effective and quick. Keywords: Insurance Blockchain · Smart Contract · web3 Insurance System· Quick Claims Processing · Cost Effective web3 Insurance

Workshop of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9cm) at RMC Pakandangan Clinic

Completeness of BPJS claim documents at the hospital includes service recapitulation and patient support files consisting of a Participant Eligibility Letter (SEP), medical resume, diagnostic statement from the treating doctor, and other proof of service. The BPJS claim process already uses the INA-CBGs program. Payment patterns with INA-CBGs organized by BPJS in hospitals must go through the file verification stage so that BPJS Health verifiers verify service Administration and ensure the suitability of diagnoses and procedures on bills with ICD-10 and ICD-9 codes. In coding patient medical actions/procedures, coders use ICD-9 CM rules to assign medical action codes to the patient's resume sheet. Coding of medical procedures is carried out to provide classification and specific information regarding medical actions grouped based on ICD-9 CM. Based on these problems, the author is interested in holding ICD-9 CM coding training at the RMC Pakandangan Clinic. This community service is important because it will reduce pending claims from PBJS. Objective: This community service aims to provide training related to ICD-9 CM coding and increase knowledge of medical recorders. This community service method is carried out using 3 stages, namely preparation, implementation, and evaluation. This workshop is to provide material regarding the use of ICD-9 CM and provide direct practice in coding ICD-9 CM based on applicable regulations. Results: This Community Service Activity (PKM) was carried out on April 8 2023 at the RMC Pakandangan Clinic, Padang Pariaman. The Community Service activity was attended by 10 participants. From the results of the pre-test and post-test in the ICD-9 CM coding training, there was an increase in understanding of ICD-9CM coding. Conclusion: This Community Service has a positive impact on the understanding of ICD-9 CM coding training participants.

A Survey on HealthCare Claim Prediction

Abstract: The life insurance industry has experienced a significant increase in claims in recent years. To cope with the large volume of claims, insurance companies are turning to machine learning models for predicting life insurance claims. This paper presents a machine-learning model for predicting life insurance claims based on various demographic and health-related features. The proposed model will be evaluated on a real dataset and will achieve a high accuracy, precision, recall, and F1 score. The results will show that the machine learning model can effectively predict life insurance claims, which can improve the efficiency of claims processing and ultimately benefit insurance companies and policyholders

Storage Rack Design to Minimize Customer Claims at PT Rekadaya Multi Adiprima Using DMAIC, FMEA, and NIDA Methods

PT Rekadaya Multi Adiprima is a manufacturing industry that produces automotive components, especially for four-wheeled vehicles. PT Rekadaya Multi Adiprima is divided into four production divisions, namely the metal division, non-woven division, plastic division (service hole), and interior division. During the implementation of production at PT Rekadaya Multi Adiprima, there was still a customer claims process which was very detrimental to PT Rekadaya Multi Adiprima. Based on the results of interviews with quality staff, it was found that the number of claims occurring in 2022 at plant 1 of PT Rekadaya Multi Adiprima exceeded the tolerance set by the company, namely 0.05%. Based on these problems, further observations need to be made to resolve existing problems. The method used to solve this problem is the DMAIC (Define, Measure, Analyze, Improve, control) method with the help of the FMEA (Failure Mode and Effects Analysis) method based on customer claim data from July 2022- December 2022. The defining stage is carried out by analysis to determine product with the highest level of claims, the measurement stage involves calculating the DPMO value and Sigma Level, the analysis stage aims to find out the cause of the claim using the help of a fishbone diagram and the FMEA Table, in the improv stage the aim is to find and make improvements with the help of the 5W+1H Table based on the diagram fishbone and FMEA tables that have been made previously. As well as carrying out design using the NIDA method, the final stage of control is monitoring the expected improvement results. The results before the improvement, the DPMO value was 77,000 units with a sigma level of 2.925 and after the improvement the DPMO value decreased to 17,400 units with a sigma level of 3.611. The results of the improvements made reduced the level of customer claims by 61.93%.

Enhancing decision-making of IT demand management with process mining

PurposeDigitalization, innovation and changing customer requirements drive the continuous improvement of an organization's business processes. IT demand management (ITDM) as a methodology supports the holistic governance of IT and the corresponding business process change (BPC), by allocating resources to meet a company's requirements and strategic objectives. As ITDM decision-makers are not fully aware of how the as-is business processes operate and interact, making informed decisions that positively impact the to-be process is a key challenge.Design/methodology/approachIn this paper, the authors address this challenge by developing a novel approach that integrates process mining and ITDM. To this end, the authors conduct an action research study where the researchers participated in the design, creation and evaluation of the approach. The proposed approach is illustrated using two sample demands of an insurance claims process. These demands are used to construct the artefact in multiple research circles and to validate the approach in practice. The authors applied learning and reflection methods for incrementally adjusting this study’s approach.FindingsThe study shows that the utilization of process mining activities during process changes on an operational level contributes to (1) increasing accuracy and efficiency of ITDM; (2) timely identification of potential risks and dependencies and (3) support of testing and acceptance of IT demands.Originality/valueThe implementation of this study’s approach improved ITDM practice. It appropriately addressed the information needs of decision-makers and unveiled the effects and consequences of process changes. Furthermore, providing a clearer picture of the process dependencies clarified the responsibilities and the interfaces at the intra- and inter-process level.