BUSINESS Team Details

ANALYSIS Ajita Chakladar (2018066)

Ayush Chhablani (2018138)
Danish Jain (2018016)

PROJECT REPORT Prajit Kane (2018224)

Saumya Mittal (2018109)

Group No : 6
 Contents

1 Executive Summary ............................................................................................................................... 2

2 Analysis Phase ....................................................................................................................................... 3
2.1 As Is process (Swimlane flow) ....................................................................................................... 3
2.1.1 Missing Requirements/Redundant requirements ................................................................ 4
2.1.2 Understanding of Ambiguous requirements ........................................................................ 4
2.1.3 Steps to be automated in the current process ................................................................... 10
3 To Be Process (Swimlane flow) ........................................................................................................... 11
4 Use Case Interaction diagram ............................................................................................................. 12
5 Use Case design .................................................................................................................................. 13
6 Prioritization of the Use Cases (In Terms of Criticality – High medium-Low) ..................................... 23
7 User Acceptance Test Scenarios ......................................................................................................... 24
7.1 Use Case scenarios and the corresponding UAT scenarios ........................................................ 24
7.2 User Acceptance Test scenarios.................................................................................................. 31
8 Data Flow Diagrams ............................................................................................................................ 43
8.1 Context Diagram ......................................................................................................................... 43
8.2 Level 0 Data flow diagram (Logical DFD)..................................................................................... 44
9 User Interface Design .......................................................................................................................... 45
9.1 Landing Page ............................................................................................................................... 45
9.2 CMS-1500 Online Form ............................................................................................................... 46
9.3 Admin Dashboard ....................................................................................................................... 47
10 Blockchain Implementation in Insurance (An introduction) ........................................................... 49

1
1 Executive Summary

XYZ Inc. is a leading Insurance provider in North America which was facing problems regarding
customer complaints due to very high claims processing time. This was impacting their business
negatively and they were struggling to find new customers in the market. They hired a Business
Analyst to have a close look at their business processes, identify problems and automate
processes in order to reduce processing time.
The BA closely understood the processes and requirements, analyzed the stages, identified
problems (processes which were redundant or took more time) and provided full analysis on
automating the processes and how it would affect their overall flow. Process Mapping original
and new through Swimlane flows, flows and interactions through Use Case Interaction Diagram,
and Use Cases with their prioritizations.
With this analysis XYZ Inc. will now know how new processes (automated) will reduce processing
time and will incur less complaints with the introduction of the Web Application by XYZ Inc. The
web application, from future, will handle all the claims right from the start of filling the form to
the final funds transfer and all the alerts for the customer. Such automation will lead to extremely
less claim processing time and happier customer.
In order to check validity and performance of each use case we did User Acceptance Testing
(UAT), using various test scenarios for each use case and review the test results for any changes
required in the Use Case.
Data Flow Diagrams (DFDs) are made to keep the whole process organized and simple. 2 DFDs
i.e. Context Diagram and Level 0 diagram are drawn.
User Interaction Design (UID) for relevant Actors with respective Use Case are made in order give
visual representation of the concerned Use case.

2
2 Analysis Phase

2.1 As Is process (Swimlane flow)

3
2.1.1 Missing Requirements/Redundant requirements

All the missing/ redundant requirement will only be cleared after having a clear discussion with the
client. Till then, what our BAs feels fit are listed below:

a) If the medical records obtained by the in-house doctor team is accurate, they forward it to the
concerned hospital for clarification. There is no alternative if the reports are imprecise. Also, if
something in the medical report seems erroneous at the concerned hospital, there is no
explanation on how to proceed further.

b) The manager reviews the claim & in case of any corrections sends the comments to the
insurance clerk/in-house team. The actions of the insurance clerk on further process is absent.
Moreover, if there are any discrepancies in the payment details, appropriate actions for the
same are missing.

c) In the first stage, after filling the claims form the customer has to call the call center to notify
that he is initiating a claims process. This is a redundant step as the company is already notified
of the claim when the customer sends the email with the claims form.

d) The responsibility of the claims rep is to close the claim at the end of the whole process. This
responsibility can be handled by the finance department once they finish the payment process.

e) No tracking mechanism in the original processing process

2.1.2 Understanding of Ambiguous requirements

Business SMART Observations Modified Assumptions and

Requirement(each for the requirement Requirement (after rationale behind
sentence in the fixing problems assumptions
claims case could be identified through
a requirement) SMART)
Customer Fills the Specific – This Customer collects the 1. Customer received
claim form. requirement is specific form from _ place, fills the form online
Measurable – How to it and submits it to _. 2. Physically collected
trace if the form is filled the form office
or not? No
confirmation Mail
Response

4
 Attainable – The filling
of claim form is
attainable.
Relevant – The details
requirement is
achievable.
Time-bound – No clear
indication of when the
request for the claim
will be realized

Customer calls the call Specific – It is not Customer calls the call 1. Source from where
center through toll free specific center through toll free customer gets the toll-
number Measurable – The call is number which is free number is not
done or not available on_ mentioned.
Attainable – The call
can be done and
received by the
customer care
Relevant – The
customer informs that
he has submitted a
claim request
Time-bound – not time
bound
Customer Submits the Specific – Details Customer submits the 1. Online/ claim Id
claim through email. specific to the customer claim(In what form) number submitted
is entered or not and any other through mail
Measurable– Customer document?_ through 2. Email id must be
submitted the form email id of _ mentioned to customer
successfully
Attainable- Customer is
able to submit the form
Relevant – It is relevant
to the claims request
process
Time-bound – There is
no time limit defined.
Insurance clerk assigns Specific – This specifies Insurance clerk assigns The claims processing
claim ID the specific claim ID for claim ID within 1 day time as to be reduced
the concerned
customer
Measurable – It can be
measured by the
number of customers
who applied for the

5
 claim and the number
of claim IDs generated
Attainable – The
process is attainable by
the system
Relevant – Relevant for
the customer, as this
stage enables
identification of the
claim
Time-bound – not
clearly defined
Insurance clerk does Specific- The insurance Insurance clerk does 1. Time of 2 days taken
the document clerk does document the document clerk to verify
verification verification of the verification in this document
customer much time__
Measurable-It can be
measured by the
efficiency with which
the details are
extracted and validated
by the clerk
Attainable – The
process is attainable if
the clerk doesn’t find
any gaps in the claim.
Relevant – Verification
of documents is
relevant to process the
claim
Time-bound – not
clearly defined
Insurance clerk sends Specific- The insurance Insurance clerk sends 1. Time taken by the
the reports to in-house clerk sends documents the reports to in-house insurance clerk to send
doctors of concerned customer doctors in (This much reports is 2 days 2.
to doctors to verify time frame) through Medium used to send
Measurable-Not (Email) reports is email
measurable
Attainable – The
process is attainable as
clerk sends the reports
to the in house doctors
Relevant – Verification
of reports is relevant to
process the claim
Time-bound – not
clearly defined

6
If there is any problem Specific- The insurance If there is any problems 1. Problems associated
with any of the items clerk informs the (with the documents with the claim are not
mentioned above, the concerned customer of submitted and claim mentioned probable
insurance clerk would any missing documents. process followed) the outcomes will be
call the customer and Items written in the insurance clerk would wrong documents,
let him know of the statement is call the customer and incorrect amount
deficiencies in the ambiguous. Thus, it is let him know of the Claimed.
claim. If the customer not specific deficiencies in the
does not provide the Measurable-It can be claim. If customer does
details within the measured by the not provide the details
stipulated time, the efficiency with which within (4days) the
claim is rejected. the details are claim will be rejected.
extracted and validated
by the clerk
Attainable – The
process is attainable by
the clerk.
Relevant – The call is
made to inform the
customer
Time-bound – not
clearly defined

The in-house doctors Specific- The doctor The in-house doctors 1. Approximate time
team verifies the claim does document team verifies the claim taken to do document
and the medical verification of the and the medical verification process will
records submitted by customer records submitted by be 3 days.
the customer and see if Measurable-It can be the customer and see if
the medical records are measured by the the medical records are
appropriate. efficiency with which appropriate. Time
the details are taken for this process
extracted and validated will be (3 days)
by the doctor
Attainable – The
process is attainable if
the doctor doesn’t find
any gaps in the claim.
Relevant – Verification
of documents is
relevant to process the
claim
Time-bound – not
clearly defined
If they are appropriate, Specific-Not Specific If they are appropriate, In house doctors team
then the team would (They?) then (In House will call the concerned
call the concerned Measurable-It can be Doctors?) team would hospital.
measured by the call the concern

7
hospital for efficiency and hospital for
clarification. convenience with clarification? In house
which the details are doctors or some other
validated team?
Attainable – The
process is attainable by
the doctors
Relevant – Verification
of documents is
relevant to process the
claim
Time-bound – not
clearly defined
If everything is fine, Specific- (Everything is If everything is fine, They communicate to
they communicate this not fine? ) Not specific they communicate this clerk to dismiss the
to manager for further Measurable-It can be to manager for further claim/ ask for more
processing. measured by the processing. If documents.
effectiveness of everything is not fine
communication the records
Attainable – The appropriate, then
process is attainable. what?
Relevant – Relevant to
inform the manager to
process the claim
Time-bound – not
clearly defined
The manager reviews Specific- It is specific How much time does Communication
the claim and Measurable- this process take? The happens through the
approves. If there are Measurable by the manager reviews the mail. This process takes
any comments he comments claim and approves. If approx. 4 days. Needs
sends them to the Attainable – The there are any to be understood while
insurance clerk/in- process is attainable by comments he sends gathering the
house team. After the the manager them to the insurance information.
approval, the manager Relevant – Proper clerk/in-house team.
sends it to finance comments to improve After the approval, the
department for bill the documentation manager sends it to
settlement. details is relevant to the finance department for
claims process bill settlement.
Time-bound – not
clearly defined
The finance Specific- Which details The finance Communication
department would look for payment? And send department would look happens through the
at the claim and information to manager at the claim and mail.
prepares details for by what means? prepares details for
payment and send it to Measurable- payment and send it to
the manager. Processing for payment the manager through
is the most relevant (Email) within (4 days)
of time

8
 stage for a claim
procession.
how much time can
manager and finance
department take to
approve the claim
Attainable – The
process is attainable by
the finance department
Relevant – Details of
payment is necessary
for claims processing
Time-bound – not
clearly defined

The manager verifies Specific- What kind of
the details and see if issues?
there are any issues Measurable-It can be
with the details of measured by the time
payment, he approves taken to verifying the
and sends the details details
to Finance for Attainable – The
electronic credit to theprocess is attainable by
claimant. the manager
Relevant – Claims
approval by the
manager is relevant
Time-bound – not
clearly defined
Then the finance gets Specific- How does the
the details of bank Finance department
account from the gets the bank details?
customer Measurable-It can be
measured by the details
provided by customer
Attainable – The
process is attainable by
the finance department
Relevant – Bank details
is relevant to process
the claim
Time-bound – not
clearly defined
The customer is Specific- It is specific
updated about the Measurable-Not
payment by the measurable
Insurance clerk through Attainable – The
an email process is attainable if
The manager verifies Documents verified by
the details and see if the insurance clerk and
there are any issues amount mentioned by
(related to documents, claim generator is
approved amount) with granted.
the details of payment,
he approves and sends
the details to Finance
for electronic credit to
the claimant within ‘x’
days.
Finance department Emails have been used
gets the details of bank to communicate to
account by what customer.
communication
medium? Within what
time?
The customer is Immediate
updated about the communication done
payment by insurance to the customers
clerk through email within 3 days.

9
 the clerk sends an
email.
Relevant – It is relevant
to inform the customer
about the status of the
claim
Time-bound – not
clearly defined
The customer account Specific- It is specific
is updated with the Measurable-It can be
claim details and the measured by the
amount left in the amount left in the
account after the claim account
is computed and Attainable – The
updated in the account process is attainable
by the finance once the claim is
department processed
Relevant – Updating of
account amount is
relevant after
processing the claim
Time-bound – not
clearly defined
within the 3 days after
the approval of claim
The customer account Amount processed in
is updated with the the claim payment
claim details which will needs to be followed
contain amount by updating the
reimbursed to claim. accounts of finance
Then the account departments for
which is left in the further process work..
insurance company
account is updated by
the Finance
department for _
within _

2.1.3 Steps to be automated in the current process

1. Online filling and Submission of form (CMS-1500)

2. Assignment of Claim ID
3. Initial verification of the claim form at the web application level
4. Notifications for customer to track the claim process and for any discrepancies (new)
5. Fetching of bank details from the online form filled initially

10
3 To Be Process (Swimlane flow)

CMS-1500 is a standard form in use worldwide for medical insurance claims. It contains all the
details of the claimant and can be verified using Optical Character Recognition.
The processes and the flows are color coded.
The flows with a shadow effect shows a Use Case Slice for a Happy Path.

11
4 Use Case Interaction diagram

12
5 Use Case design

S. No. ID Name
1 ID-01 Login
2 ID-02 Details Update
3 ID-03 Claim ID Generation
4 ID-04 Verification of Form
5 ID-05 Claimant’s Action
6 ID-06 Report Verification
7 ID-07 Action taken on Comment received
8 ID-08 Reports Verification
9 ID-09 Contact Concerned Hospital
10 ID-10 Action taken on Comment received
11 ID-11 Claim verification
12 ID-12 Payment Initiation
13 ID-13 Payment
14 CP-001 Claim Processing

Name Login
ID ID-01
Actor Claimant
Pre-Condition Claimant should have a account created on Web application of XYZ
1. Claimant opens application
2. Claimant fills in log in details
Task
3. System responds by logging in if details are correct else asks to reenter
details
Post Condition Logged in the claimant account
If the login details are incorrect, system will prompt to enter details once
again
Extends
If the login details are incorrect for two times, system displays an error
message "Try after one hour"
Includes
Data Log in details
Should have taken insurance policy, entering wrong details two times
Business Rules
displays an error message
Response time<3 sec, Should work on all operating systems, Work with 32
bit and 64 bit configuration, Mobile friendly, Scalability to 10000 users at
Non Functional
a time, User Interface should be easy to understand, Availability-
Requirements
7X24X365, Should work on windows/linux, Code should be written in
modular form, Only valid users should be able to access/site should be

13
 hackproof/peak time for the application is between 10 am to 10 PM,
Interface should be user friendly, Hassle free movement between tabs

Name Details update

ID ID-02
Actor Claimant
Pre-Condition Claimant should have Logged in properly
1. System shows an option to fill or edit form
2. Claimant clicks that option
3. System provides CMS-1500 form to fill details
4. Claimant provides data regarding claim and bank details
5. Claimant hits save button
Task
6. System saves the form
7. System gives an option to upload medical bills and reports
8. Claimant uploads medical bills and reports in CMS-1500 form
9. Claimant hits save button
10. System saves bills and reports
Post Condition Can upload all documents properly
If the policy details filled by the customer are incorrect, system shows an
error message to enter details again
Extends
If documents uploaded have size more than 5 MB, system asks to upload
documents having size less than 5 MB
Includes
Data Claim details (Expiry date, etc.), Claimant bank details
1. Policy should be a valid one
2. Policy should not be expired
Business Rules
3. Bank details are proper
4. All documents uploaded should be less than 5 MB
Response time<3 sec, Should work on all operating systems, Work with 32
bit and 64 bit configuration, Mobile friendly, Scalability to 10000 users at
a time, User Interface should be easy to understand, Availability-
Non Functional
7X24X365, Should work on windows/linux, Code should be written in
Requirements
modular form, Only valid users should be able to access/site should be
hackproof/peak time for the application is between 10 am to 10 PM,
Interface should be user friendly, Hassle free movement between tabs

Name Claim ID Generation

ID ID-03
Actor Web Application
Pre-Condition Claimant is able to save CMS-1500 form and upload all documents

14
 1. Claimant enters all details and save it
Task
2. Web Application generates a Claim ID for tracking
Post Condition A valid Claim ID is generated
Extends
Includes
Data Claim ID- 123XXXXX
Business Rules
Response time<3 sec, Should work on all operating systems, Work with 32
bit and 64 bit configuration, Mobile friendly, Scalability to 10000 users at
a time, User Interface should be easy to understand, Availability-
Non Functional
7X24X365, Should work on windows/linux, Code should be written in
Requirements
modular form, Only valid users should be able to access/site should be
hackproof/peak time for the application is between 10 am to 10 PM,
Interface should be user friendly, Hassle free movement between tabs

Name Verification of form

ID ID-04
Actor Web Application
Pre-Condition Claim ID is generated
1. System verifies the form using Optical Charter Recognition
Task 2. If it is not proper call Sub-routine 1a
3. If it is proper, then generates report
Post Condition Report is generated
Extends
1a. If it is not proper then system generates a notification and send it to
Includes
claimant to take necessary actions
Data Claim form
Response time for verification should be in accordance with the industry
Business Rules
standards
Response time<3 sec, Should work on all operating systems, Work with 32
bit and 64 bit configuration, Mobile friendly, Scalability to 10000 users at
a time, User Interface should be easy to understand, Availability-
Non Functional
7X24X365, Should work on windows/linux, Code should be written in
Requirements
modular form, Only valid users should be able to access/site should be
hackproof/peak time for the application is between 10 am to 10 PM,
Interface should be user friendly, Hassle free movement between tabs

15
Name Claimant's Action
ID ID-05
Actor Claimant
Pre-Condition Notification to take necessary action is generated by application
1. Claimant takes necessary action within time
2. If it is taken within time then process goes back to the point where it
Task
was rejected
3. If not taken within time then call extend 1b
Post Condition Necessary action taken/Claim Rejected
Extends 1b. Claim Rejected
Includes
Data
Business Rules Action by the claimant should be taken within stipulated time
Response time<3 sec, Should work on all operating systems, Work with 32
bit and 64 bit configuration, Mobile friendly, Scalability to 10000 users at
a time, User Interface should be easy to understand, Availability-
Non Functional
7X24X365, Should work on windows/linux, Code should be written in
Requirements
modular form, Only valid users should be able to access/site should be
hackproof/peak time for the application is between 10 am to 10 PM,
Interface should be user friendly, Hassle free movement between tabs

Name Report Verification

ID ID-06
Actor Insurance Clerk
Pre-Condition Report is generated
1. Report is received by insurance clerk and verified
Task 2. If it is not proper call Sub-routine 1a
3. If it is proper, then send report to in-house doctor
Post Condition Report verified/Notification sent to claimant
Extends If customer doesnot take any action within time, system rejects claim
1a. If it is not proper then system generates a notification and send it to
Includes
claimant to take necessary actions
Data Claim form and reports
Response time for verification should be in accordance with the industry
Business Rules
standards
Response time<3 sec, Should work on all operating systems, Work with 32
bit and 64 bit configuration, Mobile friendly, Scalability to 10000 users at
Non Functional
a time, User Interface should be easy to understand, Availability-
Requirements
7X24X365, Should work on windows/linux, Code should be written in
modular form, Only valid users should be able to access/site should be

16
 hackproof/peak time for the application is between 10 am to 10 PM,
Interface should be user friendly, Hassle free movement between tabs

Name Action taken on Comment received

ID ID-07
Actor Insurance Clerk
Pre-Condition Received Comment from Manager
1. Comment from manager received
2. Necessary actions taken by Insurance Clerk
Task
3. If it is not proper call Sub-routine 1a
4. If it is proper, then send report to in-house doctor
Post Condition Action taken on comment received/Notification sent to claimant
Extends If customer doesnot take any action within time, system rejects claim
1a. If it is not proper then system generates a notification and send it to
Includes
claimant to take necessary actions
Data Claim form and reports
There should be standard time taken by insurance clerk to take any action
Business Rules
on comments received
Response time<3 sec, Should work on all operating systems, Work with 32
bit and 64 bit configuration, Mobile friendly, Scalability to 10000 users at
a time, User Interface should be easy to understand, Availability-
Non Functional
7X24X365, Should work on windows/linux, Code should be written in
Requirements
modular form, Only valid users should be able to access/site should be
hackproof/peak time for the application is between 10 am to 10 PM,
Interface should be user friendly, Hassle free movement between tabs

Name Reports Verification

ID ID-08
Actor In house Doctor
Pre-Condition Report iverified by insurance Clerk
1. Reports received and verified
Task 2. If found Ok, pass it to In-house doctor team
3. If it is not proper call Sub-routine 1a
Post Condition Reports passed to team/Notification sent to claimant
Extends If customer does not take any action within time, system rejects claim

17
 1a. If it is not proper then system generates a notification and send it to
Includes
claimant to take necessary actions
Data Claim form and reports
A time window has to be specified as per the industry standards for the
Business Rules
approval of the documents by the in-house team
Response time<3 sec, Should work on all operating systems, Work with 32
bit and 64 bit configuration, Mobile friendly, Scalability to 10000 users at
a time, User Interface should be easy to understand, Availability-
Non Functional
7X24X365, Should work on windows/linux, Code should be written in
Requirements
modular form, Only valid users should be able to access/site should be
hackproof/peak time for the application is between 10 am to 10 PM,
Interface should be user friendly, Hassle free movement between tabs

Name Contact Concerned Hospital

ID ID-09
Actor In house Doctor team
Pre-Condition Report verified by Inhouse doctor and found ok
1. Contact Concerned Hospital
Task 2. If clarification Ok, claim is passed to manager
3. If it is not proper call Sub-routine 1a
Post Condition Reports passed to team/Notification sent to claimant
Extends If customer doesnot take any action within time, system rejects claim
1a. If it is not proper then system generates a notification and send it to
Includes
claimant to take necessary actions
Data Claim form and reports
Cross checking of documents with the hospital to be done in specified no.
Business Rules of days as per the agreement between the Insurance company and the
hospital
Response time<3 sec, Should work on all operating systems, Work with 32
bit and 64 bit configuration, Mobile friendly, Scalability to 10000 users at
a time, User Interface should be easy to understand, Availability-
Non Functional
7X24X365, Should work on windows/linux, Code should be written in
Requirements
modular form, Only valid users should be able to access/site should be
hackproof/peak time for the application is between 10 am to 10 PM,
Interface should be user friendly, Hassle free movement between tabs

Name Action taken on Comment received

ID ID-10
Actor In house Doctor
Pre-Condition Received Comment from Manager

18
 1. Comment from manager received
2. Necessary actions taken by Inhouse doctor
Task
3. If it is not proper call Sub-routine 1a
4. If it is proper, then send report to manager
Post Condition Action taken on comment received/Notification sent to claimant
Extends If customer does not take any action within time, system rejects claim
1a. If it is not proper then system generates a notification and send it to
Includes
claimant to take necessary actions
Data Claim form and reports
There should be standard time taken by insurance clerk to take any action
Business Rules
on comments received
Response time<3 sec, Should work on all operating systems, Work with 32
bit and 64 bit configuration, Mobile friendly, Scalability to 10000 users at
a time, User Interface should be easy to understand, Availability-
Non Functional
7X24X365, Should work on windows/linux, Code should be written in
Requirements
modular form, Only valid users should be able to access/site should be
hackproof/peak time for the application is between 10 am to 10 PM,
Interface should be user friendly, Hassle free movement between tabs

Name Claim verification

ID ID-11
Actor Manager
Pre-Condition Reports are clarified by inhouse doctor
1. Approval of Claim
2. If claim is approved, notification is sent to claimant and sent to finance
Task department
3. If it is not approved, comments are sent to inhouse doctor or insurance
clerk
Post Condition Approval of Claim/Notification sent to claimant
Extends
Includes
Data Claim form and reports
Business Rules
Response time<3 sec, Should work on all operating systems, Work with 32
bit and 64 bit configuration, Mobile friendly, Scalability to 10000 users at
Non Functional
a time, User Interface should be easy to understand, Availability-
Requirements
7X24X365, Should work on windows/linux, Code should be written in
modular form, Only valid users should be able to access/site should be

19
 hackproof/peak time for the application is between 10 am to 10 PM,
Interface should be user friendly, Hassle free movement between tabs

Name Payment Inititation

ID ID-12
Actor Finance Department
Pre-Condition Claim is Approved

Task 1. Bank details of Claimant is extracted from data base of web application

Post Condition Bank details extracted

Extends
Includes
Data Bank Details
Business Rules Valid Bank Details
Response time<3 sec, Should work on all operating systems, Work with 32
bit and 64 bit configuration, Mobile friendly, Scalability to 10000 users at
a time, User Interface should be easy to understand, Availability-
Non Functional
7X24X365, Should work on windows/linux, Code should be written in
Requirements
modular form, Only valid users should be able to access/site should be
hackproof/peak time for the application is between 10 am to 10 PM,
Interface should be user friendly, Hassle free movement between tabs

Name Payment
ID ID-13
Actor Finance Department
Pre-Condition Valid Bank Details

1. Bank details of Claimant is extracted from data base of web application

2. Finance manager process payment to customer
Task 3. Update customer account details in the system
4. Claim is closed in the system
5. System sends notification to claimant

20
 1. Notification is sent to the customer regarding successful transaction of
Post Condition payment
2. Amount is credited to the customer's account
1. If after crediting the money, the transaction failed due to some system
inconsistency, system notifiies claimant about it
Extends
2. Suppose if reprocessing the transaction is unsuccessful then they
communicate with the bank
Includes
Data Bank Details, account updation
1. A time window has to be specified as per the industry standard for
processing payments
Business Rules
2. Mode of the payment depending on the amount claimed
3. Valid Bank details
Response time<3 sec, Should work on all operating systems, Work with 32
bit and 64 bit configuration, Mobile friendly, Scalability to 10000 users at
a time, User Interface should be easy to understand, Availability-
Non Functional
7X24X365, Should work on windows/linux, Code should be written in
Requirements
modular form, Only valid users should be able to access/site should be
hackproof/peak time for the application is between 10 am to 10 PM,
Interface should be user friendly, Hassle free movement between tabs

Name Claim Processing

ID CP-001
Claimant, Web Application, Insurance Clerk, Inhouse Doctor, Manager and
Actor
Finance Department
Precondition Claimant should have bought Insurance Claim
1. Claimant logs in and fill details(General info and bank account
details/date) and upload all documents using (CMS-1500)
Tasks 2. Web application generates a claim id for tracking
3.Web application verifies documents by optical charter recognition(if
policy is valid one, expired date)
4. Generates report and send it to Insurance Clerk for verification
5. Insurance Clerk verifies it and sends it to in house doctor
6. In house doctor verifies it
7. In house doctor team calls concerned hospital and verifies it
8. Claim sent to Manager
9. Manager approves it and send it to finance department
10. Finance department extracts bank details of claimant from web
application and send money
11. Web Application sends notification of money sent to claimant
Receipt of money by the claimant/Reports not found ok/necessary actions
Post condition
not taken on time

21
 3b.If necessary action not taken on time, claim rejected
Extension 5b. If necessary action not taken on time, claim rejected
(Extends) 6b. If necessary action not taken on time, claim rejected
10b. If necessary action not taken on time, claim rejected
3a.For any discrepancies in document verification, system generates a
notification and ask claimant to take necessary actions within time
5a. For any discrepancies in document verification, system generates a
notification and ask claimant to take necessary actions within time
Extension 6a. For any discrepancies in document verification, system generates a
(Includes) notification and ask claimant to take necessary actions within time
9a. If not approved, claim is sent to in-house doctor or insurance clerk
10a. If bank details are wrong, system generates a notification and ask
claimant to take necessary actions within time
1. General info(Also date) and bank details are taken from claimant
Data 10. Finance department extracts bank details from web application (Data
Base)
Should have taken a insurance policy, Valid Bank Details, Claim should not
Business rules
be expired, valid claim
Response time<3 sec, Should work on all operating systems, Work with 32
bit and 64 bit configuration, Mobile friendly, Scalability to 10000 users at
a time, User Interface should be easy to understand, Availability-
Non functional
7X24X365, Should work on windows/linux, Code should be written in
requirements
modular form, Only valid users should be able to access/site should be
hackproof/peak time for the application is between 10 am to 10 PM,
Interface should be user friendly, Hassle free movement between tabs

22
6 Prioritization of the Use Cases (In Terms of Criticality – High
medium-Low)

We can evaluate use cases based on four criteria:

Customer priority - Importance of the use case to the business, and the urgency to have its
functionality
Risk- Need to recognize risk early. Managed closely.
Complexity – a measure of difficulty (requirements and development)
Dependencies – Need to know the connections.
Source: “Everything is URGENT – A look at Use Case Prioritization. Oracle.
From: https://blogs.oracle.com/oum/everything-is-urgent-a-look-at-use-case-prioritisation
Also, other probable criteria are:

• Urgency to meet the market needs

• Ease of Deployment

• Ease of Development

• Independence from other requirements

These criteria can lead us to assign criticality of the use case for our prioritization:

ID Name Criticality
ID-01 Login Low
ID-02 Details Update Medium
ID-03 Claim ID Generation Medium
ID-04 Verification of Form High
ID-05 Claimant’s Action Medium
ID-06 Report Verification High
ID-07 Action taken on Comment Received (Clerk) Low
ID-08 Medical Report Verification Medium
ID-09 Contact Concerned Hospital Medium
ID-10 Action taken on Comment Received (Doctor) Low
ID-11 Claim Verification Medium
ID-12 Payment Initiation High
ID-13 Payment Process High
CP-001 Claim Processing High

23
7 User Acceptance Test Scenarios

7.1 Use Case scenarios and the corresponding UAT scenarios

Use case Use case scenario User acceptance test

scenario
Portal Access Successful Portal Access To verify whether the login
Precondition: The user must portal is accessible or not
have logged in to the internet
Unsuccessful portal access

Details Verification User enters the correct log in Checking the log in attributes
details
Precondition: The user must
accessed the portal

User enters wrong log in

details

Filling of Claims form through Unsuccessful form user should not be able so
portal submission submit the form
(CMS-1500)

Successful form submission user is able to submit the

form

24
 Successful attachments user is able to submit
submission attachments

Unsuccessful attachements user not able to submit if

submission attachements are of wrong
format/size

Submission User Submits the Claim Form check the form attributes
and other details

Checking Customer Details Withdrawing of data the portal withdraws the

(In case of existing Claim ID) data associated with the
claims ID

Verification (In case of new Successful Verification of checks form details

Claim ID) details by Web Application
Precondition: 1. The Claim
with a unique ID is generated
at the clerk’s end
2. The Claim has filled all the
details and uploaded all the
documents

25
 Unsucessful Verification of
details by Web Application

Verification of report by clerk Receives the system Insurance Clerk verifies the
generated report report

Verification of claims &
medical Records
Receives the system verified
claim
Precondition: 1. The Claim
approved by the insurance
clerk
2. The Claim has medical
documents attached.
Verify the Medical Records
The In-house team of Doctors
verify the claim received by
the system.
In-house Doctor verifies the
system displayed medical
records with hospital

Claim review & approval Receives the claim The Manager receives the
Precondition: The verified claim from the in-house
and validated claim has been doctors
pushed to manager for
approval
Claim amount limit Checks whether the claims
are within coverage amounts
on the claim policy

26
 Investigation Verification verifies whether the
investigations have been
done in line with company
procedures and approval of
the claim

Inform customer about System Checks the necessary System is able to access the
claims rejection information information

System triggers the email to Information is conveyed to

inform the customer

Failure in Delivery of email System backtracks to get the

due to invalid contact right information
information

System triggers the email to Information is conveyed to

inform after getting valid the customer
information

Approval of Claims Manager accesses the system Manager is able to access the
Application by Manager to check payment and information
customer information
Manager checks the approval Manager accesses the system
limits to check the limits

27
 Manager approves the claim Manager approves the
application

Manager accesses the sytem Manager is able to access the

to check payment and information
customer information
Manager checks the approval Manager accesses the system
limits to check the limits

Preparation of payment Access claim form Finance department Is able

details Precondition: The verified to access the approved claim
and validated claim has been form
pushed to finance manager
for approval

Payment form preparation of payment

details

Verifying of payment details - Retrieve account details user able to check claim
approval of insurance claim details in system

Payment approval Verifies payment details in

the system-approves
payment

Disapproves payment Verifies payment details in

the system- disapproves
payment

28
 Inform customer about System accesses the contact System is able to access the
claims rejection within 2 information information
hours
Information is conveyed Information is conveyed to
the customer within time
limit

In case of failure of delivery System follows above steps

of message

Information is not conveyed Information is not conveyed

to the customer within time
limit

Transfer to customers bank Acess electronic Credit FD is able to access all the
account details approved details of the
electronic credit to the
claimant

Complete electronic bank FD makes the electronic

transfer transfer of the amount to the
customer

29
 Claim transfer updated in Finance Department updates The FD updates the deposit/
system and closure of claim the user account electronic transfer of amount
in the user account

Finance Department Closes Finance department

the Claim Sucessfully closes the claim

Finance Department Closes Finance department fails to

the Claim close the claim

30
 7.2 User Acceptance Test scenarios

44 UAT cases

Test Test Test Test Case Test Steps Execution Steps Expected Result Test Data
Scenari Scenario Case Name Description
o number ID
Portal TS01 TC01 Succesful To verify Step 1 The user opens The broswer opens Website URL
Access Portal Access whether the the browser
Precondition: login portal Step 2 The user enters The Login home page
The user is accessible the Portal URL of the portal is
must have or not loaded on the
logged in to browser
the internet
TC02 Unsuccessful Step 1 The user opens The broswer opens Website URL
portal access the browser
Step 2 The user enters The Login home page
the Portal URL of the portal is not
loaded on the
browser
Details TS02 TC03 User enters Checking the Step 1 system checks if existing user ayush_chhabl
Verifica the correct log in the log in id exists ani
tion log in details attributes
Precondition:
The user
must Step 2 System checks PW correct 12345'
accessed the the PW
portal Step 3 system displays Claims Dashbaord
the Claim's with options to
dashboard Enter/Edit Claim's
Form
TC04 User enters Step 1 System checks if User does not exist ayush-ch
wrong log in the login id does
details not exist
Step 2 System checks PW incorrect 34567'
invalid PW
Step 3 Dashboard is not Does not display
displayed dashboard, error
message
Filling TS03 TC05 Unsuccessful user should Step 1 log in to the Home page is ayush_chhabl
of form not be able portal with valid displayed ani
Claims submission so submit user ID and
form (CMS-1500) the form password
throug Step 2 User clicks on Display CMS-1500 Name: Ayush
h Enter/Edit Form form showing Chhablani; ID:
portal button from the prefilled details : 345676543;
dashboard name, customer ID, Max Claim
Max Claim Amount, Amount: ₹
Bank Details and 50,00,000;
blank fields for Date, Account
Bills, Medical Number: xxx
xxx xxx01 IFSC

31
 records, Actual claim Code: 09876;
amount, and others Address: 987
fghj; Account
Holder Name:
Ayush C

Step 3 System displays CMS-1500 form with Name: Ayush

form with prefilled details Chhablani; ID:
prefilled details 345676543;
Max Claim
Amount: ₹
50,00,000;
Account
Number: xxx
xxx xxx01 IFSC
Code: 09876;
Address: 987
fghj; Account
Holder Name:
Ayush C
Step 4 System allows to CMS-1500 form with Date, Bills,
enter remaining fields to enter Medical
data records,
Actual claim
amount, and
others
Step 5 Click on 'SUBMIT' redirect and check
at the end of mandatory fields
form
Step 6 Display error error message is
meggase and displayed
highlight empty
mandatory field
TC06 Successful user is able Step 1 log in to the Home page is ayush_chhabl
form to submit portal with valid displayed ani
submission the form user ID and
password
Step 2 User clicks on Display CMS-1500 Name: Ayush
Enter/Edit Form form showing Chhablani; ID:
button from the prefilled details : 345676543;
dashboard name, customer ID, Max Claim
Max Claim Amount, Amount: ₹
Bank Details and 50,00,000;
blank fields for Date, Account
Bills, Medical Number: xxx
records, Actual claim xxx xxx01 IFSC
amount, and others Code: 09876;
Address: 987
fghj; Account
Holder Name:
Ayush C

32
 Step 3 System displays CMS-1500 form with Name: Ayush
form with prefilled details Chhablani; ID:
prefilled details 345676543;
Max Claim
Amount: ₹
50,00,000;
Account
Number: xxx
xxx xxx01 IFSC
Code: 09876;
Address: 987
fghj; Account
Holder Name:
Ayush C
Step 4 System allows to CMS-1500 form with Date, Bills,
enter remaining fields to enter Medical
data records,
Actual claim
amount, and
others
Step 5 all fields are filled system is able to
detect and record all
the data
Step 6 Click on 'SUBMIT' system saves data
at the end of and displayed details
form submission
successful message
TS04 TC07 Successful user is able Step 1 Click on present form window
attachement to submit Attachment is closed and new
s submission attachement submission indow for
s button sttachements is
opened
Fields are visible Documents,
where upload option Medical
openes tab with Records
upload options like
camera, computer
etc
Step 2 user attaches Documents uploaded
document images succesfully
in JPEG format
Step 3 System auto- filled details are
saves the form at saved
regular intervals
Step 4 System does not blank fields displayed
save the form
Step 5 Click Submit Message displayed
button showing documents
attached succesfully
TC08 user not Step 1 log in to the Home page is ayush_chhabl
able to portal with valid displayed ani

33
 Unsuccessful submit if user ID and
attachement attachement password
s submission s are of Step 2 click on tab 'Claim separate tab with the
wrong form ' form is opened
format/size Step 3 submit redirect and check
mandatory fields
Step 4 attachment present form window
section is is closed and new
displayed indow for
sttachements is
opened
Step 5 user attaches Fields are visible Documents,
document images where upload option Medical
in JPEG format openes tab with Records
upload options like
camera, computer
etc
Step 6 click submit error to be displayes
if format or size of
uploaded document
is incorrent, else
display documents
successfully submited
Submis TS05 TC09 User Submits check the Step 1 System checks all All details filled.
sion the Claim form required fields Submission
Form attributes are filled Successful
and other
details
TC10 Step 1 System checks all Submission failed.
required fields Displays error
are not filled message
Checki TS06 TC11 Withdrawing the portal Step 1 Check the claim id Claim id is dislplayed 235468
ng of data withdraws Step 2 Match the claim access data bank
Custom the data id with the
er associated existing databank
Details with the step 3 If the claim ID opens the approved
(In case claims ID matches in the tab page, highlighting
of existing data bank new approved forms
existing If the claim ID the approved tab
Claim does not match in page does not
ID) the existing data highlight the new
bank forms
Verifica TS07 TC12 Sucessful checks form Step 1 System verifies Report Generated for
tion (In Verification details form details using Insurance Clerk
case of of details by Optical Character
new Web Recognition
Claim Application Step 2 checks Policy if policy not expire
ID) Precondition: expiry check other details, if
1. The Claim not mail customer
with a that claim rejected

34
 unique ID is Step 3 check Name, age if details not
generated at and other details matching mail
the clerk’s from claim customer for
end resubmission, if not
2. The Claim forward claim to in-
has filled all hiuse team
the details Step 4 System generates Claim ID is generated 123456
and claim ID
uploaded all
the
documents
TC13 Unsucessful Step 1 System does not Notification
Verification verify form details generated for
of details by using Optical customer to edit
Web Character form
Application Recognition
Verifica TS07 TC14 Receives the Insurance Step 1 Insurance Clerk is System dashboard Insurance_Cle
tion of system Clerk verifies able to access the opens up rk
report generated the report system by login
by clerk report Step 2 Report is visible in Reports are displayed Verified
the claims page by the system Report
step 3 Insurance Clerk Reports displayed by
verifies the the system are
Reports corresponding with
the claim
Reports and medical
records are sent to
In-house doctor
Verifica TS08 TC15 Receives the The In-house Step 1 In house Doctor is System dashboard In house
tion of system team of able to access the opens up Doctor_2
claims verified claim Doctors system by login
& Precondition: verify the Step 2 Medical Records Medical records are Medical
medica 1. The Claim claim are visible in the displayed by the Records
l approved by received by claims page system
Record the the system. Step 3 In house Doctor Medical records
s insurance verifies the displayed by the
clerk medical records system are
2. The Claim corresponding with
has medical the claim
documents
attached.
TC16 Verify the In-house Step 1 Checks the claim Hospital name is In house
Medical Doctor with the hospital shown in the system Doctor_2
Records verifies the displayed reports
system Step 2 Checks the Hospital authority in
displayed authencity the system matches
medical with confirming
records with person which
hospital inhouse doctor
contacts
Step 3 Claim is verified Medical records in Medical
the system match Records

35
 with the hospitals
records
Step 4 Claim is not Medical records in
verified the system do not
match with the
hospitals records
Reject button
displayed by the
system
Step 5 Verified claim is Approval button is
forwarded visible in system and
forwarded to
manager by in-house
doctor
Claim TS09 TC17 Receives the The Step 1 Manager is able System dashboard Claim Record
review claim Manager to access the opens up
& Precondition: receives the system by login
approv The verified claim from Step 2 Claim is verified Approved status in
al and validated the in-house by the in-house the system
claim has doctors doctor
been pushed Step 3 Manager goes to System displays the
to manager claim policy next button
for approval details page
TS10 TC18 Claim Checks Step 1 Manager sees the System dashboard Claim Record
amount limit whether the policy claim opens up displaying
claims are amount details the maximum claim
within amount in the policy
coverage Step 2 Clicks on Claim Page gets routed the
amounts on Tab the claim tab
the claim Step 3 Click on user Page displays the
policy account details claim amount being
asked by the
customer
Step 4 Manager cannot Comments section is
match the system displayed by the
displayed amount system
and policy
amount
Step 5 Manager matches System displays the
the system next button
displayed amount
and policy
amount
TS11 TC19 Investigation verifies Step 1 Manager sees the System dashboard Claim Record
Verification whether the claim page opens up
investigation Step 2 Manager sees the System displays the
s have been investigations are investigation details
done in line within company
with procedures
company Step 3 Manager sees the Comments section is
procedures investigations are displayed by the
and not within system

36
 approval of company
the claim procedures
Step 4 Approval of the Approval button is
claim visible in system and
forwarded to finance
department by
manager
Inform TS12 TC20 System System is Step 1 System checks for Contact Details field FD_11
custom Checks the able to the contact of the respective
er necessary access the information of Customer Id is read
about information information the customer
claims Step 2 System rechecks Reason for rejection
rejectio the reason for field contains
n rejection information is
checked
TC21 System Information Step 1 System goes to New window with an
triggers the is conveyed generate email auto generated email
email to to the tab and sends opens and the email
inform customer sent message pops
up
TS13 TC22 Failure in System Step 1 Email does not Dialogue box appears
Delivery of backtracks get delivered that the message
email due to to get the delivery to the
invalid right recipient failed
contact information Step 2 The Clerk gets A notification is
information notified created in the User
Tab- Recipent
information invalid
Step 3 Clerk takes action Once the notification
by informing the tab is opened, a filed
call center appears - start follow
up through call
center
Step 4 Call center gets Call center gets a
notified notification in user
tab - Start follow up
which is further done
maually
Step 5 Callcenter Update information
updates the tab is opened
correct
information
TS14 TC23 System Information Step 1 System detects System generates the
triggers the is conveyed the new update email again and
email to to the and shoots the sends to the new
inform after customer email email address
getting valid
information
Approv TS15 TC24 Manager Manager is Step 1 Accesses the Payment details form FD_12
al of accesses the able to system to check is displayed
Claims sytem to access the payment details
Applica check information form

37
tion by TC25 payment and Step 1 Acesses the Customer Id and
Manag customer sytem to verify payment information
er information the Customer Id is displayed
and payment
details
TC26 Manager Manager Step 1 Checks the limit Selects next in case
checks the accesses the of payment of amount within
approval system to limit
limits check the
limits

TC27 Manager Manager Step 1 Approvesthe Clicks approves

approves the approves application
claim the
application
TS16 TC28 Manager Manager is Step 1 Accesses the Payment details form
accesses the able to system to check is displayed
sytem to access the payment details
check information form
TC29 payment and Step 2 Acesses the Customer Id and
customer sytem to verify payment information
information the Customer Id is displayed
and payment
details
TS17 TC30 Manager Manager Step 1 Checks the limit If within limits
checks the accesses the of payment approves it
approval system to
limits check the
limits
Step 2 Approves the Application is
application approved
Prepar TS18 TC31 Access claim Finance Step 1 FD is able to acess System dashboard Finance_123
ation of form department the system by opens up
payme Precondition: Is able to login
nt The verified acess the Step 2 click on the opens the claim 1234567
details and validated approved Claims icon page.
claim has claim form Step 3 click on the opens the approved Claim Record
been pushed Approved claim tab page, highlighting
to finance tab new approved forms
manager for the approved tab
approval page does not
highlight the new
forms
Step 4 click on view opens up the
claim approved claim with
all claim details
mentioned
TS19 TC32 Payment prepration Step 1 FD is able to acess System dashboard Finance_123
form of payment the system by opens up
details login

38
 Step 2 click on payment opens payment form 1234567
form subsection tab, highlighting
incompleted form
Step 3 click on a payment from opens
payment form up
Step 4 fill all mandatory manual entries/
field autofill option
Step 5 click complete if all details are
once all details entered te form gets
are entered send to manager
Step 6 if manadatory fieds
are empty, they are
highlighted
Verifyin TS20 TC33 Reterive user able to Step 1 accesses the Details of claim Name: Ayush
g of account check claim system to find should be displayed Chhablani; ID:
payme details details in claim details 345676543;
nt system through claim ID Max Claim
details Amount: ₹
- 50,00,000;
approv Account
al of Number: xxx
insuran xxx xxx01 IFSC
ce Code: 09876;
claim Address: 987
fghj; Account
Holder Name:
Ayush C
Step 2 verifies all the manual check
details
Step 3 verifies the claim verifies the claim
amount amount sanctioned
sanctioned
Step 4 select 'Proceed' page should move to
payment aproval
portal
TS21 TC34 Payment Verifies Step 1 accesses the Details of claim
approval payment system to find should be desplayed
details in the claim details
system- through claim ID
approves Step 2 verifies Bank verifies bank details
payment details provided
in claim form
Step 3 selects 'APPROVE' page closes with
message 'payment
approved'- message
goes to finance
department to
proceed with
payment
TS22 TC35 Disapproves Verifies Step 1 accesses the Details of claim manager_123
payment payment system to find should be desplayed

39
 details in the claim details
system- through claim ID
disapproves Step 2 verifies Bank verifies bank details 1234567
payment details provided
in claim form
Step 3 selects page closes with
'DISAPPROVE' message 'payment
rejected'- message
goes to finance
department to
rework payment
details
Inform TS23 TC36 System System is Step 1 System checks Customer FD_13
custom accesses the able to the contact information is read
er contact access the information
about information information Step 2 Systems checks Reason for rejection
claims the reason for field is checked
rejectio rejection
n TS24 TC37 Information Information Step 1 Email is triggered In case of above two
within is conveyed is conveyed immediately steps being done,
2 hours to the email is sent
customer immediately i.e
within time within 2 hours
limit
TS25 TC38 Incase of System Step 1 System follows Receives an email ,
failure of follows the above steps message delivery
delivery of above steps sent
message
TC39 Information Information Step 2 Information does Information does not
is not is not not get conveyed get conveyed within
conveyed conveyed to within 2 hours 2 hours
the
customer
within time
limit
Transfe TS26 TC40 Acess FD is able to Step 1 FD is able to acess System dashboard Finance_123
r to electronic to access all the system by opens up
custom Credit details the login
ers approved Step 2 Clicks on the transfer payment tab 1234567
bank details of transfer payment opens up
accoun the subsection
t electronic Step 3 Cllick on the pop-up shows all
credit to the pending tab approved payment
claimant details form, that are
yet to be completed
Step 4 click on a pay all details pertaining
ment detail form to electronic transfer
are available
Pop-up show claim
details do not appear

40
 TS27 TC41 Complete FD makes Step 1 FD is able to acess System dashboard Finance_123
electronic the the system by opens up
bank transfer electronic login
transfer of Step 2 Clicks on the transfer payment tab 1234567
the amount transfer payment opens up
to the subsection
customer Step 3 Cllick on the pop-up shows all
pending tab approved payment
details form, that are
yet to be completed
Step 4 click on a pay all details pertaining
ment detail form to electronic transfer
are available
Pop-up show claim
details do not appear
Step 5 Click on make New netbanking
Electronic window opens up
transfer button dashboard shows up
Step 6 Account ID & Pin details manually
code needs to be entered, if no details
filled entered than
highlight
If no details entered
and deosnt highlight
Step 7 Click make Payment is made,
payment and rerouted to the
payment summary
page
If details are wrong
error message
appears
Claim TS28 TC42 Finance The FD Step 1 FD is able to acess System dashboard Finance_123
transfe Department updates the the system by opens up
r updates the deposite/ login
update user account electronic Step 2 Hover mouse Drop down displaying 1234567
d in transfer of over payment option appear
system amount in Step 3 sub-section No drop down is
and the user shown
closure account Step 4 click on payment Routes to payment
of summary option summary page
claim Step 5 Click on payment pop-up shows the
form payment summary
form
pop-up fails to show
summary form
Step 6 click on update pop-up shows the
user account users system account
details being updated with
the same amount
If the amount
updated in user

41
 account does'nt
match
TS29 TC43 Finance Finance Step 1 FD is able to acess System dashboard Finance_123
Department department the system by opens up
Closes the Sucessfully login
Claim closes the Step 2 Clicks on Claim Page gets routed the 1234567
claim Tab the claim tab
Step 3 clicks on partiular Pop-up shows the
claim form entire claim summary
with all completed
task checked by
system
Step 4 Clicks on Close the system is
Claim Option updated and the
claim is Closed
TS30 TC44 Finance Finance Step 1 FD is able to acess System dashboard Finance_123
Department department the system by opens up
Closes the fails to close login
Claim the claim Step 2 Clicks on Claim Page gets routed the 1234567
Tab the claim tab
Step 3 clicks on partiular Pop-up shows the
claim form entire claim summary
with all task are NOT
checked by system
Step 4 Clicks on Close System displays error
Claim Option saying"All tasks are
not complete" ,
highlighting the field
that are not checked
by system

42
8 Data Flow Diagrams

8.1 Context Diagram

43
8.2 Level 0 Data flow diagram (Logical DFD)

44
9 User Interface Design

9.1 Landing Page

45
9.2 CMS-1500 Online Form

46
9.3 Admin Dashboard

47
48
10 Blockchain Implementation in Insurance (An introduction)

From an insured’s perspective, industry use of blockchain may enhance the customer experience,
improve affordability, provide a means for greater product innovation and allow for faster entry
into emerging markets. From an insurer’s perspective, use of blockchain may lower costs, ease
data retrieval, simplify processes, offer new products, combat fraud and lower regulatory
burdens.

Claims Processing through Blockchain

49
As we have identified earlier that the Verification process is the key at different stages and
different stakeholders are involved for this verification. the power of blockchain lies in cutting
out the middleman. With so much personal data at stake, the insurance industry is currently
bogged down by countless checks and rechecks. When all that information is on a blockchain,
virtually all those checks can be dispensed with. Information is trusted and can flow directly from
one party to the other. The savings in both time and money are astronomical.

50