This section is intended for insurance personnel reviewing reports on submitted claims.

You must have a solid working knowledge of Oracle Business Activity Monitoring (BAM) before creating or editing the Oracle Insurance Claim Management (ICM) dashboards and reports. For information on creating and editing Oracle BAM reports, see "Creating and Managing Reports," in Oracle Fusion Middleware User's Guide for Oracle Business Activity Monitoring.

This section covers the Oracle BAM dashboards and reports delivered with Oracle ICM. Oracle Insurance Claim Management includes two dashboards, ICM Operational Dashboard, and ICM Performance Dashboard, with twelve views. These views use information from the claims submitted in Oracle ICM. Information from saved claims is not used in the views.

ICM Operational Dashboard

The ICM Operational Dashboard consists of eight views. The first four are listed under Today's Activities report. These display the number of new claims, declined claims, paid claims, and amount paid out on a claim. The remaining views provide information on open claims. The following provides an explanation and a sample image of the views.

Today's Activities

New Claims

The New Claims view is a collapsed list that displays the number of new claims created within the day.

Declined Claims

The Declined Claims view is a collapsed list that shows the number of claims that went to a Closed status with a Declined close reason within the day.

Paid Claims

The Paid Claims view is a collapsed list that displays the number of claims that went to a Closed status with a Paid closed reason within the day.

Amount Paid

The Amount Paid view is a collapsed list that displays the total dollar amount paid out on claims that went to a Closed status with a Paid close reason within the day.

Open Claim by Status

The Open Claim by Status view is a 3D bar chart summarizing the number of claims by status on the X-axis. The statuses vary based on what is set up in Oracle ICM. The total number of claims appears on top of each bar. The Y-axis shows the total number of claims in increments of two, from zero to infinity.

Open Claims by Loss Type

The Open Claims by Loss Type view is a 3D pie chart summarizing the number of claims by loss type. The loss types vary depending on what is set up in Oracle ICM. Each slice displays the number of claims for that slice.

Participant Workload

The Participant Workload view is a collapsed list summarizing the total number of claims by role.

Alerts

Alerts is an updating ordered list view that displays alert messages when a claim has been open for more than 30 days, or when a claim has a fraud likelihood of 90% or higher. The left column displays the alert message. The right column specifies the time the alert was received.

ICM Performance Dashboard

The ICM Performance Dashboard consists of four views pertaining to the historical analysis of processed claims. You can filter the views using the report parameters Period and Line of Business. The following provides an explanation and a sample image of the views.

Average Resolution Time

The Average Resolution Time is a 3D bar chart summarizing the average time it takes to resolve a claim. The X-axis displays the time period by year and quarter for the resolution. The average resolution time is displayed on the top of the bar. The Y-axis displays the number of days to resolve the claim from zero to infinity. You can click a bar to see the details.

New to Closed Claims Comparison

The New to Closed Claims Comparison view is a 3D bar chart summarizing the number of new claims to closed claims. The X-axis displays the time period by year and quarter for new and closed claims. The Y-axis displays the number of claims from zero to infinity, in increments of five.

Total Payments

The Total Payments view is a line chart summarizing the total payments paid out on claims for a period of time. The X-axis displays the time period by year and quarter. The Y-axis displays the payment amount in dollars from zero to infinity. You can click a bar to see the details.

Fraudulent Claims

The Fraudulent Claims view is a line chart summarizing the percentage of fraudulent claims for a period of time. The X-axis displays the time period by year and quarter. The Y-axis displays the percentage of fraud from zero to 100 percent.