Defining Business Requirements

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 Be able to have a common vocabulary for the
participating team members
 Speed up the process to define a comprehensive set of
business requirements
 Ensure that there is completeness of requirements
 Ensure that all external stakeholders to be involved in
the process are properly identified

 “Panorama 360 is a reference framework that has been integrated at La Capitale General
Insurance and its subsidiaries for over 8 years, both in our projects, architectural approaches and
various analyses.
 Whether it is used to organize and analyze business processes, prepare projects, perform
requirements modeling or for our ROI activities, this reference framework provides a reliable
source of information. The richness found in Panorama 360 is based on the fact that the 500
documented business functions are focused on the insurance industry.
 Now integrated into our business activities, the Panorama 360 insurance reference framework
ensures greater velocity and more particularly in validating that all business areas and services in
our companies are addressed. Used in concert with our official project management, architecture
and business analysis methodologies, Panorama 360 ensures consistency in our practices,
offering a value proposition centered on business.”
Constance Lemieux, C.Dir., President and Chief Operating Officer
Property and Casualty Insurance Sector of La Capitale

Enterprise Business
Architecture
Panorama 360
Enterprise Model
The LEGO TM blocks of the industry
11
Domains
75+ Major Capabilities
500+ Business Functions/Capabilities
Enterprise/Application Architecture Framework

Fonctional Information Model
The Industry LEGO TM Blocks
Business Domains
Major Capabilities
Business Functions/Capabilities
Information Domains
Information Subjects
Information Topics
Processes

In
scope
Integr
ation

Manage
Distribution
Channel
Manage
Service
Providers
Manage
Collectibles
and Payables
Manage
Human
Resources
Administer
Contracts
Manage
Claims
/Benefits
Service
Customers

Example of Stakeholder Integration showing in and out flow of information
1. Claimants
 From Claims to Claimants:
◦ Acknowledgement of claim receipt
◦ Explanation of the claim process and roles and responsibilities of claimant
◦ Request information –explanation of forms that need to be completed
◦ Forms that claimant may need to complete
◦ Status of claim
◦ Contract interpretation to enhance claimant's understanding of a Claims decision
◦ Notification of decline/acceptance when a Claims decision is made
◦ Correspondence in reply to questions raised by claimant
◦ Confidentiality notices to explain to claimant how the personal information provided to Claims will be treated
◦ Any follow up with claimant regarding outstanding requests

 From Claimants to Claims:
◦ Notice of disability (paper, call, fax, email, …) which will initiate the Claims process
◦ Completed forms which are required to prove disability as per the contractual definition

In scope
Integrate
with

6.4.3 Assign Benefit Request
Benefit requests can be assigned to internal or external experts according to workload, request type,
expertise level and severity of potential request. The required skills by the experts to handle certain
types of losses would also be taken into consideration. The request can be handled by one or more
experts and may need to be accessed and updated by all or have restricted access based on the
confidentiality of the information.
6.4.6 Confirm Eligibility
Benefits requests are payable only if the contract stipulates that they are. Verifying that the contract
contains the clauses related to the claimed benefits is key being moving forward with the requests.

Benefit requests can be assigned to internal or
external experts according to workload, request type,
expertise level and severity of potential request. The
required skills by the experts to handle certain types
of losses would also be taken into consideration. The
request can be handled by one or more experts and
may need to be accessed and updated by all or have
restricted access based on the confidentiality of the
information.
The activities are:
• Confirm location
• Confirm availability
• Confirm expertise level
• Confirm language required
• Confirm current workload
• Match current workload with expected workload
• Assign benefit request
• If assigned to robots, ensure knowledge required is
available
6.4.4 Complete Forms
Forms need to be completed depending on the type of
benefit requests. These forms could be related to
professional verifications, servicing invoices, or others
documents to justify the requested amounts or to
release the company’s liability.
The activities are:
• Complete all the forms requested to assess the
situation and to bring the benefit request to the
desired result.

Benefit requests can be assigned to internal or external experts according to workload, request type,
expertise level and severity of potential request. The required skills by the experts to handle certain types
of losses would also be taken into consideration. The request can be handled by one or more experts and
may need to be accessed and updated by all or have restricted access based on the confidentiality of the
information.
The activities are:
• Confirm location
• Confirm availability
• Confirm expertise level
• Confirm language required
• Confirm current workload
• Match current workload with expected workload
• Assign benefit request
• If assigned to robots, ensure knowledge required is available
GREEN: Automated
YELLOW: Not Required
RED: Manual

Assign Benefit Request (6.4.3)
Definition: Based on location, availability, expertise and workload, benefit request is assigned to the most appropriate HCMS.
 Business Triggers
◦ Confirm Eligibility
◦ Active benefit request
 Activities
◦ Confirm location
◦ Confirm availability
◦ Confirm expertise level
◦ Confirm current workloads
◦ Match current workload with expected workload
◦ Assign benefit request
 Services Performed by
◦ Technology will assign automatically (best practice)
◦ Manual dispatch may occur if no one is qualified for this benefit request
 Information Referenced
◦ Human resource management (11.1.2 Maintain Human Resources, 11.1.4 Manage Productivity, 11.1.6 Provide Education & Training)
◦ Active benefit request file
◦ Assignment rules (10.1.7 Maintain Process Rules)
 Information Managed
◦ Assignment allocation
 Triggered Services
◦ Provide & Collect Information
◦ Close Benefit Request
What are your rules
and algoritms?

 Be able to have a common vocabulary for the participating team
members
 Speed up the process to define a comprehensive set of business
requirements
 Ensure that there is completeness of requirements
 Ensure that all external stakeholders to be involved in the process
are properly identified
All Panorama 360 frameworks, models can be imported on any
modeling tool
Panorama 360 is affordable and of great value immediately.
Ask us at Pierre.Gagne@InsuranceFrameworks.com.

or
Pierre.Gagne@InsuranceFrameworks.com
Any Questions?

Defining Business Requirements

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