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United States Patent - Google Compute Engine



(12)   United States Patent                                                                          (10) Patent N0.:               US 6,862,573 B2
       Kendall et al.                                                                                (45) Date of Patent:                           Mar. 1, 2005

(54)    AUTOMATED TRANSACTION                                                                       2002/0032636 A1 *   3/2002   Shields et a1. .............. .. 705/37
        MANAGEMENT SYSTEM AND METHOD                                                                2002/0059107 A1 *   5/2002 Reich et a1.                      705/26
                                                                                                    2002/0082881 A1 * 6/2002     Price et a1. .................. .. 705/7
                                                                                                    2002/0161620 A1 * 10/2002    Hatanaka et a1. ........... .. 705/10
(75) Inventors: John Kendall, Boulder, CO (US);
                                                                                                    2003/0018555 A1 *   1/2003 Callan et a1.                     705/35
                Chris Phillips, Longmont, CO (US)                                                   2003/0046665 A1 *   3/2003   Ilin ............... ..     .. 717/126
                                                                                                    2003/0167219 A1 *   9/2003 Quraishi et a1.                   705/36
(73) Assignee: Clear Technology, Inc., Westminster,                                                 2003/0208684 A1 * 11/2003    Camacho et a1. ......... .. 713/186
                       CO (US)
                                                                                                             FOREIGN PATENT DOCUMENTS
(*)     Notice:        Subject to any disclaimer, the term of this
                                                                                              W0             WO 94/29804         * 12/1994        ......... .. G06F/15/21
                       patent is extended or adjusted under 35
                       U.S.C. 154(b) by 688 days.                                                                 OTHER PUBLICATIONS
                                                                                               Leite et al., “Business Rules as Organizational Policies”,
(21) Appl. No.: 09/815,143                                                                     1998 IEEE.*
(22) Filed:            Mar. 22, 2001                                                           * cited by examiner
(65)                   Prior Publication Data                                                 Primary Examiner—James P. Trammell
        US 2002/0138449 A1 Sep. 26, 2002                                                      Assistant Examiner—Jalatee Worj loh
                                                                                              (74) Attorney, Agent, or Firm—Reed Smith LLP; Harry K.
(51)    Int. Cl.7 .............................................. .. G06F 17/60                Ahn
(52)    US. Cl. .................... .. 705/7; 705/8; 705/9; 705/10
(58)    Field of Search ...................................... .. 705/8—10                     (57)                     ABSTRACT
                                                                                              An automated knowledge dependent transaction manage
(56)                        References Cited                                                   ment system for processing both the front-end and back-end
                   U.S. PATENT DOCUMENTS                                                       of a transaction is provided. The system contains hard-coded
                                                                                               transaction management module to support the processing of
       5,216,592 A           6/1993       Mann et al.                                          deterministic manual Work independent of the speci?c trans
       5,235,507 A           8/1993       Sackler et a1.                                       actions. According to the invention, the hard-coded module
       5,530,861 A           6/1996       Diamant et a1.
       5,535,322   A         7/1996       Hecht
                                                                                               is separated from the business logic that comprise the
       5,630,069   A         5/1997       Flores et a1.                                        de?nition and con?guration of the transaction speci?c data
       5,764,923   A         6/1998       Tallman et a1.                                       models, business rules and process steps Which drive the
       5,870,711   A         2/1999       Huffman                                              manual Work of human operators. Such separation of code
       5,893,911 A      *    4/1999       Piskiel et al. ............... .. 707/10             and business logic alloWs any ordinary business adminis
       5,930,759 A           7/1999 Moore et a1.                                               trator Without any computer programming experience to
       5,950,169 A           9/1999 Borghesi et a1.                                            quickly develop the business logic through a simple GUI.
       5,999,911 A          12/1999 Berg et a1.                                                Further, any change in the business logic can be imple
       6,003,011   A        12/1999       Sarin et al.                                         mented quickly using the GUI by the ordinary administrator
       6,041,306   A         3/2000       Du et al.
       6,058,413   A         5/2000       Flores et a1.
                                                                                               to accommodate changes in the business environment With
       6,151,583   A        11/2000       Ohmura et a1.                                        out relying on computer programmers.
     6,230,201 B1 *          5/2001 Guck et al. ............... .. 709/228
 2002/0016761 A1 *           2/2002 Foster et al. ................ .. 705/37                                   34 Claims, 10 Drawing Sheets

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U.S. Patent   Mar. 1,2005   Sheet 1 0f 10   US 6,862,573 B2
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                              1                                                                     2
         AUTOMATED TRANSACTION                                        management system for processing both the front-end and
      MANAGEMENT SYSTEM AND METHOD                                    back-end of a transaction to reduce human error, reduce
                                                                      labor costs and alloW Web-enablement of business transac
              FIELD OF THE INVENTION                                  tions. An exemplary system includes a storage device that
                                                                      stores data of a customer transaction, business rules and
  The present invention relates to data processing systems,           business process steps. Each business rule has one or more
and in particular to automated transaction management
                                                                      deterministic outcomes based on evaluation of the stored
                                                                      data. The system also includes a transaction management
           BACKGROUND INFORMATION                                     module that collects as part of the front-end transaction the
  Over the years, huge resources Were committed to devel         10   next data of the customer transaction that depends on the
oping rule-based technologies, ranging from stand alone               deterministic outcomes of the business rules associated With
inference engines and expert systems to development tools             the data already collected. The transaction module further
that alloWed programmers to program business rules and                processes the back-end of the customer transaction by
processes into the existing system environments. These                executing the tasks of the business process steps. The next
efforts included development of sophisticated Work?oW and        15   business process step to be executed depends on the execu
routing applications, customer relationship management                tion result of a current business process step.
(CRM) and enterprise resource planning (ERP) systems for                 As can be appreciated, because the transaction manage
automating portions of business transactions. Moreover,               ment system automates and integrates both the front-end and
many companies have developed proprietary applications                the back-end processing, and the business rules have non
based on hard-coded rules and process con?gurations.                  inferential deterministic outcomes, the present invention
   Despite these automation efforts, many front and back              processes transactions ef?ciently and substantially decreases
of?ce operations to process complex transactions in the               the number of potential errors, resulting in substantial sav
services industry still rely greatly on human operators Work          ings for the businesses.
ing With legacy systems. Manual Work processes that have
these same generic characteristics exist in the insurance        25         BRIEF DESCRIPTION OF THE DRAWINGS
industry (including policy underWriting and issuance and
customer service), the telecommunications industry (service             FIG. 1 is a functional block diagram of an automated
provisioning, contract and billing administration), the gov           transaction management system according to an exemplary
ernment (Social Security Bene?ts administration, Medicare             embodiment of the present invention.
and Medicaid eligibility and compliance), the utilities indus            FIG. 2 illustrates a conceptual frameWork of the present
tries (service provisioning and product bundling) or the like.        invention.
Even the neW economy Internet companies such as                          FIG. 3 illustrates a detailed diagram of various functional,, and are building                 components of an exemplary softWare architecture of the
people-intensive service infrastructures to manually handle           present invention.
complex service transactions.                                    35     FIG. 4 is a table shoWing the components of FIG. 3 that
  For example, to process automobile accident claims, an              are included in each module of FIG. 2.
auto insurer relies on a large number of both the call center
                                                                         FIG. 5 illustrates an example of a graphical display of data
agents in the front of?ce and claims management staff in the          collection rule packages of the present invention.
back of?ce to take initial notice of loss details, establish a
claims case ?le, generate data requests from various third       40      FIG. 6 illustrates an example of an element rule package
parties, notify repairers and assessors, communicate With             of the present invention.
policyholders, Wait for data inputs and outputs in both paper            FIG. 7 is an example How diagram of a process according
and electronic format and eventually hand the case over to            to the present invention.
experienced claims adjusters for resolution.                             FIG. 8 is another example How diagram of a process
  These agents must become skilled at navigating multiple,       45   according to the present invention.
divergent legacy claims and policy administration systems.              FIG. 9 is an exemplary screen shot of a scenario builder
They must learn and apply complex business rules and                  according to the present invention.
processes outside of these systems Which are frequently                 FIG. 10 is an exemplary screen shot of a rule builder
changing, handle in?nite combinations and permutations of             according to the present invention.
incident types and knoW their employer’s many product and
bene?t entitlements intimately. And While managing these                         DETAILED DESCRIPTION OF THE
complex knoWledge matrices, they must also remain tuned                                   INVENTION
in to the needs of the policyholder Who is usually distressed
and Wants clear af?rmation and con?dence in the resolution               The manual Work performed by human operators in
of their claim. At each step in the manual processing of these   55   conjunction With legacy administration systems can be
claims there is an opportunity for human error. Each error            delineated into deterministic knoWledge Work Where there
exposes the insurer to substantial losses, and the unneces            are clear consistent conclusions, and inferential knoWledge
sary additional administration costs that result from the             Work Where the conclusions may differ depending on the
reWork required to resolve the error, not to mention the              judgments made by the operators. The present invention
frustration of the policy holder.                                     focuses on the rapid automation of manual Work that is
   Therefore, it can be appreciated that there is a signi?cant        based predominantly on deterministic knoWledge.
need for an improved system and method for automating                   Deterministic knoWledge dependent transactions (KDTs’)
such manual processes in processing business transactions.            are transactions that form the basis of the majority of manual
                                                                      Work in industries, and in particular, service industries.
            SUMMARY OF THE INVENTION                             65   These KDTs’ rely on appropriate application of various
   According to the principles of the present invention, there        business rules, case speci?c collection of prede?ned data
is provided an automated knoWledge dependent transaction              sets and execution of prede?ned processes for accurate
                                                   US 6,862,573 B2
                             3                                                                     4
resolution. Typically, the business rules, data and processes          The system 100 includes, for example, memory storage
in KDTs’ change constantly from time to time. Examples of            104, processor (CPU) 106, program storage 108, and data
KDTs’ include insurance claims, customer service, insur              storage 110, all commonly connected to each other through
ance policy underwriting, telecommunications provisioning,           a bus 112. The program storage 108 stores, among others, a
e-tailing customer service and problem resolution, Social            transaction management program or module 114. Any of the
Security bene?t administration and eligibility, or the like.         software program modules in the program storage 108 and
   At the front end, the present transaction management              data from the data storage 110 are transferred to the memory
system uses tightly integrated rule processing and process           104 as needed and is executed by the processor 106. The
control to deliver the transaction speci?c data set needed to        system 100 can be any computer such as a WINDOWS
process a KDT. This replicates the work that a human            10   based or UNIX-based personal computer, server, worksta
operator undertakes in the data collection phase of manual           tion or a mainframe, or a combination thereof. While the
service work. The transaction management system then                 system 100 is illustrated as a single computer unit for
triggers the back end processing by executing process steps          purposes of clarity, persons of ordinary skill in the art will
containing decision rule packages, task rule packages, and           appreciate that the system may comprise a group of com
process rule packages to deliver the business outcome that           puters which can be scaled depending on the processing load
will enable complete resolution and closure of the transac           and database siZe.
tion. The present transaction management system also
enables the back and front end processing to be electroni               FIG. 2 illustrates a conceptual framework of the present
cally integrated into emerging web-based supply chains and           invention. An Industry Domain Knowledge (“Knowledge”)
business exchanges.                                                  22 comprises business processes, data and rules that are used
                                                                     for executing an automated KDT.
   Speci?cally, the system contains the inbuilt, hard-coded,
programmed functionality (“universal transaction automa                The business process includes an automation process
tion framework”) needed to support the common and com                which is a sequence of automation steps to perform KDT
plex requirements of processing deterministic manual work            automation. The different types of automation steps are
independent of the speci?c transaction. The universal trans          organiZed into a logical sequence in which information is
action automation framework (containing programming                  collected, managed, decided upon and acted upon. Aprocess
codes) is separated from the business logic (comprising the          can be con?gured, enabling the business to update the
de?nition and con?guration of the transaction speci?c data           automated KDT processing as quickly as changes in the
models, business rules and process steps) that drives the            business necessitate.
manual work of human operators. One advantage of this                   Data is the second type of Knowledge 22. The data for a
separation of code and business logic is that the business           KDT is divided into three basic types: case data, direct
logic can now be developed through a simple GUI                      business data, and extended business data. The case data is
(graphical user interface) outside of the programming code           the information that is collected and transacted against
by any ordinary business administrator without any com               during KDT automation. Case data is de?ned by a case data
puter programming experience. A further advantage is that       35
                                                                     pro?le, or smart case, which is the structure of the case data,
any change in the business logic can be implemented                  created by logically grouping the data into virtual electronic
quickly using the GUI by the ordinary administrator to               “documents”. Case data pro?les also contain meta-data that
accommodate changes in the business environment without              provides attributes about the data elements beyond simple
relying on computer programmers.                                     structural information. Each type of automation uses this
   Referring now to FIG. 1, a transaction management                 meta data to perform various functions on the case. A data
system 100 of the present invention is an Internet-enabled           collection scenario collects data for multiple documents
application solution framework that automates KDTs’. The             from a single source over a single medium. During a data
system 100 is a multitasking, real-time software technology          collection interaction, users may be provided a script, which
that can simultaneously set up a transaction query, gather           is de?ned in the data collection scenario and assists users
resolution data from internal and external sources, apply            through data collection. The invention uses the transaction
even the most complex client-speci?c business rules to the           resolution logic de?ned during a con?guration and testing
data, and put on hold or complete the transaction while              phase to dynamically create end-user GUI scripts for stream
simultaneously providing the user with continued and unin            lined data collection and customiZed interaction based on the
terrupted visibility of the ongoing automated processing of          source of the data being collected and the type of data being
KDTs.                                                                collected.
   Different from existing sequentially driven automation               The direct business data is information that is resident on
technologies, the transaction management system 100 sig              external business systems and integrated into a case data
ni?cantly reduces the time required to process business              pro?le as a document. Through a data map, data elements in
transactions by eliminating as much manual involvement as            the document are mapped to ?elds on the external business
possible by using deterministic non-inferential rules which     55   system.
can be changed very easily according to changes in the                  The extended business data is information that is required
business environment. At the same time, the system 100               to support KDT automation, but is not directly available and
navigates through numerous transaction gateways error-free           should be supplied and managed as part of the solution. This
with minimal, but controlled human intervention only when            data is de?ned through an extended business data pro?le as
appropriate during the transaction.                                  will be discussed in detail later herein.
  As illustrated in FIG. 1, the transaction management                  Rules, the third type of Knowledge 22, are constructed
system 100 is connected to the Internet through, for                 and applied in a number of different ways throughout the
example, an I/O interface 102, such as for a LAN, WAN,               processing of KDTs’. The rules are made up of conditional
?ber optic or cable link, which receives information from            “if-then-else” statements organiZed into logical packages
and sends information to Internet users and to one or more 65 and are executed together to provide a distinct business
operators using a work station 118. The system is also               bene?t. The rules used in KDT automation provide a deter
connected to existing legacy systems 116.                            ministic package structure whereby each package is capable
                                                      US 6,862,573 B2
                               5                                                                       6
of decision making, action automation or scoring. One                   complex mainframe interactions normally performed by a
example of a rule that results in a decision is “if Estimated           case worker. A task automation step may provide informa
Damage>500 and Liable Party is Insured, Then Set Docu                   tion for a case that is waiting at the case management
ment Required: Repair Estimate”.                                        automation step to be completed.
  The Knowledge 22 comprising data, rules and processes                   The Management Information module in FIG. 2 aggre
as well as the case data for individual transactions including          gates and analyZes case data, transaction history and rule
external data are stored in the data storage 110 in a relational        results to provide detailed and summary information to
database format. Alternatively, the Knowledge can be stored             management, enabling visibility of the end-to-end KDT
in Extensible Markup Language (XML). The advantage of                   automation process. Importantly, it provides the key analysis
storing the data in XML is that such data can be shared            10   data that can be used to drive and constantly improve the
across branch of?ces of a company regardless of what legacy             management of data, rules and processes.
system each branch may employ. For example, rules and                      FIG. 3 illustrates a component based interconnected sys
processes de?ned in one branch of?ce can be shared with                 tem that represents an exemplary software architecture of
another branch that might have a different legacy system                the present invention. The transaction automation program
such that modeling a slightly different type of transaction        15
                                                                        114 is divided into several separate functional modules or
can be done very rapidly since most modeling was done at                systems where each module may be developed indepen
another branch.                                                         dently as a separate system.
  The Knowledge 22 comprising the above data, rules and                   A Data Control System (DCS) supplies services to de?ne
processes is used by a transaction management module 20 of              smart case pro?ling and control data retrieval and storage for
the system to automate the KDT. The transaction manage                  KDT automation, and provides services to de?ne and main
ment module 20 comprises data collection automation 24,                 tain extended business data as well as map the direct
case management 26, decision 28, and task automation 30                 business data to external system requests. Within the Data
modules.                                                                Control System, a DCS builder is a graphical interface that
   The data collection automation module 24 collects the                allows an analyst to enter document pro?les, sections and
correct information during a given interaction with a data              elements that comprise a case pro?le. A DCS Business
source. Business rules determine what data is required for a            Services subsystem provides other systems with the ability
given circumstance and how the information is collected.                to access DCS data without having to know the underlying
The primary goal for the module 24 is to gather and validate            database structure. ADCS Engine controls storage, retrieval
the proper information as ef?ciently as possible based on the           and modi?cations to the case data.
speci?c circumstances of the case.                                        A Rule Processing System (RPS) performs rule process
   The case management automation module 26 tracks and                  ing for the automation modules and provides services to
manages the state of the case—what information is collected             de?ne and maintain rules, analyZe rule results and test new
and what information is still required. Business rules use the          rules. Furthermore, it provides visibility of individual rule
currently available data to decide what, if any, additional        35   execution paths, enabling full graphical viewing of a given
information is required to act on the KDT. If more infor                decision. Within the RPS, a Rule Builder is a primary
mation is required, the “smart case” pro?ling indicates how             graphical interface to create and maintain rules. Rules are
to request the information and how long to wait for the data            presented in a tree structure with True/False results that are
to arrive. Ade?ned automation process controls the order of             easy to follow as will be discussed in detail later herein with
case-state evaluation and request processing.                      40   reference to FIG. 5. Rule packages and result sets, which are
   The case management automation module 26 performs                    also discussed in detail later herein with reference to FIG. 6,
automation in four stages: evaluating the data elements                 are managed graphically as well. A Rule AnalyZer is a
collected, setting up the case for remaining required                   graphical analysis tool that measures previous rule results,
information, issuing requests for missing data elements, and            and provides cross sectional analysis of rule results and
waiting for information to arrive. As new data elements            45   package results.
arrive via data collection, the case is re-evaluated and the              A Rule Engine executes rules for a given activity while a
cycle begins again. Once all of the data elements are                   Rule Business Services interface provides a series of classes
collected for a speci?c decision and action process, a mes              that wrap up multiple database interactions and data manipu
sage is sent for ?nal decision and action execution. If these           lations into single transactions for use by the Rule Builder
data elements are not received within a certain time frame as           and RPS Engine. A Custom Function plug-in interface
determined by the smart case pro?le, additional automated               allows user-de?ned functions that can be used in rule
requests are made or the case is routed for manual interven             conditional expressions.
tion. Once it is determined during case management auto                   A Process Control System (PCS) furnishes services that
mation that a case is complete and all required data elements           control process activity across the automation process
have been captured for a speci?c process, a message is             55   including the ability to execute offline, real-time operations
received to make a decision. Each KDT may have several                  in a controlled sequence. Within the PCS, a Process Builder
de?ned processes that together provide the automation of the            is a graphical interface that is used to de?ne and maintain
necessary business decisions.                                           processes, process steps and step transitions. In one
  The decision automation module 28 uses business rules to              embodiment, it includes a graphical front-end application to
make business decisions while using a process to control the            allow an analyst to crate processes using a ?owcharting tool
order in which decisions are made. Decisions automated                  such as Visio. Each process step and transition can be
during decision automation may provide input information                created or edited using simple mouse clicks. For example, a
to the case for which the case management automation                    transition between two process steps can be created by
module is waiting.                                                      pointing to a source process step and dragging a mouse to a
  The task automation module 30 performs automated                 65   destination process step. At that point, the process builder
processes that replace tasks normally performed manually.               brings up a transition properties screen for de?ning that
For instance, a task automation step may consist of a set of            transition by the user.
                                                     US 6,862,573 B2
                              7                                                                     8
  A PCS Manager is a graphical interface that allows a                 information elements to be displayed in a portion of the case
system administrator to vieW, con?gure and control the                 agent’s display during data collection.
system run-time environment. In addition, it alloWs servers              A Dynamic WindoWs is a primary interface for the data
to be de?ned, process steps to be assigned to servers, threads         collection module 24 in a WindoWs environment. WindoWs
to be de?ned for a process step/server con?guration, and               are dynamically generated based on a case pro?le and
display of number of queued items, active threads and                  collection scenario. Similarly, a Dynamic Web Pages is a
process rate and errors. A PCS Business Services interface             primary interface for the data collection engine in a Web
provides for transactional updates during process de?nition.           environment. Web pages are dynamically generated based
   A PCS Engine controls the How of documents through a                on a case pro?le and collection scenario. Both interfaces use
process and executes process step logic and puts a document       10   an Interface Engine to determine the next page or WindoW
in the next step’s queue. A PCS Daemon monitors process                during data collection either through a live operator or the
step queues and starts process step executions When an                 Internet.
eligible document is selected. A Custom Operation plug-in                 A DIS Business Services subsystem provides for trans
provides the ability to create business speci?c behavior that          actional logic and an interface to DIS data for other systems
is not offered directly by the system 100. An example could       15
                                                                       as needed. A DIS Interface Engine interacts With Rule
be an operation that provides pre-processing of information            Processing and Data Control Systems to determine What
before rules are executed.                                             information should be collected. This determines the “next”
  Still referring to FIG. 3, a Dynamic Interface System                WindoW or page during data collection. A Custom WindoW/
(DIS) provides services for scripted, dynamic end-user inter           Page plug-ins’ enables customiZation for a speci?c look and
actions that are the primary interface for the data collection         feel in both the WindoWs and Web environments, and
automation module 24, and supplies services to de?ne and               overrides generation of dynamic WindoW or page. They
maintain scripts that guide the data collection activity.              facilitates additional functionalities that are not directly
Within the DIS, a Scenario Builder alloWs a business admin             provided by the Dynamic WindoWs and Dynamic Web pages
istrator Who may have no programming knoWledge to                      interfaces.
graphically de?ne case data collection scenarios Which are 25            An External Mapping System (EMS) provides services to
used to provide direct phone call scripting or data entry              de?ne and execute external system requests, mapping input
guidance. A scenario can be used, for example, by a call               and output data for each request. In the EMS, a Service
center and typically de?nes a data collection session for a            Builder de?nes available external system services such as
customer transaction such as What documents or information             “Lookup Member” or “Pay claim”. It maps business struc
should be collected, in What order, hoW should the customer            tures as de?ned in Data Control to the external system
be guided through data collection and What access to the data          requests inputs and outputs and maps system requests to
the customer should have.                                              interface plug-in parameters. An EMS Business Services
   Scenarios can be linked to perform a seamless transition            interface provides for transactional updates during service
from one scenario to another. The target scenario is selected          con?guration. An EMS Engine executes requests to external
according to the data collected so far. Linking is performed           systems by any of the Systems in FIG. 3 and interacts With
by using a decision rule package (rule packages are                    an external system by calling the plug-in de?ned by an EMS
described in detail later herein). A decision rule package is          service. A Custom Interface plug-in provides the ability to
associated With the scenario that is being linked from and             create a custom interface to communicate With an external
each decision from the rule package is associated With a          40
                                                                       system. Examples may be a terminal emulator plug-in that
scenario to be transitioned to. This Way, a single scenario can        performs table driven screen scraping or a simulation plug
transition to any number of other scenarios depending on a             in that simulates any external system request by simply
set of rules de?ned in the rule packages.                              mapping given inputs to knoWn outputs.
   FIG. 9 is an exemplary screen shot of a scenario builder  A Data Extraction System (DES) furnishes services that
that illustrates how any business administrator with no 45 de?ne and extract data vieWs across case data, business data,
programming knoWledge can build scenarios. A scenario                  transaction history and rule-processing results. In the DES,
may comprise chapters, pages, sections and elements. A                 an Extraction Manager is a graphical interface that alloWs a
chapter is a logical grouping of data in a scenario. Each              user to de?ne and maintain extract pro?les and alloWs
chapter includes one or more pages of data. Each page                  extract pro?les to be executed by a user. A DES Business
includes one or more sections and each section includes one            Services provides for transactional updates during extract
or more data elements. In FIG. 9, “TlAccident Report” is a             pro?le de?nition. ADES Engine is a Middle-tier component
chapter, “Page 2” is a page, “Approved Repairer” is a                  that executes extract pro?les, alloWs extracts to be executed
section, and “Approved Repairer Name” and “Specialty” are              from the Execution Manager and alloWs extracts to be
elements.                                                              executed unattended in a “batch” mode. A Custom Data
  As shoWn, the element “Approved Repairer Name” is               55   Domain plug-in interface alloWs custom data domains to be
highlighted. The business administrator creating the sce               de?ned While a Custom Data Export plug-in interface alloWs
nario has set up the scenario such that When an agent is about         custom output formats to be de?ned.
to collect that information, a prompt script of “Do you have             An Enterprise Administration System (EAS) supplies
the name of the repairer you have chosen?” is displayed on             security services for the automation engines and provides a
the agent’s screen.                                                    common audit trail mechanism. It also provides services to
   Tabs in FIG. 9 such as “Search Page” “Transition” and               control administrative system concurrency through a logical
“Info Elements” alloW the business administrator to navigate           access locking mechanism. Within the EAS, a WindoWs
through various parts of the scenario to be built. Brie?y, the         Login interface includes an ActiveX component that con
Search Page tab alloWs the user to set up an initial search            trols the login for each of the program’s user interface
page for locating an existing case. The Transition tab is         65   applications. A Security Manager is a front end application
Where transitions to other scenarios using decision rule               that provides a system administrator With the ability to
packages are de?ned. The Info Elements tab alloWs a set of             maintain users, user groups and to assign security rights to
                                                     US 6,862,573 B2
                              9                                                                       10
groups. An IDK Manager is a graphical interface that                        Element 3: Address Line 1
provides a uniform interface to gain access to “builder”                    Element 4: Address Line 2
components to maintain industry domain knowledge 22.                        Element 5: City
  ASecurity Manager Business Services interface provides                    Element 6: State
for transactional updates during user de?nition and security               Element 7: Zip
maintenance. A Security Engine processes all security                    Section 2: Policy Information
requests While a Promotion Controller is a Middle-tier                     Element 1: Policy Number
component that controls the veri?cation and sequencing of                  Element 2: Policy Name
the promotion of IDK data and structures from a source to                  Element 3: Policy Excess Amount
target Zone. The Promotion Controller uses promotion inter        10     Sections can also be used to include data in a document
face plug-ins to execute a promotion. A Security Import                that originally came from an external system. For instance,
plug-in alloWs SAS to connect to an external security system           if it is necessary to run a rule against information for a
and load user security details. A Login Interface plug-in              customer that is only available on a mainframe, it’s possible
provide the ability to validate a user login and provide login         to retrieve that information from the mainframe, and make
information to the WindoWs Login component. The Promo             15   it a section in the case. This is accomplished by creating a
tion Interface plug-in is an interface that promoter plug-ins          special kind of section for a document, called an External
implement to perform the promotion of data and structure in            Business Section. This type of section uses an EMS Busi
the promoter’s domain. Each of the systems in FIG. 3 should            ness Services to gather its data. Since this type of section is
create a promoter plug-in that implements this interface to            generally used to look data up on an external system, these
be able to promote its data across Zones.                              sections are designed so that they can provide information to
  The various systems in FIG. 3 are shared by the modules              be used to look up the data. This happens by de?ning a
of FIG. 2 as shoWn in FIG. 4. For example, the Rule                    number of input parameters to the EMS Business Services to
Processing System is shared among the Data Collection 24,              be run from other parts of the case. For instance, if an
Case Management Automation 26, Decision Automation 28                  insured’s details on a mainframe need to be looked up, the
                                                                  25   EMS Business Services Would be provided With the
and Management Information modules.
                                                                       insured’s name, address, gender, or What ever information is
                             Data                                      needed to uniquely identify that person on the mainframe.
                                                                       The data that is returned from the mainframe is then mapped
  As a step in con?guring the system, a business user or               into the elements that have been de?ned for that section.
administrator uses a document builder in the Data Control                In one embodiment, the data returned is in a ?at ?le
System to build a case pro?le that de?nes the data to be               format. In another embodiment, the data is in an XML
collected during a transaction. There are tWo types of data:           format for easier manipulation by the system 100 and easier
data used in a rule execution, and data used to complete a             sharing of data across disparate branch of?ces running
transaction.                                                           different legacy systems.
   The case pro?le de?nes a set of data containers that hold      35
all of the data required to process a case. The data containers                                     Rules
include documents, sections, and elements. Documents are                 A rule package is a set of business rules organiZed into
the highest-level containers of information. Documents con             logical groupings that Will be used for data collection by the
tain logically independent sets of data for a case. For                Data Collection System and processing by the Process
example, an accident report from the insured and a third          40
                                                                       Control System for a particular KDT.
party report Would each be documents. Each document type
                                                                         A rule package includes a scope, one or more rules and
(called a document pro?le) can be associated With a process
that Will be performed on the document after it has been               corresponding results, and an outcome. The scope de?nes
collected.                                                             the data available for rules to be de?ned and evaluated
                                                                  45   against. Rules have the folloWing basic structure: If
   Sections are smaller logical containers of information.
They contain sets of data that can be logically grouped
                                                                       (condition) Then (child rules Or valid result) [Else (child
                                                                       rules Or valid result)]. Thus, each rule can have child rules
together, and are generally used to make the data in a                 and each rule package can have dependent rule packages to
document more coherent. For instance, the insured’s per                accommodate complex business scenarios.
sonal information Would be one section of an accident
                                                                         There are tWo different types of rules: standard and
report, While the details of the damage to the car Would be
                                                                       inclusion rules. Each standard rule in the rule set is in the
another. Sections are composed of elements.
                                                                       form of if-then-else format. The standard rules are de?ned as
   Elements are the smallest containers of data. They hold             a condition or set of conditions that evaluate to a true or false
individual pieces of data such as the insured’s name, the date         value based on the speci?c information provided. Based on
of an accident, or the amount charged by a repairer for each           the value determined by the condition(s), the rule de?nition
item in an itemiZed list. Each of these containers can be              should indicate either to evaluate a set of child rules, or
marked as “repetition”. Repetition alloWs multiple instances           provide a result Within the alloWed values of the result set
of the section to be collected for a single instance of a              associated With the rule package in Which the rule is being
document. This feature is used for smaller sets of repeating           de?ned. The inclusion rules alloW one rule package to
data, like the itemiZed list of charges on an invoice.                 simply include the results of another package. An inclusion
  For example, the analyst may con?gure the data With the              rule does not have any conditions, but may be conditionally
folloWing documents, sections, and elements as part of a               included in the results of the rule package if it is a child rule.
case pro?le called Notice of Loss: Auto.                                  Result sets are used to de?ne the possible outcomes of
  Document Pro?le: Policy Details                                      rules and hoW rule packages use those results in reaching an
  Section 1: Subscriber Information                               65 outcome or conclusion for the package. Result sets are
     Element 1: Subscriber Name                                        separate from rule packages to separate the de?nition of
     Element 2: Policy Number                                          possible results from the logic (rules) that determine the
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                              11                                                                       12
results. This provides the ability to control results for               rules are treated equally, all rules are evaluated (regardless
speci?c types of rule packages effectively, as Well as have             of preceding results), and it is the collective set of results that
result sets shared across rule packages.                                are then revieWed by the result set logic to present a
  In the exemplary embodiment, there are ?ve different                  deterministic outcome.
types of result sets: 1. single conclusion, 2. compound                   While rule chaining is not alloWed in the embodiment
conclusion, 3. binary, 4. score, and 5. action. During the              shoWn, there are child rules and dependent rule packages as
result set de?nition, a set of alloWed values for the result set        discussed above. They may appear to be similar to rule
are de?ned. For example, alloWed values for a result set may            chaining but are not. Child rules are conditionally executed
include: “set document as required”, “set document as                   based upon the parent rule result and are a self-contained
optional”, “set document as unavailable”, “set element as          10   units that pass a deterministic result back up the tree. This is
required”, “set element as optional”, “set element                      very much a structure for rule organiZation and abstraction
unavailable”, and “shoW prompt”.                                        management. Dependent rule packages assist With the re-use
  The outcome section receives the result set and by using              of business logic and again are self-contained units of
a result set logic, produces one or more conclusions. The               business logic that can be nested into the overall business
                                                                   15   decision.
outcome section may further process the result set through
one or more mathematical algorithms or simply pass the                     This type of modulariZation provides an important bene?t
result set as its conclusion. In the exemplary embodiment,              of preventing rule collision such that a de?nite deterministic
there are eight different algorithms or logics: priority,               and non-inferential result is guaranteed for any rule package.
frequency, Weighted, normal list, sum, average, minimum,                It has the added bene?t that it is easier to understand than a
and maximum.                                                            conventional large rule base and it correlates Well With
   The priority algorithm means the outcome of the rule                 typical business logic.
package Will be set to the conclusion of the highest ranked               In the exemplary embodiment, there are nine rule package
value that Was the result of any rule. This algorithm enables           types: case management, decision, section, element,
logic to be created so that each single rule may affect the        25   document, complex validation, common, prerequisite and
outcome of the entire rule package.                                     custom.
  The frequency algorithm produces the conclusion that                    Three of the nine rule package types deal With data and
Was the most frequent result of the collective set of rules.            data collection controlled by the Data Collection System:
  The Weighted algorithm produces a conclusion that is a                complex validation rule packages, element rule packages,
function of both rank and frequency. The conclusions are                and document rule packages.
counted as the rules are evaluated and are multiplied by their            Document rule packages are associated With one or more
ranked value to determine a Weight. The conclusion With the             documents in the case pro?le. Document rule packages
highest Weight is the outcome of the package. If tWo                    facilitate data collection by alloWing data in some docu
conclusions have the same Weight, the one With the highest              ments to make other documents or elements required,
rank Will be the outcome of the package.                           35   optional, or unavailable.
   The normal list algorithm produces a list of conclusions                Element rule packages are associated With individual
that resulted from all rules With each conclusion appearing             elements of data, and facilitate data collection by alloWing
in the list one time at most. The list of all conclusions from          one element to change the required/optional/unavailable
all rules is normaliZed to remove unnecessary duplicates                status of other elements in the same document.
from the outcome of the rule package.                              40
                                                                           Complex Validation rules are attached to a document
   Other algorithms are standard mathematical functions that            pro?le, and are used to verify that the data submitted for that
are self-explanatory.                                                   document is valid. The result of these rules is either a “valid”
   In conventional rule processing systems, there are infer             or “invalid” judgment on the document. When a document
ence engines that arbitrate contradictory logic or rule colli           is submitted that has an associated Complex Validation rule
sions. As an example of a rule collision, assume that rule A            package, it is evaluated to determine if the document is
is “if DamageCategory<$1000 then RepairType=                            logically valid (as de?ned by the rules in the package). One
Immediate”, rule B is “if RepairType=Immediate then                     example is a validation rule that checks to see if the policy
PoliceReport=Optional”, and rule C is “if AccidentType=                 Was in affect on the date of an incident.
PersonaliInjury then PoliceReport=Mandatory”. If a claim                   Three of the nine rule packages deal With process step
to be processed as a customer transaction contains an                   executions controlled by the Process Control System: case
AccidentType=PersonaliInjury and a DamageCategory=                      management, decision and section.
$750, it is unclear Whether a PoliceReport is Mandatory or                 A case management rule package is used for the purpose
Optional.                                                               of ensuring that all the information required for the process
  This type of con?ict or collision is caused by the result of     55   ing of a speci?c case, as set by the scope of the rule package,
one rule forming the condition of another. This chaining of             is collected. The case management rule packages are utiliZed
dependencies is complex and hard to test in a deterministic             during the execution of a document requirements process
Way. The problem With inference engines is that they alloW              step. The process step inherits the scope of the rule package
introduction of inconsistent logic in a rule base (either on            to Which it is associated. The case management rule package
purpose or by accident) and the outcome is dependent on the             associated With the process step evaluates and returns an
inference algorithm.                                                    action result list as the result of the rule package. The actions
  The present invention, hoWever, has a unique rule engine              in the list determine What actions Will be taken on the any
Where no rule conditions are dependent upon the result of               documents Within the scope of the rule package.
other rules, and no conventional inference engine is required              A decision rule package is used in deciding What the next
to arbitrate contradictory logic or rule collisions. In a pre      65   step in the process Will be during the KDT. Once scope
ferred embodiment, each rule package performs a single                  checking is performed during processing, the decision rule
high level business decision. Within each rule package, all             package associated With the process step evaluates and
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                              13                                                                       14
returns a result that represents a single decision. This out             clicks, and drag and drop operations. The rule calculates a
come is mapped to a step transition that determines What                 risk of an insurance policy holder. If the holder had the
next process step is executed.                                           policy for less than 365 days before the accident occurred,
   A section rule package is similar to a decision rule                  then the rule assigns a relatively high risk score of 8. To
packages in that they Will make a decision on What the next              build the rule, the user Would simply click appropriate items
step in the process Will be during the KDT. The difference               and drop them into appropriate boxes. For example, the user
is that Section rule packages Will provide a result for each of          can open the Function folder, click on the Date Difference
several similar “lines” of data (e.g., Invoice line items)               Function and drag it into the If portion of the rule. The same
Within a document of a case. The results returned for each               can be done for the loss date and inception date by going to
section Will be used to determine the overall decision that is      10   the Scope folder Which contains all the data elements that are
made.                                                                    used for the rule package.
  A common rule package enables the construction of                                                Processes
business speci?c logic of Which the results Will be used by
a rule package of another type, or another common rule                     Once all data for a document have been collected, a
package. The common rule packages are only utiliZed as              15   process executed by the Process Control System takes that
dependent rule packages When used by another rule package.               document through a series of steps, executing actions at each
  Prerequisite rule packages are used to conditionally evalu             step, in order to achieve the ?nal goal for the document (e. g.,
ate individual rules in other rule packages. Prior to evalu              approval of payment on a claim).
ating rules in a rule package, it is ?rst determined Which                  To identify processes that need to be implemented, each
rules and versions of rules apply. This is accomplished by               document in the case should be considered for Whether rules
evaluating applicable prerequisite rule packages to deter                need to be applied to the document and Whether the docu
mine Which rules in the package apply. The prerequisite rule     ment needs to interact With a back end system.
packages return a binary result of true or false to determine       Not all documents in the system Will need a process run
if the associated rule or rules should be evaluated.             on them. For instance, support documents, such as a police
   Custom rule packages are created for a speci?c business       report in an auto insurance claim context, may be involved
purpose that cannot be met by any of the other rule package              in the rules and processing for a theft claim, but the theft
types.                                                                   claim is the only document that needs to be processed. Once
   FIG. 5 illustrates an example of a graphical display of data          processes are identi?ed, process steps for each process is
collection rule packages by the rule builder. Rules are                  de?ned.
presented in a tree structure With True/False results that are              Each step in a process completes a business function and
easy to folloW. FIG. 5 shoWs a data collection rule package              the results of each function determine the next step that Will
called “Loss Type Is Accident”. Under a True condition, that             be executed in the process ?oW. There are seven different
rule package includes a set of business rules: “Driver Is                types of process steps, each of Which provides the capability
Named On Policy”, “Police Have Been Noti?ed”, “Injuries             35   to perform a speci?c type of business function.
As A Result of Accident”, “Lights Are Applicable”, “Other                   In the exemplary embodiment, there are seven types of
Vehicles Involved”. In the “Driver Is Named On Policy”                   process steps: case management, request and Wait, section
rule, if it evaluates to a True condition, then the conclusion           decision, business decision, service task, custom task, and
is an Action called “Request Object: Named Driver Valida                 manual resolution.
tion”. If False (Else condition), then the conclusion is one        40      The case management step uses a rule package to deter
Action called “Request Object: Non-Named Driver Cap                      mine additional documents and elements are needed for the
ture” and another Action called “Auto Action: Outbound                   case, based on the information already collected.
Call to Non-Named Driver”. As can be appreciated by                        The request and Wait step sends requests for document
persons of ordinary skill in the art, such a graphical display           pro?les that are required for the document being processed.
alloWs an analyst With no programming experience to                 45   Once requests have been issued, the process step enters a
modify, add or delete any rule or action.                                ‘Wait’ state until the requested documents are submitted, or
   A detailed example of an element rule package is shoWn                a timeout is reached.
in FIG. 6. The result type is set to Action and alloWed values             The section decision step evaluates each section in a set
for this rule package are “Set Element Unavailable”, “Set                of sections for the document, and stores the results of each
Element Optional”, “Set Element Required” and “ShoW                      evaluation. This is accomplished by running a section deci
Prompt”. The scope is limited to Element 1 Which means                   sion rule package.
data from that single element is available for rules to
                                                                           The business decision step evaluates a decision rule
evaluate against. Assuming that all the rules evaluate to a
                                                                         package to determine the next transition to execute.
true condition, the results are “Set Required Element 1”,
“Set Optional Element 4”, “ShoW Prompt ‘Prompt Text’”,                     The service task step executes an EMS service to perform
“Set Unavailable Element 18”, “Set Unavailable Element                   a de?ned task.
19” and “Set Unavailable Element 19”. In the outcome                       The custom task step executes a custom task using a
section, the result set logic or algorithm is set to Normal List.        plug-in that implements a standard interface.
Accordingly, the conclusion includes one occurrence of all                 The manual resolution step executes an EMS service to
results in the result set. Although not shoWn, the program               perform in order to route the document to an external
114 according to the present invention alloWs the adminis                Work?oW system. Once the service has been executed, the
trator building the rules to easily manipulate the rule pack             item Waits until the document is resubmitted With a manual
ages through the use of scrollable WindoWs, pull doWn                    decision, or a timeout occurs.
menus, and drag and drop operations.                                       Similar to the scope of the business rule package, every
   FIG. 10 is an exemplary screen shot of a rule builder that 65 process step type except the request and Wait step has a
illustrates hoW a user With no computer programming              document scope. This scope is a list of documents that
knoWledge can build a rule With simple typing, mouse                     should be in a speci?ed state for the step to be executed. The
                                                      US 6,862,573 B2
                              15                                                                     16
states that can be speci?ed are: optional, complete and valid,          the step is de?ned, manual transitions are created Which give
complete only, and exists only.                                         the Work?oW user the choices of making a manual decision.
  For instance, if the step performs a business decision, the           When the user has corrected or completed the document,
documents that are in the decision rule package scope should            they return the document back to the Process Control
also appear in the process step’s scope. There are automated            System and send the document to a manual transition. Step
means of guaranteeing that the minimum required scope for               5 has tWo transitions, F and G. A revieWer chooses either F
a step is set When the step is created. “Requested and Wait”            or G after the document has been revieWed or updated. If the
steps do not have a document scope, since they are intended             revieWer chooses F, transition F Will be triggered Which Will
to request documents that Will be needed to meet the scope              send the document to Step 4. If the revieWer chooses G,
of later steps.                                                    10   transition G Will be triggered Which Will send the document
  Each process step has one or more transitions. Atransition            to Step 3.
de?nes What happens to a document When it is ?nished With                 If an unexpected system error occurs in any step, a system
a process step. Transitions move a document from one                    administrator intervenes. Once the error is corrected, the
process step to another, or handle error conditions. Any                administrator sends the case back to the process step Where
transition can be con?gured to delay the processing of a           15 the error occurred.
document for a period of time. This delay can be setup to                 Another ?oW diagram of a sample process that processes
occur from the current time or the document’s creation time.            an auto accident claim Will noW be described With reference
The possible transitions from one process step to another               to FIG. 8 to further illustrate the bene?ts and novel features
depend upon the type of process step. There are standard                of the present invention.
transitions that should be de?ned for each type of process                Initially, a subscriber calls a call center to report an
step.                                                                   accident. Under the control of the DCS, an appropriate data
  Asample process is shoWn in FIG. 7. Step 1 is a ‘Request              collection scenario is selected and the dynamic WindoWs
and Wait’ step that looks at documents that are in the scope’s          interface of the DIS displays prompts and instructions to
step and determines if they are complete, incomplete,                   assist a call center operator to collect the subscriber’s
requested or not requested. Step 1 has one transition A. The            identi?cation and policy number. Alternatively, the present
result of the scope check is S1 (meaning scope complete),               invention can use the DIS Dynamic Web Pages interface to
Which is mapped to transition A. If the result of the scope             collect information through the Internet Without the assis
check is S1, transition A Will be triggered, Which Will send            tance of a live operator. When the corresponding ?elds on
the document to Step 2.                                                 the screen are populated, they are used to perform a search
   Step 2 is a ‘Rule Run’ step. Case management, section                on an external system (e.g., an external database or
decision and document decision step types are ‘Rule Run’                mainframe) for the policy details through the EMS.
type steps Where the associated Rule Processing System rule               Still under the control of the DCS, the EMS returns the
packages are executed. When the step is de?ned, the selected            appropriate policy details from the external system and the
rule package’s rule outcomes are mapped to the step’s              35
                                                                        details are displayed to the operator as the next page in the
transitions. Step 2 has tWo transitions, B and C. The asso              data collection scenario. In addition to the policy details
ciated rule package has three rule outcomes, R1, R2, and R3.            being displayed, the operator is prompted to enter additional
R1 and R2 are mapped to transition B and R3 is mapped to                data such as description of the accident, time of day, cars
transition C. After the rule package runs, if the rule result is        involved, injuries, and Witnesses.
R1 or R2, transition B Will be triggered Which Will send the       40      Based on the data collected, rules associated With them
document to Step 3. If rule result R3 is returned from the rule         are executed under the control of the Rules Processing
run, transition C Will be triggered Which Will send the                 System. Rule execution as part of the front-end drives the
document to Step 4.                                                     call to completion. As previously discussed, the rules are
  Step 3 is a ‘Custom Task’ step that executes a custom                 used to determine additional data required, the manner in
action plug-in component. When the step is de?ned, each of         45   Which it is collected and hoW it is presented to the operator.
the values in a list that are associated With the component is          For example if the operator indicates that injuries are
mapped to the step’s transitions. Step 3 has tWo transitions,           involved in the accident being reported, then the transaction
D and E. The associated action has three outcomes, A1, A2,              management program 114 through the RPS displays speci?c
and A3. A1 and A2 are mapped to transition D and A3 is                  ?elds and prompts the operator to collect information about
mapped to transition E. After the custom action runs, if the            the injuries.
outcome is A1 or A2, transition D Will be triggered Which                  At times, rules Will determine that a request be sent
Will send the document to Step 4. If outcome A3 is returned,            outside of the system to ask for the data from a third party.
transition E is triggered, Which sends the document to Step             An example of this is a police report. The subscriber may
5.                                                                      indicate that police are involved. A rule executed not only
   Step 4 is a ‘Service Task’ step that executes an EMS            55   presents to the operator some basic ?elds for collection of
Service to send data to an external system. When the step is            police information, but it may also send an automated action
de?ned, transitions are mapped to standard return codes                 to the Process Control System to request the accident report
from the execution of an EMS service. Step 4 has tWo                    from police headquarters. In the past, this Would be an
transitions, H and I. The EMS service return codes are E1               activity that the operator Would manually perform. With the
and E2. After the EMS service call is made, if the return code          present invention, hoWever, this activity is automated.
is E1, transition H is triggered Which Will send the document             The data collection process continues until the operator
back through the same step (for example, if the external                has completed the collection scenario. Upon completion of
system Was unavailable, the step can be rerun). If the return           collecting the data, the operator submits the claim.
code is E2, transition I Will be triggered Which Will complete             Next, the claim is processed through a series of complex
the process.                                                       65   validation rule packages to determine Whether the data
   Step 5 is a ‘Manual Resolution’ step that sends the                  collected is valid. If the rules detect a validation error, the
document to an external Work?oW system for revieW. When                 operator is presented With the errors that Were encountered
                                                      US 6,862,573 B2
                              17                                                                     18
and is prompted via prompt messages the actions to take in              the invention. For example, While the embodiment disclosed
order to correct the errors presented, for example, to verify           illustrates the present invention in an Internet environment,
the incorrect information With the subscriber. Upon                     persons of ordinary skill in the art Will appreciate that the
correction, the operator submits the claim again and the                system can be implemented in any computer netWork envi
claim is sent to the Process Control System to process the              ronment including the Intranet, LAN, WAN or the like.
back-end part of the transaction.                                       Accordingly, the present invention is not limited except as
  Under the control of the PCS, the claim is executed
                                                                        by the appended claims.
                                                                          What is claimed is:
through a series of process steps as part of a claim process              1. An automated knoWledge dependent transaction man
300 shoWn in FIG. 8. In process step 302, a customer                    agement system for processing customer transactions, the
speci?c set of actions are executed to preprocess the claim.       10
                                                                        system comprising:
Typically, this Would involve validating and manipulating                 a storage device operable to store:
the case data to ensure that further process steps Will have                 data of a customer transaction,
data available in expected format. HoWever, such a step                      user-con?gurable business rule packages With each rule
could perform any task by creating a custom component. If                       package having one or more business rules, each rule
unsuccessful, process step 306 is executed Where unex              15
                                                                                package having a deterministic outcome, at least
pected errors are handled. This can be a manual resolution                      some of the rule packages being associated With the
step requiring manual intervention by an operator or an                         data of the customer transaction, and user
automated step. Typically it is a manual resolution step that                   con?gurable business process steps With at least one
handles all transitions that are unexpected. Under certain                      process step being associated With a rule package
circumstances, the claim can be sent back to step 302 to                        and operable to execute a task based on the deter
restart preprocessing.                                                         ministic outcome of the associated rule package; and
   If the result from step 302 is successful, on the other hand,          a transaction management module operable to:
process step 304 is executed. Step 304 is of a business                      collect a next data element of the customer transaction
decision type and therefore executes a decision rule package                    that depends on the deterministic outcome of the rule
to check Whether the claim is a duplicate. If the result is yes,   25           package associated With the data already collected,
then process step 308 is executed. Step 308 is typically a                   process the customer transaction by executing the tasks
manual step Where an operator manually determines Whether                       of the process steps, a next process step to be
the claim is in fact a duplicate. If it is, the process 300 is                  executed being dependent on the execution result of
terminated. OtherWise, the operator sends the claim back                        a current business process step.
into process How (process step 310) for further processing.                2. The system according to claim 1, further comprising a
   Step 310 is also executed When the decision rule package             rule builder that displays a graphical representation of a
in step 304 determines that the claim is not a duplicate. Step          business rule and alloWs a business administrator to graphi
310 is of a case management type and therefore executes a               cally change the business rule Without using any computer
case management rule package to determine the additional           35   programming code.
information required to continue processing. For example,                 3. The system according to claim 2 Wherein the rule
based on the data that have been processed thus far the rule            builder displays the plurality of rule packages in a tree
package may determine that additional items or documents                structure.
are required. This process step executes an associated rule               4. The system according to claim 1, further comprising a
package that determines the additional items or documents               process builder that displays a graphical representation of
required and marks them as such in the case pro?le for                  the process steps and alloWs a business administrator to
further processing. An unexpected result from step 310 is               graphically change the process steps Without using any
handled by step 306. If, however, all required additional               computer programming code.
items are successfully identi?ed and marked, process step                  5. The system according to claim 4 Wherein the process
312 is executed.                                                        builder displays the process steps in a How chart format.
   Step 312 requests the additional items that have been                  6. The system according to claim 1, further comprising:
marked by step 312 and enter into a Wait state. If step 312                an external mapping module operable to retrieve data
times out, process step 314 is executed. Similar to step 308,                resident on an external system Which are requested by
step 314 is typically a manual step Where an operator                        the transaction management module according to the
manually determines Whether the claim in fact does have all                  outcomes of the rule packages or process steps.
required items. If it does, the process 300 is terminated.                7. The system according to claim 6 Wherein the data
OtherWise, the operator sends the claim back into process               stored in the storage device contains an external business
How (process step 316) for further processing.                          portion that stores information regarding What data is to be
  Step 316 is of a business decision type and therefore                 passed to the external mapping module to retrieve the
executes a decision rule package to check Whether any 55                requested data resident on the external system.
automated or manual action is required. If no, claim pro                  8. The system according to claim 6 Wherein the external
cessing is completed and the process 300 terminates nor                 mapping module receives the requested data resident on the
mally. If yes, hoWever, the routine 300 has determined that             external system in an XML format.
some type of additional action is required before the claim               9. The system according to claim 1, further comprising:
processing can be completed. If the required action is                    a dynamic user interface module operable to dynamically
handled successfully, processing completes normally and                      change the display to guide either a data collector or the
the routine 300 terminates. OtherWise, step 306 is executed                  customer as to hoW to provide the data being collected,
Where unexpected errors are handled.                                         the dynamic change of the display being dependent on
  From the foregoing, it Will be appreciated that, although                  the outcomes of the rule packages or process steps.
speci?c embodiments of the invention have been described           65     10. The system according to claim 1 Wherein the data of
herein for purposes of illustration, various modi?cations               the customer transaction includes a case pro?le that de?nes
may be made Without deviating from the spirit and scope of              the data to be collected to process the customer transaction.

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