Risk Analysis And Compliance Checking of Business Rules In Insurance By Using of Process Mining Technique Case Study : Third-Party Claim Handling Process

Objective: Nowadays, Organizations have adopted process-driven approaches in order to improve their operations. Process identification and refining them in organizations is essential to save time and reduce costs. Process management, enterprise risk management and compliance checking with the rules are of the main challenges of today's process-oriented organizations, especially insurance companies. Today, insurance has made tremendous progress in our society. In the meantime, the process mining helps insurers identify the existing process and understand the extent of noncompliance with business rules.Methodology: This study aims to identify the existing process and understand the extent of non-compliance with the business rules timely by using Process Mining technique through PMPM implementation methodology, conducted in one of the active insurance companies of Iran.Finding: In this study, the process has been visualized using existed event logs registered in the organization's information systems. Then, by applying ProM software, business processes are analyzed, the sequences of the activities related to the process are reviewed regarding selected business rules and finally some improving suggestions for process improvement are presented.Conclusion: Generally, this case study gives some new insights which can be propose to process analyst in the finance area. This approach can be used in parallel with the other control and audit methods as well as performance improvement of information system in order to diminish operational risks. Therefore, it can create a useful insight by presenting a timely rule-based process analysis in a short-term