Case Study(Academic Project)

Unifying Claims Operations Through Business Architecture

Building clarity, alignment, and a scalable operational model after a major insurance merger.

PROJECT OVERVIEW

The merger of Green Lizard and Global Promise created a fragmented, duplicated, and culturally misaligned claims operation. Two legacy teams were using different processes, tools, and decision patterns — causing resistance, confusion, and missed efficiencies.

My role in this project was to design a strategic business architecture blueprint that brought:

value-stream clarity
aligned stakeholder expectations
harmonized processes
capability maturity insights
a measurable performance framework

This case study demonstrates how structured modeling, experience mapping, and capability analysis can unify operations after a merger.

Details

Building Alignment, Clarity & Structure in a Post-Merger Claims Organization

Challenge

After the merger of Green Lizard and Global Promise, the organization faced a fragmented claims operation with misaligned processes, duplicate work, and inconsistent decision-making. Two legacy teams were operating independently, creating friction, inefficiencies, and customer dissatisfaction.

The core challenges included:

  • No unified claims workflow across the merged companies

  • Overlapping roles and unclear ownership

  • Variations in process maturity and cultural resistance

  • Missing capability visibility and performance metrics

  • Lack of a shared future-state direction

To move forward, the organization needed clarity, alignment, and a structured architecture to unify how claims work would be performed.

Solution

We applied a structured business architecture approach to bring alignment across people, process, and technology. Our solution included:

  • Mapping the end-to-end claims value stream to understand how work currently flowed

  • Modeling current-state processes using BPMN to expose redundancies and gaps

  • Designing a unified future-state claims process aligned with best practices

  • Building a capability map + maturity model to identify gaps and investment priorities

  • Clarifying stakeholder roles across both legacy teams using a responsibility matrix

  • Defining a performance measurement framework to track operational improvement

This structured approach created a clear, shared, and scalable operating model for the new claims organization.

CAPABILITIES MAPPED

18

PROCESS MODELS CREATED

4

Modeling Artifacts Created

6

MATURITY GAPS IDENTIFIED

12

Our Solution Approach

We applied a structured business architecture approach to bring alignment and clarity.

1. Scoping Business Architecture Work

Defined the boundaries of the work using:

• Value streams
• Stakeholder alignment workshops
• Empathy tools & experience mapping (Kalbach)
• Jobs-To-Be-Done (JTBD)

This created a unified vision across both organizations.

2. Process Architecture for Claims

Using Exhibits C & D, I mapped the current processes across:

claims intake
validation
investigation
resolution

Tools used:

• BPMN 2.0
• Swimlane diagrams
• Business Process Manifesto principles

Future-state process was designed to remove redundant steps and standardize the lifecycle.

3. Capability Map Development

Capabilities identified:

• Claims Intake Management
• Fraud Detection
• Claims Assessment
• Digital Document Management
• Customer Service Communication

Using the 5-Level Capability Maturity Model, we produced a heatmap to show:

current maturity
target maturity
critical gaps
investment priorities

4. Business Performance Measurement Plan

Metrics were defined using:

• Balanced Scorecard
• Outcome mapping
• BPM lifecycle metrics

KPIs included:

• Cycle time
• NPS
• Validation accuracy
• Fraud detection rate
• Employee engagement

This ensured the future claims organization could measure progress and make data-driven adjustments.

Details

Results & Reflection

Outcomes

This engagement delivered:

• A unified, value-driven architecture across both companies
• Standardized future-state claims process
• Capability maturity baseline + target roadmap
• Role clarity across the merged organization
• A measurable performance framework to guide execution
• Stakeholder alignment around a shared future vision

Together, these created the blueprint for a scalable, efficient claims operation.

​

Reflection

This engagement delivered:

• A unified, value-driven architecture across both companies
• Standardized future-state claims process
• Capability maturity baseline + target roadmap
• Role clarity across the merged organization
• A measurable performance framework to guide execution
• Stakeholder alignment around a shared future vision

Together, these created the blueprint for a scalable, efficient claims operation.

​

CAPABILITIES MAPPED

18

PROCESS MODELS CREATED

4

Modeling Artifacts Created

6

MATURITY GAPS IDENTIFIED

12

Testimonial

“However beautiful the strategy, you should occasionally look at the results.”

 Winston Churchill

Get In Touch

Adivarekar.s@northeastern.edu

https://www.linkedin.com/in/swapnilaadi/