Process a commercial claim

  • Release version: Xanadu
  • Updated August 1, 2024
  • 2 minutes to read

    • A processor can initiate a claim, review a claim to verify it and after an adjuster’s evaluation, complete fulfillment tasks and close a claim.

    Before you begin

    Role required: sn_ins_claim_cml.auto_processor

    Update and close the tasks of the claim case.

    Procedure

    1. Navigate to All > Financial Services Operations > Workspace.
    2. Open the claim case and task one of the following ways.
      OptionSteps
      From the landing page Select an active case from the My pending tasks or My open claims list.
      From the case playbook
      1. Select the lists icon (lists icon.).
      2. In the Lists tab, under Commercial auto claim cases, open the case list.
      3. In the list, select the case that contains the task.
      4. If the claim case is in New status or not assigned to you, select Accept to be able to work on it.
      5. Select the Playbook tab.
      6. Under one of the following stages, select the task activity to work on.
        • First notice of loss
        • Claim validation
        • Fulfillment
      From a commercial auto claim case
      1. Select the lists icon (lists icon.).
      2. In the Lists tab, under Commercial auto claim cases, select Assigned to me.
      3. In the list, select the case that you want to open.
      4. If the claim case is in New status, select Accept to be able to work on it.
      5. In the case, select the Tasks tab and select the claim task.
      From the Commercial auto claim tasks list
      1. Select the lists icon (lists icon.).
      2. In the Lists tab, under Commercial auto claim tasks, select All.
      3. In the list, select the task that you want to open.
      You may need to select Accept to accept assignment of the task to you, enabling you to work on the task.
    3. Finish the work that is required to complete the tasks in your claims system.
      The work you may need to complete could include steps in any of the following stages.
      • Completing first notice of loss stage tasks to initiate the claim, such as providing incident details, adding claim participants, and collecting documents.
      • Evaluating the validity of the claim reported by the customer.
      • Completing and closing the claim.
    4. Optional: In the Work notes field, enter any comments that are related to your findings.
      Manually posted comments and system-generated work notes add to the Activity stream for the claim case.
    5. Close the task from the playbook activity or the task form.
      Claim taskAction
      To submit incident details In the case playbook, select Mark complete.
      To validate a claim A claim validation task is created when a business rule determines a duplicate claim due to the same insurance policy and loss date.

      To validate a claim: In the task form, select Approve to validate the claim or Reject to deny and close the claim.
      To add claim property, participant, or coverage information In the case playbook, select Save.
      To initiate a claim In the case playbook, select Submit.
      To close a claim In the case playbook, select Close to close the claim.