Exploring Insurance claims
Summarize
Summary of Exploring Insurance claims
The Insurance claims application in ServiceNow enables organizations to create and configure a comprehensive claims workflow tailored to property and casualty (P&C) insurance lines of business. It supports various user roles involved in the claims process, including first notice of loss (FNOL) representatives, adjusters, processors, and managers. The framework is flexible enough to handle multiple lines of business, with a sample travel insurance claim flow included for reference.
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User Roles and Responsibilities
- Administrator: Configures the Insurance claims application by setting up service definitions, product models, policies, and incident tables. They also manage claim incident configurations for new or existing lines of business.
- FNOL Representative: Front-office staff responsible for creating claim cases on behalf of customers and uploading supporting documentation.
- Claims Adjuster: Evaluates claims, approves reserve and payment amounts, and settles payments.
- Claims Processor: Manages claim cases by creating and tracking adjuster tasks and adding additional tasks as needed.
- Claims Manager: Authorizes reserve and payment amounts that require further approval and monitors team performance using dashboards and metrics.
Claims Workflow
The typical insurance claim workflow follows these steps:
- A customer reports a claim.
- The FNOL representative selects claim type, policy, participants, and incident details, adds itemized losses and documents if applicable, then submits the claim.
- The claim is assigned to a claims specialist or adjuster who reviews policy details and may request additional information.
- The adjuster sets reserve funds and payments, adjusts coverage exposures over time, and monitors claim handling.
- If reserve or payment amounts exceed approval limits, an approval task is generated for the claims manager.
- The claims specialist or adjuster makes final approval or denial decisions based on evidence, concluding the workflow.
Benefits
- Versatile Framework: Adapts to any single policy P&C claims without needing to create separate case types or flows.
- Rapid Configuration: Allows claims administrators to quickly set up a complete end-to-end claims workflow.
- Support for Multiple Adjusters: Enables collaborative work on adjuster tasks.
- Customizable Workspaces: Persona-based landing pages and workspaces tailored to distinct roles enhance user experience and efficiency.
Next Steps
To maximize the value of the Insurance claims application, ServiceNow customers should explore detailed guides on setup, usage, and reference materials that provide deeper insights into configuration and operational best practices.
Learn how to create and configure a claims workflow for your organization by using the Insurance claims application. Your first notice of loss (FNOL) representatives, adjusters, processors, and managers can use this claims workflow to create and manage claims.
Insurance claims overview
With the Insurance claims application, you can easily set up an entire claims process for a single policy use case under property and casualty (P&C) lines of business. The Insurance claims application provides a claims framework that you can use for multiple lines of business.
A travel insurance claim flow is included with this application as an example.
Insurance claims users
| User | Description |
|---|---|
| Administrator | Claims administrators are responsible for configuring the Insurance claims application. They set up the service definitions, product models, policies for personal and commercial products, and tables to record information on claims incidents. They can also set up the claim incident configuration for a new line-of-business claims flow or to update an existing configuration. |
| FNOL representative | FNOL representatives are front-office staff who create a claim case on behalf of a customer and upload the relevant documents. |
| Claims adjuster | Claims adjusters are middle or back-office staff that work on adjuster tasks to evaluate claims, approve reserve and payment amounts, and settle payments. |
| Claims processor | Claims processors are middle or back-office staff that own cases. They create claim tasks for adjusters, track adjuster tasks to ensure they're worked to completion, and add additional tasks as required. |
| Claims manager | Claims managers are middle or back-office staff that authorize the reserve and amounts that require additional approval. They also monitor staff performance with dashboards and metrics. |
Insurance claims workflow
Here's a typical workflow for an insurance claim in the Insurance claims framework.
- A customer reports a claim.
- The FNOL representative, in the claim intake playbook, selects the claim type, the policy, the claim participants, and the incident details. If applicable, they add any itemized losses and supporting documentation provided by the customer.
- The claim is submitted and assigned to a claims specialist or adjuster.
- The claims specialist or adjuster reviews the policy details and requests additional information from the customer if necessary.
- The claims specialist or adjuster sets the reserve funds and payments, modifies the coverage exposures and reserve funds over time, and monitors the claim handling activity.
- If the reserve or payment amounts are above the adjuster's approval limit, an approval task is generated for the claims manager, who approves or rejects the amount.
- The claims specialist or adjuster makes the claim approval or denial decisions based on the provided evidence, and the workflow ends.
Benefits of the Insurance claims application framework
| Benefit | Feature | Users |
|---|---|---|
| Versatile framework that adapts to any single policy P&C claims without the need to create case types or flows | Using Insurance claims | Claims administrators, FNOL representatives, claims processors, claims adjusters, or claims managers |
| Rapid configuration that enables the setup of a comprehensive end-to-end claims workflow quickly and easily | Setting up Insurance claims | Claims administrators |
| Support for single and multiple adjusters | Work on Insurance claims adjuster tasks | Claims adjusters or claims managers |
| Customizable persona-based workspaces to fit specific roles and responsibilities | Insurance claims landing pages and workspaces | Claims administrators, FNOL representatives, claims processors, claims adjusters, or claims managers |