Exploring Insurance claims

  • Release version: Xanadu
  • Updated August 30, 2024
  • 2 minutes to read
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    Summary of Exploring Insurance claims

    The Insurance claims application in ServiceNow provides a comprehensive, adaptable framework to create and manage claims workflows tailored for property and casualty (P&C) insurance lines of business. It supports the entire claims lifecycle from first notice of loss (FNOL) through resolution, enabling roles such as FNOL representatives, adjusters, processors, and managers to efficiently handle claims. The application includes a sample travel insurance claim flow to illustrate use cases.

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    Key Features

    • Versatile Claims Framework: Supports single policy P&C claims without requiring new case types or workflows, allowing quick adaptation to different lines of business.
    • Role-Based User Personas: Defined roles include administrators (configuring policies, service definitions, and incident tables), FNOL representatives (creating claims and uploading documents), claims adjusters (evaluating and settling claims), claims processors (managing and tracking tasks), and claims managers (authorizing funds and monitoring performance).
    • End-to-End Workflow Support: Facilitates claim intake, assignment, review, reserve setting, approval processes, and final decisions within a structured workflow.
    • Customizable Workspaces: Persona-specific landing pages and workspaces tailor user experiences to fit responsibilities and streamline task management.
    • Rapid Configuration: Enables administrators to quickly set up or update claims workflows and configurations to meet organizational needs.

    Claims Workflow Process

    • A customer reports a claim, which an FNOL representative enters by selecting claim type, policy, participants, and incident details.
    • Supporting documentation and itemized losses are uploaded if applicable.
    • 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 payment amounts, adjusts coverage exposures, and monitors claim activities.
    • If reserve or payment amounts exceed approval limits, claims managers are tasked with approval decisions.
    • The claims specialist or adjuster finalizes claim approval or denial based on evidence, concluding the workflow.

    Benefits for ServiceNow Customers

    • Streamlines claims management by providing a tested, configurable framework that reduces the need for custom development.
    • Improves coordination among front-office and back-office roles with clear responsibilities and task assignments.
    • Enhances operational efficiency through customizable workspaces and dashboards tailored by role.
    • Supports compliance and governance with structured approval processes for reserves and payments.
    • Accelerates implementation timelines by offering a ready-to-use claims process adaptable to various P&C insurance products.

    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

    Table 1. 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.

    Infographic that shows a typical workflow for an insurance claim. For the text description, refer to the steps that follow.

    1. A customer reports a claim.
    2. 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.
    3. The claim is submitted and assigned to a claims specialist or adjuster.
    4. The claims specialist or adjuster reviews the policy details and requests additional information from the customer if necessary.
    5. 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.
    6. 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.
    7. 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

    What to explore next

    To learn more about configuring and using Insurance claims, see: