Manage an Individual Life Claims case

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

    • Review claims in a case to verify the documents, evaluate the claim coverages, determine the claim payment details, and approve the settlement for a claim.

    Before you begin

    Role required: sn_ins_claim_indl.dbn_adjuster

    Procedure

    1. Navigate to All > Financial Services Operations > Workspace.
    2. Open a claim from either the adjuster landing page or from the individual death claims list.
      OptionSteps
      From the adjuster landing page Open a claim that is assigned to you by selecting the Number link in the My active cases section.
      From the Individual death claims list
      1. Select the lists icon (Lists icon.).
      2. On the Lists tab, under Individual death claims, select All.
      3. In the list, select the claim that you want to open.
    3. Complete the actions in the claim workspace.
      Claim taskClaim workspace actions
      To verify a document
      1. In the Tasks section, open the Document Verification task.
      2. Select Verify to verify the documents, or select Reject to reject the submitted documents.
      To add claim coverage
      1. Expand a related death claim record by selecting the down arrow (Down arrow icon.).
      2. Select Add coverage.
      3. In the Claim coverage field, search for the claim coverage.
      4. Select Save.
      To add a reserve or payment
      1. Expand a related death claim record by selecting the down arrow (Down arrow icon.).
      2. In Coverages, select one for the respective policy:
        • Add reserve
        • Add payment
      3. Fill in the required fields.
      4. Create the record by selecting Save.
      5. Review the details, and then select Submit.
      To add an ad-hoc claim task
      1. In the Tasks list, select Add claim task.
      2. Fill in the required fields.
      3. Select Save.
      To submit a reserve or payment amount for approval

      If the reserve or payment amount is above your approval threshold, an approval task is created and assigned to your manager when you submit the amount.
      To submit a claim settlement decision
      1. Expand a related death claim record by selecting the down arrow (Down arrow icon.).
      2. Select Settle claim.
        • Approve the claim and send for fulfillment by selecting Approve claim.
        • Choose Deny claim to reject the settlement.
      3. Enter comments for the settlement decision.
      4. Select Submit.
    4. Optional: Within a case, in the Work notes field, enter any comments that are related to your findings.
      The manually posted comments and system-generated work notes are added to the activity stream for the task and claim case.

    Result

    • When you accept the task, the task status is set to Work in progress.
    • When you submit a reserve or payment amount within your authorization limit, it’s auto-approved.
    • If a claim validation is rejected for all policies, the claim case closes with a case status of Closed rejected. System-generated work notes about the rejection are automatically added to the activity stream for the task and claim case.
    • If you settle the claim, the claim case automatically closes, with the case status set as Closed complete.