Insurance claims landing pages and workspaces

  • Release version: Xanadu
  • Updated September 19, 2024
  • 3 minutes to read
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    Summary of Insurance Claims Landing Pages and Workspaces

    The Insurance claims application provides users with landing pages and workspaces tailored for different roles involved in claims processing. These features enable users to efficiently manage and track their claims tasks and statuses.

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    Key Features

    • Landing Pages: Each role, such as FNOL representative, Claims Processor, Claims Adjuster, and Claims Manager, has a dedicated landing page displaying relevant claim metrics and tasks.
    • Case Section Tabs: Users can navigate through various tabs within the claim case, including playbooks, claim summaries, customer information, task SLAs, and interactions.
    • Claim Summary: Provides an overview of the claim's status, participants, and financial data, although FNOL representatives do not have access to this feature.
    • Claims Workspace: Adjusters can access a unified view of all actions required for claims, such as document verification, coverage evaluation, and settlement approvals.

    Key Outcomes

    By utilizing the Insurance claims application, users can efficiently manage claims through role-specific dashboards, streamline their workflow via organized task views, and enhance collaboration on claims processing, ultimately improving response times and service delivery in the claims management process.

    In the Insurance claims application, you can view summaries of your claims work in the landing page. You can also work on your claim tasks from the claim workspace.

    Landing pages

    The following dashboards are included as part of the Insurance claims application:
    • Claims Processor landing page
    • Claims Adjuster landing page
    • Claims Manager landing page
    • FNOL landing page (as part of Financial Services Operations Core)

    Each Insurance claims role can have a different landing page.

    For example, in the included travel insurance claim line of business (LOB) model, the following table shows the layout of what each role sees.
    Table 1. Landing pages for roles in Insurance claims
    Role Landing page elements
    First notice of loss (FNOL) representative
    • List of draft claims
    • List of all open claims
    Claims processor
    • Claims overview (such as the number of new claims, high-priority claims, claims not updated in the last 7 days, overdue claims, and claims that are pending an adjuster assignment)
    • List of user's pending tasks
    • List of user's open claims
    Claims adjuster
    • Claims overview (such as the number of new claims, rejected reserves, rejected payments, overdue claims, high-priority claims, claims pending document verification, and claims that haven't been updated in the last 7 days)
    • List of user's pending tasks
    • List of user's open claims
    Claims manager
    • Claims overview (such as the number of new claims, high-priority claims, overdue claims, claims that haven't been updated in the last 7 days, claims pending document verification, pending tasks from the user's teams, and claims pending an adjuster assignment)
    • List of user's pending tasks
    • List of user's pending reserve and payment approvals
    • All open claims

    Case section tabs

    In the Insurance claims application, you can use section tabs to add information on the claim case. For example, in the base level travel insurance LOB model, the following table shows the section tabs that are available.
    Table 2. Case section tabs for cases in Insurance claims
    Section tab Description
    Playbook Displays the responses to the FNOL intake playbook.
    Claim summary Displays a summary of the claim. See Reviewing claims in the claim summary.
    Details Contains the details on the claim case record, such as the case number, consumer or account, insurance policy, case status, or case work notes.
    Customer information Contains the workspace cards that show the customer record details, policy overview, claim overview, insurance policy details, case history, or recent phone and chat interactions.
    Task SLAs Displays the associated task service level agreements (SLAs).
    Tasks Lists the adjuster tasks for this claim.
    Interactions Lists the interactions with the claimant.
    Emails Lists the emails for this claim.
    Document verifications Lists the document verification tasks for this claim.

    Reviewing claims in the claim summary

    The claim summary contains an overview of the claim's status, its participants, and data about the coverages and financials.
    Note:
    FNOL representatives don’t have access to this workspace.
    For example, in the Insurance claims application's travel insurance LOB model, you can navigate through the sections in the following table.
    Table 3. Claim summary containers in Insurance claims
    Container Description
    Claim details Displays the details about the claim number, policy holder, policy snapshots, priority, stage, report date, and incident date.
    Claim SLAs Displays the service level agreements (SLAs) for this claim and the remaining business time left of the SLA.
    Adjuster tasks Lists the adjuster tasks that are associated with the claim, including the status and the assigned adjuster.
    Incident details Displays the incident details for the claim.
    Claim participants Lists the claim participants.
    Claim status Displays the status progress of the claim.
    Coverages and financials Displays the coverages, reserves, and payment information for this claim.
    Notes and activities Displays the work activity and work notes against this claim.

    Working on adjuster tasks in the claim workspace

    Use the claim workspace to get a unified view of all the actions that you can perform as an adjuster on an Insurance claims claim. From the claim workspace, you can work on a claim to verify documents, evaluate claim coverages, determine claim payout details, and approve a settlement for a claim.

    For example, in the included travel insurance LOB model, you can navigate through the sections that are shown in the following table.
    Table 4. Claim workspace containers in Insurance claims
    Container Description
    Claim details Reviews the details about the claim number, policy holder, policy snapshots, priority, stage, report date, and incident date.
    Incident details Reviews the details about the incident records.
    Claim participants Views the claim participants and their roles.
    Adjuster assignment details Updates the assignment group and who the case is assigned to.
    Tasks Views, creates, and works on the adjuster tasks for the current claim case.
    Coverages and financials Works on the claim coverages, reserves, and payments.