Work on Insurance claims adjuster tasks

  • Release version: Xanadu
  • Updated September 19, 2024
  • 2 minutes to read

    • Review a claim 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_gen_claim.adjuster

    Important:
    To access the Claim workspace, and Summary adjuster workspace related tabs, you must activate the CSM default record page. By default, the page is set to inactive. To determine the default page for displaying records in CSM Configurable Workspace, see CSM Configurable Workspace record pages.

    About this task

    This procedure references service definitions and products that are used in the included travel insurance claim line of business. Your workflow may vary depending on your configuration.

    Procedure

    1. Navigate to All > Financial Services Operations > Workspace.
    2. Open the task in one of the following ways.
      OptionSteps
      From the landing page From the All open claims list, select a task.
      From the Insurance claim adjuster task list
      • Select the lists icon (Data visualization list type - icon).
      • On the Lists tab, under Insurance claim adjuster tasks (or the list category that is specific to your custom workflow), select All.
      • In the list, select the task that you want to open.
    3. Work on the adjuster task by completing actions from the claim workspace.
      Claim taskClaim workspace actions
      Add a document verification task
      • In Tasks, open the task drop-down list and select Add document verification task.
      • On the form, fill in the fields.
      • Select Save.
      Verify a document In a Submitted document task, select Verify to verify the submitted document.
      Reject a document In a Submitted document task, select Reject to reject the submitted document.
      Add claim coverage
      • In Coverages and financials, select Add coverage.
      • On the form, fill in the fields.
      • Select Save.
      Add a reserve or payment
      • In Coverages and financials, select one from the Claim coverages list:
        • Add reserve
        • Add payment
      • On the form, fill in the fields.
      • Select Save.
      Add an ad-hoc claim task
      • In Tasks, select Add claim task.
      • On the form, fill in the fields.
      • Select Save.
      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.
      Submit a claim settlement decision
      • Select Settle.
        • Select Approve claim to approve the claim and send for fulfillment.
        • Select Deny claim to reject the settlement.
      • Enter comments for the settlement decision.
      • Select Submit.
    4. Optional: Within a task, 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 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, 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.