This content applies solely to Connected Claims, which must be purchased separately from the Appian base platform. This content was written for Appian 21.4 and may not reflect the interfaces or functionality of other Appian versions. |
New claims involve a number of tasks, from the investigation, inspection, document verification, and payment. Suppose you are a claims adjuster or have a team of claims adjusters. In that case, you need the Operations & Settlement module within the Connected Claims solution to streamline your claims management and settlement tasks. This module has all the data views, workflows, and tasks you need to investigate a claim and quickly work through any settlement tasks in one centralized location. This reduces the time to close as you work through the claims lifecycle.
This quick start guide gets you started with your Connected Claims solution's Operations & Settlement module. Learn the basic views, tasks, and actions you will perform as you move a claim through the settlement phase, including verifying documents, reviewing related contacts, entering payment amounts and methods, and settling a claim.
Note that your specific implementation of the Connected Claims solution may have more automation and customization to meet your business and process needs.
The How to Process a Claim quick start guide walked you through the basic steps for reporting Maria Garcia's car insurance claim, which is now in the hands of Anthony Hill, the claims adjuster. Anthony must:
With Connected Claims, Anthony can use the Operations & Settlement module to gain visibility into all the data views and workflows he needs to decide whether to settle Maria's claim. He logs in to the solution, where he sees the Operations & Settlement module on the HOME page, and with one click of the module, Anthony is ready to get started reviewing Maria's claim.
Like the FNOL module, the Operations & Settlement module defaults to the CLAIMS page when opened. From here, Anthony can see the claims dashboard, which shows key metrics at the top of the page that indicates how many active claims are currently in the pipeline. Relevant KPIs provide a summary of all claims, including the total number of open and overdue claims, a daily total of reported claims, the highest percentage of claims by the line of business, and the US state with the maximum number of claims. These KPIs provide Anthony with a clear snapshot of the overall process health for all claims in the pipeline.
Anthony can also see a complete list of all recent claims, including open and settled claims and their priority. This will allow him to prioritize his work and work on the most critical claim tasks first.
The Claims dashboard has search fields and filters that give Anthony greater control over the claims list. When he clicks the filter icon and enters the data available to him, like the claim number, policy number, customer name, or claim status, Connected Claims returns only the claim records he wants to see.
Anthony needs to complete any open data enrichment and settlement tasks for Maria's claim, so he enters her claim number into the Claim Number Search field and clicks Apply Filter to locate her claim in the list. Clicking on the claim number allows him to drill down into Maria's claim and see the claim details.
The Summary view opens, which displays a workflow visual of where the claim is in the process. Anthony can see the claim details and that it has worked its way to the settlement phase. He can also see a workflow timeline showing exactly where the claim is in the claims lifecycle. In addition, he sees pending documents he needs to review, Completed and Pending tasks associated with the claim, a milestone timeline of claim activities by the user, details about any related entities, and so much more. Instead of going to different, disparate systems to view all of this information, Connected Claims provides Anthony with a single, unified view of the claim data.
With all this data at his fingertips, Anthony is ready to proceed with his claim tasks.
In addition to centralizing the claim details in a single record, Connected Claims also allows Anthony to access the data and actions he needs to complete important claims tasks directly from the claim record. This view makes it easy for him to perform actions like adding case notes, creating on-demand tasks, managing documents, completing payment tasks, and reopening the claim from one central view without navigating multiple pages or different systems.
Case notes allow you to keep a log of all your interactions with a customer and any important notes you want to track as the claim moves through each step in the claims life cycle.
To add a new case note:
As a claim moves through the claims journey, you may need to create and assign additional tasks and activity reminders that are not already part of the workflow but are required to move the claim through the claims process. You can create and schedule an On-Demand task for this type of activity.
When Anthony called Maria to update her on the claim, he could not reach her. The CREATE ON-DEMAND TASK action allows him to create a reminder to contact Maria again at a future date.
To create an on-demand task:
New P&C claims usually involve a lot of documentation, which could increase the time to close if Anthony used separate systems to manage the claim documents. Connected Claims simplifies document management by allowing Anthony to view a list of all pending__ and _existing documents for each claim, add new documents, and edit existing documents from a single interface in the claim record.
This next section will examine how Anthony manages the required documents for Maria's insurance claim.
Yesterday, Anthony reached out to Maria and requested that she submit the following documentation so that he could continue to process her claim:
Maria followed up right away and sent her documents to Anthony via email. After downloading and verifying the documents, Anthony is ready to upload them to Connected Claims.
From the Claim summary, he will click the Documents tab to view the list of PENDING DOCUMENTS he needs to collect, verify, and upload before proceeding to his settlement tasks.
Five pending documents are required to process Maria's insurance claim. Let's walk through the steps for uploading Maria's lease agreement to verify proof of address.
To upload a document:
In the appropriate fields, enter a description and a document expiration date.
After Anthony uploads Maria's documents to her claim record, Connected Claim adds a green checkmark next to each document indicating that it has been verified and attached.
At any point in the claims process, Anthony can drill down into a specific claim record, click the Documents tab and MANAGE DOCUMENTS to view all pending documents, view and download existing documents, add new documents, or edit the details for any existing document.
Now Anthony is ready to view all of the financial data associated with Maria's claim and complete any open payment tasks.
Connected Claims makes it easy for you to view and track all of the financial data for any claim in your pipeline, including the following insurance payment types:
Take the stress out of managing your claims financials with a unified view of all your payment transactions and activities that Connected Claims provides.
From the Claim record, Anthony can click the Financials tab to see a breakdown of all expenses, completed and scheduled payments, and payment recoveries at the top of the page.
Clicking CLAIM INDEMNITY allows Anthony to filter the payments list, so it only displays the payments that match this type. If he has questions about a specific payment transaction associated with Maria's claim, he doesn't have to hunt around in separate systems or interfaces to find what he's looking for. The payments list displays all the pertinent information he needs about a specific payment, including the transaction date, payment type, source, payment method, and more.
Anthony can also perform specific payment actions, including initiating or scheduling a payment against Maria's claim, managing reserves, or canceling a scheduled payment.
To initiate or schedule a claim payment:
After investigating Maria's claim, Anthony discovered a discrepancy in the $1000 payment that was previously made to Maria against her loss reserve. Before he can correct the payment error, he needs to cancel this payment. Let's walk through the steps with him.
To cancel a payment:
Anthony can also manage the Expense and Loss reserves for Maria's claim from the Financials tab. This allows him to add or modify the reserve amount as Maria's claim moves through the claims lifecycle.
Note that he can only request a raise for one reserve at a time, so if he needs to increase both reserves, he will have to initiate two separate requests.
To increase the amount of a claim reserve:
Now that Anthony has completed all his data enrichment and payment tasks, Connected Claims will move Maria's claim into the settled phase.
After the claim is settled, Maria may contact Anthony with additional documentation or accident details and request that he re-open her claim.
You can reopen a closed claim quickly and easily from the claim summary view by clicking RE-OPEN CLAIM. After entering the reason for re-opening the claim, click RE-OPEN CLAIM to move the claim back into the claims workflow.
Now that you have walked through this simple workflow for settling a car insurance claim and understand some of the basic features and views of the Operations & Settlement module, you can start using Connected Claims to process and settle your insurance claims.
How to Settle a Claim