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. |
The Connected Claims Claim Recovery module allows you to manage first party and third party claim recoveries through process automation. The Claim Recovery module facilitates the ability to track recovery cases, manage tasks, and other associated actions.
This guide demonstrates the pages and views available within the Claim Recovery module. Note that your specific implementation of the Connected Claims solution may have more or less functionality.
Armando works for a large insurance provider, regularly receiving calls from policy holders who are in the process of recovering funds from various claims. Many calls Armando takes require him to be capable of the following actions:
Armando receives a call from James, who is inquiring on the status of his recovery case. From the Connected Claims home page, Armando clicks the CLAIM RECOVERY card to access the module.
Once within the Recovery module, the RECOVERY dashboard displays by default, allowing Armando to view basic information on recent recovery cases, including the claim number, customer, line of business, and status of the case.
To filter the record table:
Clicking the hyperlink in the RECOVERY # column of the record table presents the Recovery Summary page, providing helpful information in an accessible view. Prominent on the page are the milestones of the recovery process, payment and settlement figures, and a summary of claim details.
In the instance Armando receives a call from a policy holder requesting a new recovery, the new recovery must be reported. Recoveries may only be reported on claims that are closed and settled.
To report a recovery:
To add an insurance company into the system:
As a recovery case moves through its life cycle, you may need to create and assign additional tasks and activity reminders to move the case through the process flow. You can create and schedule an On-Demand Task for this type of activity.
To create an On-Demand Task:
Note: On-Demand Tasks appear under the Recovery Summary page as well as under the Tasks tab.
The following actions for managing communications and documentation, viewing audits, and adding case notes are available through the tabs located along the top of the Recovery Summary page.
Connected Claims simplifies document management by allowing you to view a list of all pending and existing documents for each case, add new documents, and edit existing documents all from a single interface in the Recovery record.
To upload a document:
Tip: The Add New Document link allows you to upload multiple documents at once.
At any point in the recovery process, you can drill down into a specific claim record, click the Documents tab and MANAGE DOCUMENTS to view all pending documents, view, download, and edit existing documents, or add new documents.
Clicking on the Audits tab from the Recovery Summary page will open the Audits page, showing all of the actions performed on a case.
Communications items include automated messages and exchanges between customers and customer service representatives.
Note: Self-service items are communications that are automatically generated and sent to the customer as a result of a customer-performed action.
Selecting a Communications item provides a detailed look at the message transmitted. The Communications item screen shows the message, method, and details.
To create a new communication message:
Tip: Email and WhatsApp messages support file attachments. SMS does not.
While on the phone, Armando is given new information that may be important to add to the recovery case. Notes can be added to a recovery case when new information becomes available after a case is created.
To add notes:
Tasks associated with recovery cases are available on the TASKS dashboard by clicking TASKS on the navigation bar. This brings you to the MY TASKS ACROSS RECOVERY screen, which displays a list of all tasks assigned to the user. Clicking a hyperlink from the TASK NAME column of the record table displays the task information.
The items within the recovery case task flow fall under three main categories:
There is one task within this phase:
To complete the task:
There is one task within this phase:
To complete the task:
There are four tasks within this phase:
To complete the Initiate Arbitration task:
To complete the Apply Online Arbitration task:
To complete the Awarded Detail task:
To complete the Arbitration Settlement task:
Each recovery case must have a claim item linked to it. Claim items can be accessed from its associated recovery case via the CLAIM DETAILS window on the Recovery Summary page.
For information on performing actions on a claim record, visit the How to Settle a Claim guide.
Now that you have walked through the steps to facilitate a claim recovery, you are prepared to assist and inform your customers with their needs.
How to Process a Claim Recovery