How to Process a Claim Recovery

Getting started

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.

Use case: recovering claims

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:

• View recovery claims
• Report recovery claims
• Manage insurance information
• Create and complete tasks

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.

Viewing recovery claims

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:

1. From the RECOVERY dashboard, click the filter icon on the RECENT RECOVERY table header.
2. Enter the values you want to filter the table by.
3. Click Apply Filter.

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.

Reporting recovery cases

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:

1. From the Recovery Dashboard, click REPORT RECOVERY.
2. In the Claim for Recovery field, enter a Claim Number.
3. Complete all fields.
4. Click LOG CASE.

Adding insurance companies

To add an insurance company into the system:

1. From the Recovery Summary page, click ADD INSURANCE COMPANY.
2. Complete all fields.
3. Click SUBMIT.

Creating on-demand tasks

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:

1. From the Recovery Summary page, click CREATE ON-DEMAND TASK.
2. Enter the following information in the form:
   • Task Name: A unique title for the task.
   • Task Description: The description of the task.
   • Default assignee: Who the task will be assigned to once it is created.
   • Activity cost: The cost of the task.
   • Escalate with respect to: How long to wait before escalating the task to a supervisor or other user, and what to base duration off of.
   • After Case Creation: Base the duration before escalation off the case start date.
   • After Phase Step Assignment: Base the duration before escalation of the task assigned date. If selecting this option, add the duration of time to wait before escalation. The duration can be in hours, days, or weeks.
3. Click CREATE ON-DEMAND TASK.

Recovery record tabs

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.

Managing documents

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:

1. From the Recovery Summary page, click the Documents tab.
2. Click the MANAGE DOCUMENTS button to access the the UPLOAD DOCUMENT(S) form.
3. Complete all fields in the ADD NEW DOCUMENT(S) AGAINST THE CASE section.
4. Click SAVE DOCUMENTS.

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.

Viewing audits

Clicking on the Audits tab from the Recovery Summary page will open the Audits page, showing all of the actions performed on a case.

Managing communications

Communications items include automated messages and exchanges between customers and customer service representatives.

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:

1. From the Communications tab, click RESPOND TO [CUSTOMER NAME].
2. Select a mode of communication from the options available alongside the message box.
   • Email: The envelope icon will configure the message box for email delivery.
   • WhatsApp: The WhatsApp icon will configure the message box for WhatsApp delivery.
   • SMS: The speech bubble icon will configure the message box for SMS delivery.
3. Select from the Keyword and Template fields to pre-populate information into the message box.
   • Keyword: The options available in this field will populate different pieces of customer-specific claim information into the message box.
   • Template: The options available in this field will populate the message box with pre-written template to draft the communication.
4. Click SEND EMAIL/MESSAGE/SMS.

Adding case notes

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:

1. Click the Related Actions tab, then the Add Case Note button. This will present the ADD CASE NOTES form.
2. In the Title and Description boxes, enter the applicable information.
3. Set the visibility to either public or private:
   • Public: Case notes are visible to everyone.
   • Private: Case notes are visible to only users with permission to view them.
4. Attach any supporting evidence using the file upload box.
5. Click SAVE NOTE.

Completing tasks

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:

• Initiate Recovery
• Decision
• Arbitration

Initiate Recovery

There is one task within this phase:

• Set Initial Amount for Recovery

To complete the task:

1. Enter the INITIAL AMOUNT for recovery.
2. Ensure the CASE DETAILS are accurate.
3. Click SUBMIT to initiate the recovery.

Decision

There is one task within this phase:

• Take Action

To complete the task:

1. Select a subrogation option from the Action field.
   • Accept will close the case
   • Reject will initiate arbitration
   • Counter will keep the case open
2. Enter any applicable comments.
3. Click SUBMIT to enter the subrogation actions.

Arbitration

There are four tasks within this phase:

• Initiate Arbitration
• Apply Online Arbitration
• Awarded Detail
• Arbitration Settlement

To complete the Initiate Arbitration task:

1. Confirm all case details are accurate.
2. Click INITIATE.

To complete the Apply Online Arbitration task:

1. Complete all fields.
2. Click SUBMIT to enter the details.

To complete the Awarded Detail task:

1. Complete the following fields:
2. Confirm the amounts in the Total Payable Amount and Total Recovery Amount fields are accurate.
3. Click SUBMIT to confirm the details.

To complete the Arbitration Settlement task:

1. Confirm all case and payment details are accurate.
2. Click SUBMIT.

Accessing claims

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.

Ready to start

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.

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