CLAIMS MANAGEMENT SYSTEM

Transcription

1 TRAINING GUIDE This training manual shows a high-level overview of our claims management system. This training guide should be considered as a work in progress; because, as we develop new advancements to our systems we will update this training manual as required. Last Updated: 06/20/2016

2 ABOUT THE CLAIMATIC GROUP... 2 SUPPORT HOURS... 2 CHANGE REQUESTS... 2 MAKING A REQUEST FOR CHANGE... 2 DISCLAIMER / SECURITY LIMITATION WHICH ARE BUILT INTO THE SYSTEM... 2 LOGON SCREEN & WEBSITE ADDRESS... 3 HOME SCREEN... 4 SEARCH MENU / OPTIONS... 5 CREATING NEW CLAIM OR WORKING WITH CLAIMS... 6 SHARE CLAIM WITH FELLOW ADJUSTER... 7 DUPLICATING A CLAIM... 8 SENDING A CLAIM ACKNOWLEDGMENT TO INTERNAL REP... 9 CLAIM TAB DOC. LIBRARY FILE NOTES TIME LOG ENTERING GROSS LOSS MAKING FIRST CONTACT SITE INSPECTED TIME ENTRY END RESULT EXAMPLE REPORTS & LETTERS SENDING YOUR CLAIM IN FOR REVIEW REVIEW PROCESS INVOICE PROCESS NO BILL INVOICE CREATING THE INVOICE CREATING A CREDIT MEMO QUICK REVIEW OF PROCESS NOTIFICATIONS NEW ASSIGNMENTS NOTIFICATION OTHER COOL FEATURES WITHIN THE SYSTEM HOW TO RE-ASSIGN A CLAIM COMMUNICATING TIME OFF... 21

3 ABOUT THE SYSTEM The claims management system has been developed over the course of several years and is primarily based on claims management processing and overall management of claim related data. ABOUT THE CLAIMATIC GROUP Claimatic is a close team of software professionals who work hard and play hard. We are parents, gamers, runners, jokesters, friends and more. We are passionate about building software that transforms the insurance claims environment. At Claimatic we create ground-breaking software that improves the way resources and claims are managed in the claims environment. Claimatic is the only intelligent, automated resource management software for claims. It completely changes the way claims are assigned to resources. Claimatic ICM is a comprehensive, full-featured claims management solution powered by Claimatic s rules-based automation engine. Your claims are managed intelligently with Claimatic ICM. We strive to promote growth, drive action, generate results and transform the way business is done. We are passionate about what we do and that s why we do it so well. We also think its fun to code, of course. SUPPORT HOURS Technical support is provided during normal business hours which are Monday through Friday from 8:00 AM to 5:00 PM Central Time. Times might very depending on staff availability, holiday schedule and overall type of support request. Emergency support provided 24/7 EMERGENCY SUPPORT IS DEFINED Complete work stoppage impacting 5 or more persons Loss of life caused by system outage CHANGE REQUESTS We encourage innovation and change with our systems because those innovations produce results that make us all more efficient and can simplify the overall claims process for us all. While we do not fulfill all requested changes, we do listen and explore them as possible enhancements to our system. MAKING A REQUEST FOR CHANGE Please send a detailed explanation to us via and include any materials which might better explain your requested change. DISCLAIMER / SECURITY LIMITATION WHICH ARE BUILT INTO THE SYSTEM Based on those rights and privileges granted to you at time of your user account creation will drive what options you see through-out the system. Some options might be read-only and other options might not appear at all. During the course of this training manual there might be certain options we highlight that you do not have access to. Should you require access to these options please consult your systems administrator or network security officer.

4 LOGON SCREEN & WEBSITE ADDRESS CLAIMS MANAGEMENT SYSTEM Claims Management System Website IAS Claim Services Web Address Cat CREW Claims Web Address Enter your assigned username and password. NOTICE All usernames and passwords are case sensitive After you have successfully logged in; you will have the ability to change your password by going to the Tools Menu and selecting View My Profile Upon a successful logon you will see a screen similar to the one below.

5 MENU, TABS & OVERALL SYSTEM REVIEW HOME SCREEN The home screen is made up of three sections. Which are Notifications, Status and Open Claims. NOTIFICATIONS From time to time we will change this message per storm if necessary to communicate a message to all users instead of sending s or trying to call everyone. STATUS Red: Those files which are new to the system and contact to the Insured is required Green: Open files or in progress. It will be every file you have not closed and all new claims. Purple: Files you have completed and sent to us for review. If one is being reviewed, it will be locked. Lime: Files on hold awaiting Examiner s review Blue: Files which are ready to be invoiced. Maroon: Files we have reviewed and returned. There will be file notes, and the name of the correct person that reviewed for each returned claim. Yellow: File you have currently re-opened You will need to call us to have a file re-opened Grey: Files which are in denial status awaiting a letter to be written to client. YOUR OPTIONS If you want to show more than the default view of 25 claims per page you can optionally choose between showing 25, 50 and 100 claims per page

6 You can click on the top of each column to sort claims by the headings For example: if you want to sort the list based on zip code you would click on the ZIP Code column Additionally, if you know only part of an insured s name, or maybe a partial address or other detail you can type that in to the search box provided on the home page and it will return results based on the information you provided which most closely matches. SEARCH MENU / OPTIONS The search menu can be used to locate claims which have been closed along with many other search options. Invoices that have been exported to Accounting but voided from our system can be search by checking the box next to Search Voided invoices. Notice: By default adjusters will NOT see Invoice Search as shown below, and can only search through those claims which are still in them name. Also please consult your manager if a claim is required to be re-opened. Adjusters do not have the security rights to open claims once closed.

7 WORKING WITH A CLAIM & CLAIMS TABS CLAIMS MANAGEMENT SYSTEM When an adjuster received a new assignment notification they will have the opportunity to either click on the claim number within their or visit the claims portal as to begin entering data for the claims process. SECURITY DISCLAIMER: An adjuster is limited to those claims which have been assigned to them. This adjuster will have the ability to review open and closed claims which they have worked on themselves. If a claim reassigned to another adjuster the original adjuster who worked the claim will lose the viewing rights to the claim. CREATING NEW CLAIM OR WORKING WITH CLAIMS From time-to-time it might be required to setup a claim manually, and the below directions should help with this process. Disclaimer: Once a claim is created, it cannot be deleted for audit reasons. A claim can be edited and closed without an invoice being sent to a client; however the claim itself cannot be deleted from the system once created. CREATING A NEW CLAIM STEPS STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 STEP 6 From the main menu click on the Claims button Provide all information which is required. Required fields will be represented by a small Red Star * Once you have entered all required fields on the Claim tab, press the SAVE button Click on the REPORT/LETTER tab found at the top of the screen From the Document drop down list choose Loss Notice Click the browse button and locate the Loss Notice also called First Notice of Loss FNOL Notice: This step assumes you have either scanned the FNOL or received the FNOL via an . If you receive an with data non-attachment please print to PDF and attach to claim as the Loss Notice. STEP 7 If known, you can assign the claim to an adjuster at this point from the CLAIM tab. Otherwise, the claim will be placed in the Unassigned Claims menu for assignment at a later time. If you choose to assign the claim now, the adjuster will receive an automated later in the date which this new assignment with detailed information needed to contact the insured.

8 OTHER FEATURES OF THE CLAIM PAGE CLAIMS MANAGEMENT SYSTEM There are a couple of other features which Admin s are granted which include 1. Sharing a claim with Multiple Adjusters 2. Duplicate a Claim, this is used to create separate claims which are invoiced separately but have the same loss information IE Insured Name and Loss Location but would be assigned to a different adjuster 3. Looking for past claims that match the Loss Address (must be exact match) 4. Sending Acknowledgement Letters to Insurers Internal Rep 5. Manual reassign the claim to another party Disclaimer: The following option is ONLY AVAILABLE to Admin s, and Adjusters do not have the options outlined in this section Next to the Claim Setup Header you will notice a small ARROW pointing downward. If you hover over this arrow a new menu will be displayed similar to the above example. SHARE CLAIM WITH FELLOW ADJUSTER To share a File with another adjuster, select Share Claim With. This will present a screen similar to the one show here. To share the file with another adjuster simply find their name in the list and click on their name. After completed hit the Save Button, or Cancel button if you do not want to save your changes. Disclaimer: When sharing a file with another adjuster that adjuster is able to add Time Log entries, File Notes and work on the claim the same as the assigned adjuster(s), however adjusters who you share a file with will not get a new assignment notification.

9 Example Example End Results DUPLICATING A CLAIM From time to time you may need to duplicate a claim. This is normally done when there is an inside piece to a claim along with an external piece and the claim is assigned to two different adjusters. This process will make an exact copy of the claim that is currently in the system. The claim will hold the same claim number which the client issues to us; however, the file will take on a new file number.

10 SENDING A CLAIM ACKNOWLEDGMENT TO INTERNAL REP When creating a manual claim in the system, it is important to thank the internal representative that sent the claim to your company. This is driven by the Internal Rep that is selected at time of claim creation at the top left of the claim input screen. Disclaimer: If the internal rep does not have an address on file the acknowledgement letter will not be sent, and an error message will be generated In the event the Internal Rep does not have an address in the system, you can update this information, by going into the Clients Record and locating this internal rep on the Internal Rep tab and updating their contact information if known.

11 CLAIM TAB There are several tabs within a single claim where each tab represents a phase of the claims process itself. DOC. LIBRARY The document library is where adjusters and administrators can locate customer and company specific shared documents such as logos, letter heads, and client guidelines and so on. FILE NOTES If you click this tab you will see a trail of what has happened on the file, and you can also add notes of your own. However, use extreme caution, because comments are permanent and cannot be deleted. Within notes you have the option to send a note to XactAnalysis from Claimatic by checking the box shown here in the below screenshot. Note this option is only available if the claim was received through XactAnalysis TIME LOG The time log is the heart of the claim when it comes to payment for adjusters and those that work on the file which drives the invoices later on in the process.

12 ENTERING GROSS LOSS CLAIMS MANAGEMENT SYSTEM Enter a gross loss on a claim can be done by admins or adjusters. In order to accomplish this you would go to the Time log screen of a claim and click on the More Options button. Enter the Gross Loss of the claim, and click Save, or click Cancel if you do not wish to save changes. Disclaimer: The Gross Loss cannot be done this way after the file has been moved to Ready for Review. However, Admins and Billers can enter the gross loss on the Invoice screen, or the Claim Screen.

13 MAKING FIRST CONTACT CLAIMS MANAGEMENT SYSTEM A claims status of First Contact Needed should be updated for all claims which are done on the Time Log screen of a claim. The step of making First Contacted is an important step in the claims process where the adjuster can make note of when the insured was contacted. Disclaimer: if you were unable to reach the insured DO NOT set the claim as being contacted but instead make a file note on the claim stating the time, date and a general message that you left for the insured/member. Set date of first contact, enter a note as to whom you spoke with or left voic and click the Save button Notice: If first contact has already been made the First Contact Made menu item will be grayed out similar to the following example Feature Alert: Please be aware that when First Contact is completed if the client is a XactAnalysis client the claim will be marked as contacted and the claim will also be marked as contacted in XactAnalysis with the note/information you enter upon making first contact in the notes section shown above SITE INSPECTED From the time log you can also enter the date of the claim being inspected as well. This is done by clicking the button Site Inspected under the Time Log and entering the date of inspection. Notice: As a benefit to the invoicing module Site Inspection is a required field. If this information is not present the claim cannot be closed or billed which may delay payment to adjusters.

14 TIME LOG ENTRY The Time Log entry screen is a very straight forward process. Where you would select the Expense, enter the Qty and if required enter a cost. For example if you drive 500 miles for a claim. You would enter mileage and then the QTY as 500, and select a date you drove those miles. You can also enter a description of the expense if you choose. Disclaimer: Most expenses have a cost associated with them already which is an agreed upon cost by the client. Change to these costs is discouraged and unauthorized changed might result in a delay of payment to the adjuster. Notice: If you are sharing the file with another adjuster they can enter time within the time log as well. TIME ENTRY END RESULT EXAMPLE

15 REPORTS & LETTERS CLAIMS MANAGEMENT SYSTEM The reports and letters tab is where you will upload your reports, and other documents which support the claim you are working on. To upload a file, follow these steps 1. Title is an Optional Field NOT REQUIRED 2. Select the document type 3. Click Browse and navigate to the folder you have saved the file to on your local computer 4. Click Upload Notice: If the claim has multiple locations you will be required to select the location the document you are uploading applies too. FEATURE NOTICE: Only PDF documents can utilize items 1-8 from the Document Type drop down list. This is due to the fact that Claimatic has the option to merge PDF documents together for QA review. Any document not in the PDF format must be uploaded as a number 10 Other (NO MERGE), unless it is an ESX file from Xactimate where that can be uploaded as number 11 EST (NO MERGE) Notice: If you make a mistake or upload the wrong file, you can safely delete it by clicking on the Red X next to the file name shown in the Report subsection of this page, and then uploaded the correct document

16 SENDING YOUR CLAIM IN FOR REVIEW CLAIMS MANAGEMENT SYSTEM When you are ready or completed with a claim and want to have it reviewed please click on the Ready for Review button on the claim screen Notice: If you do not click this button, a Reviewer will not be alerted that your file is ready for review and in turn might delay payment for your work. Disclaimer: In the event the adjuster submitted the claim for review by mistake, the adjuster can now click click on Ready for Review UNDO, which is only available if the file has been submited for review.

17 REVIEW PROCESS CLAIMS MANAGEMENT SYSTEM Security Disclaimer: Adjusters and client will not see these options. The next several steps are only seen by Administrators, Billers and Reviewers STEP 1 QA Reviewer locks the file for review. STEP 2 Reviewer would go to the REPORT / LETTER tab and open reuired documents to be reviewed STEP 3 Once approved QA Reviewer would click APPROVE button which moves the claim into a READY for INVOICE stage If QA reviewer RETURNS the file, they will be forced to enter a reason why the claim is being retured to the adjuster. From this point the adjuster will be notified by that their claim has been returned and requires additional work to be done. The claim is put in a File Returned Status Once the above steps are completed from a QA processing prospective, the QA Reviewer or Biller can proceed on to the Invoice phase of the claims process.

18 INVOICE PROCESS CLAIMS MANAGEMENT SYSTEM Security Disclaimer: Adjusters and clients will not see these options. The next several steps are only seen by Administrators, Billers and Reviewers. Invoice costs are driven by Fee Schedules and/or T&E Costs that are created and managed at the client level of the system where only Administrators have access to this section of the system. If you find a fee schedule incorrect, please consult with your manager or team lead. THERE ARE THREE DIFFERENT INVOICE TYPES 1. Final First invoice ever sent 2. Supplemental Invoice sent only after Final sent Supplemental to final invoice 3. Interim This type of invoice is used rarely when claims last longer than expected and there might be costs which need to be captured prior to a final or supplemental being sent out. NO BILL INVOICE From time-to-time you might be required to write off an invoice as a zero bill because an error might have been caused by the company or other parties. In this case check the box next to NO BILL. CREATING THE INVOICE STEP 1: STEP 2: STEP 3: STEP 4: STEP 5: STEP 6: STEP 7: STEP 8 Select an invoice type from the available drop down list Select a Fee Schedule you would like to apply from the drop down list Enter a Loss amount Gross Loss If known, enter Payment Pymt given to insured by Client Enter RCC if known Click on the Auto Expense button to make sure all expenses that are allowed on the file have been added. For example XactAnaylsis fee. Hit the Preview button and review the invoice to be submitted for payment Once approved click the Approve button (if not approved please press cancel) If new invoice is required beyond final invoice, the file must be open and where you would click on the NEW button found on the invoice screen

19 CREATING A CREDIT MEMO THE PROCESS Step 1: Ready to Create a Credit Memo? Step 2: Logon to Claimatic and search for the invoice you need to create the credit memo for Step 3: If there are multiple invoices on the file make sure you click on the correct invoice so the invoice number if BLUE see example here Notice invoice is blue in the below screenshot which is the active invoice you will be working with Step 4: From the invoice screen, hover your mouse over the Invoice Maint. Button as shown here, and choose Credit Memo Step 5: Click Preview and verify the credit memo is correct. Step 6: Once everything looks good, click Approve

20 SO WHAT IS NEXT RE-Invoice or Not and the Process CLAIMS MANAGEMENT SYSTEM What is next? Well this depends on if you are going to re-invoice the claim or not. If you are not going to reinvoice the claim then there are no additional steps you need to follow. If you re going to re-invoice the claim follow the below steps; Step 1: Hover over the Invoice Maint. Bar shown below and choose Void Invoice IMPORTANT NOTE: Once you void an invoice the claim will be placed Ready for Invoice status DISCLAIMER: If the claim does not have a credit memo the VOID option will not be available Step 2: Enter your password when prompted and hit VOID IMPORTANT NOTE: Once you void the invoice this will release all time log entries associated to that invoice so that you might re-invoice the claim and modify the expenses if required or adjust the gross loss if required. Step 3: Navigate to the Time Log and make any changes or corrections which are required which might be required Step 4: Go back to the Invoice Screen tab and click the New button and re-invoice the claim like you normally would. QUICK REVIEW OF PROCESS Our system will all adjusters new assignments daily When an adjuster receive the loss notices, the new claim will already be set up in the system Adjusters will work their claim(s) to an agreed conclusion for scope and pricing Upload your completed PDF file If all is correct with your report and once you have reviewed the PDF you have uploaded, you will need to click Ready for Review in order to alert us that your work product is ready for review If there is a mistake on your paperwork, you will notice a returned file on your home screen

21 NOTIFICATIONS IMPORTANT: Please be aware that these notification are sending from an automated system and reply s will not be read NEW ASSIGNMENTS NOTIFICATION Adjusters will be alerted to new assignments for open and re-opened assignments via or by phone depending on the nature of the claim. notifications will look similar to the following From these notifications the adjuster can choose to click on the Claim number and they would be direct claim itself in the system. Logon required. OTHER COOL FEATURES WITHIN THE SYSTEM HOW TO RE-ASSIGN A CLAIM 1.) Open and logon to the claims system normally 2.) Go to the Administration Menu and select Company 3.) Select Bulk Claims Reassign 4.) Select Adjuster you wish to reassign FROM 5.) Select Team 6.) Select new adjuster 7.) Check the box in the Action column to select claim 8.) Click Assign

22 COMMUNICATING TIME OFF The importance of the calendar is that if time is entered by the adjuster, team leader or admin claims will not be assigned to that adjuster during the period of time they have requested off regardless of their capacity, radius or availability within Claimatic. How to get to the Calendar 1. Logon to Claimatic 2. Click on the Tools menu 3. Choose View My Profile How to Enter Time Off 1.) From the Start Date, choose the date you wish to take off 2.) From the End Date enter when you will return 3.) In the event type; choose the type of time you will be taking if applicable 4.) Enter a description optional 5.) Click Add New NOTICE: The days off section of this page only shows those days off which have not past yet. To update one of the days

23 How to Edit Time Off 1.) Click Edit on the time period you wish to edit and change the Start or End Date 2.) Click Update In the event a manager or adjuster would like to cancel their time off, they would hit the $