The Claim Approval Matrix outlines when a claim will automatically be approved. If the claim won’t automatically be approved, we either have to get more information from the adjuster/insurance company or we will need to have the claim manually overridden.How does the Matrix work?
Collect data up front as much as possible when a claim arrivesReview files on a regular basis and update missing dataClean up old files so that we have everything we need.Our objective is to clean up all of 2010-2011 files before dend of December 31,2011.
Customer Approval. A new step has been added to creating a customer file. Once a customer is created, a few selected people will now have the ability to approve those customers. Clients associated with approved companies are automatically approved such as an adjuster that is associated with Aviva Head OfficeYou can create a claim with an unapproved customer, but phases can’t be closed until approved customers are used.You no longer have to select an adjuster in order to be able to open a claim. All of the variations of customers that were created in order to work around the problems associated with having to select an adjuster for a claim have been removed. This includes Private, To Be Announced, Unknown, Direct etcPrivate work will be allowed through a Claim Approval OverrideAdministrative staff will be expected to review all claims on a regular basis to update information and ensure accuracy and completion
Approved customers will appear black in the list. Unapproved customers will appear in red.Anyone can use an unapproved customer on a claim; however, a phase can’t be closed until that customer gets approved.Database cleanup may have assumed that the adjuster no longer existed; and, therefore, didn’t approve the company. Send an email to your regional client database contact, and they will update the system.
Yes, as long as we have an adjuster and insurance company, then the claim will automatically be approved.NOTE: If it is a new adjuster, then that individual would have to be created as a client. As long as the client is attached to an approved company, the client will be approved.
No, we don’t have an insurance company.
Yes, HBC is a Property Manager. Therefore, there is no need for an adjuster or insurance company to be on this claim in ClaimTrak.
No, we will need to know who the adjuster is.What should Debby do if there is no adjuster?NOTHING—simply leave the field as ‘no adjuster’ until that information is known.
No adjusterNo insurerNo property managerNo, this claim will require a manual ‘claim approval’ override.
It’s important to review new claims on a weekly basis to see if there is data missing. Keep in mind that files with missing data will not be able to have phases closed.Our goal is to review all files for 2010-2011 before December 31, 2011.
Claim trak claim approval for admin
Claim Approval New Business Rules will apply to Phase Closure as of October 31, 2011 1. In order for a phase to be closed on a jobs, the claim must meet the new business rules of the Claim Approval Matrix. If the claim does not meet the established rules, 1. No phases can be closed on that claim until the issues are resolved OR 2. A manual Claim Approval override is done.2
Objective • To get rid of Private/Private as a common customer • To force review of claims and better data collection • To produce more accurate sales figures and information4
Claim Approval Matrix Adjuster Insurer Property Mgr Auto- Approved? Yes Yes No Yes Yes No Yes No No Yes No No No No Yes Yes No Yes Yes No3
What do you have to do? 1.Collect 2.Review 3.Clean5
Changes to ClaimTrak 1. Customer Approval 2. Private, To Be Announced ,Unknown will no longer be a choice 3. ‘No adjuster’, ‘No Insurer’ are valid selections when inputting a claim 4. Ability to find Unapproved Projects5
Customer Approval • All approved customers appear in black type. • Unapproved customer appear in red font • Applies to – Adjusters – Insurers – Property Managers5
Scenario 1• Anne receives a claim over the phone from the local Intact Insurance adjuster. She receives a Adjuster Insurer Property Mgr Auto- Approved? – Claim number Yes Yes No Yes Yes No Yes No – Adjuster No Yes No No – Insurance Company No No Yes Yes – Name, address, etc. No Yes Yes No Is there enough information for the claim to be approved? 10
Scenario 2• Betty receives a claim over the phone from a local independent adjuster. She receives a – Adjuster Adjuster Insurer Property Mgr Auto- Approved? – Name, address, etc. Yes Yes No Yes Yes No Yes No – Loss description No Yes No No No No Yes Yes No Yes Yes No Is there enough information for the claim to be approved? 10
Scenario 3• Cathy receives a claim over the phone from HBC. She knows that HBC is a Property Manager in the system. She inputs the following: Adjuster Insurer Property Mgr Auto- Approved? – Store Name, address, etc. Yes No Yes No No Yes No No – Loss description No No Yes Yes No Yes Yes No Is there enough information for the claim to be approved? 10
Scenario 4• Debby gets a claim from a PM. He says that it’s an Intact claim. She inputs the following: – No adjuster Adjuster Insurer Property Mgr Auto- Approved? – Insurer = Intact Yes Yes No Yes – Name, address, etc Yes No Yes No – Loss description No Yes No No No No Yes Yes No Yes Yes No Is there enough information for the claim to be approved? 10
Scenario 5• Edith gets a call from Ima Bean. Mrs. Bean wants FOS to come and clean up mould in her house, but there is no insurance coverage. How should this claim be entered when entering the adjuster, insurer, etc? Is there enough information for the claim to be approved? 10
Scenario 5• How do truly private claims get approved? Claim Approval Override!!This is limited to a select group of individuals.You must request override and be able to justify. 10
Reviewing Files(Looking for Unapproved Projects)
Reviewing Files To review files, go to the Search page, and select the following: Insert a reasonable date range. Update the files listed5
ClaimTrak – Claim Approval Service Delivery ModelAccess documentation, training aids and presentations on the FOS Intranet under the Operations Tab – Claim Approval Ingrid Himmelman firstname.lastname@example.org