Claims Management consists of Hotline Claim Notification, Claims Handling, Adjuster Assignment modules.

Hotline Claims Notification Module

Claims can be initiated through Hotline application, where upon receiving claim related calls, call center officer registers initial information on claims and events, specifying whether those are urgent or non-urgent. Urgent cases are sent to Adjuster Assignment module for immediate actions by in-house adjusters.

hotline

Functional Highlights

  • Advanced search tools to promptly find the subject policy, searching by multiple criteria of client (policy holder) policy or insured object
  • Registration of hotline notification, including date and time of call, caller details, call description, attachment of voice file of recorded conversation and other general information
  • Registration of event description
  • Easy view of covers and limits under the subject policy
  • Full integration with Underwriting, Claims Handling, Service Providers Management, Service Provider Office,Adjuster Assignment, CRM and Customer Suppor modules.

Claims Handling

Registration of claims is facilitated by user friendly interfaces, which can be accessed through dedicated section or from the selected policy.

clime

Functional Highlights

  • New claim registration or making changes in the existing claim
  • Advanced search and filter tools to find claims having searched parameters
  • Mapping claims to existing or new events
  • Claims reserve assessment
  • Registration of invoices
    • Manual or automatic application of deductibles
    • Preauthorization workflows for approval of invoices (above defined limits)
    • Create prepayments
    • Categorization of invoices by recipients and by expense types used for various reporting purposes
    • Uploading and archiving scanned copies of documents for easy access in future
  • Multiple beneficiaries in a single claim
  • Uploading and archiving claim related documents for future reference such as compliance check with mandatory list of documents configured at product level (e.g. scanned copy of Traffic Police statement for Motor Claims)
  • Adjusters’ notes
  • Denoting claims as doubtful for investigation by Quality Control or other related officers
  • Actions taken on a claim as per the list of possible actions configured at product level
  • Registration of Subrogation (Recovery)
  • Full integration with Underwriting, Policy Reinsurance, Hotline, Service Providers Management, Service Provider Office, HR, Accounting and Finance, Claims Reinsurance, Adjuster Assignment, Service Providers Management, CRM, Workflow and Analytics Dashboard modules.

Adjuster Assignment

Adjuster Assignment module serves for assigning claims to in-house adjusters, for relevant actions (e.g. Inspection visit to the occurrence place such as car accident or property fire).

hotline

Functional Highlights

  • Add or remove adjuster from the pool of company employees
  • Assign and reassign claims to Adjuster
  • Advanced search and filter tools for finding required list of claims
  • Linking service providers to adjusters for automatic case assignment
  • Fully integrated with Hotline, Claims Handling, Service Providers Management and Workflow Management.

Copyright © 2016 Sylex Technologies. All rights reserved.