Here at ClaimVantage, we’re continually upgrading our claim system to improve usability and claim processing efficiency. Workflows and Tasks have always played a key role in the core product automation to improve claim processing efficiency. Self-service workflows have recently been implemented in the claims system to allow users to set up workflows internally, based on specific claim conditions.

Tasks, emails, letters and text messages (SMS) can be set up to trigger based on specific claim events such as Claim Created, Payment Approved, Payment Denied, or Claim Status Changed. These events can also be specified based on the benefit type, such as a Short-Term Disability (STD) claim, Survivor Benefit, or Term Life.

Let’s look at an example; click on the image below to view the workflow being set up so that when an STD claim payment is approved, the system automatically generates an email to be sent to the claimant. The email can also be personalized based on a company’s business best practices, by clicking on the Details button. Dropdown menus (identified by the blue arrows) offer users an array of options, based on common scenarios.

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Alternatively, tasks can be set up to trigger a certain amount of days after a claim has been created, as a reminder for claims administrators to complete an associated task. Click on the image below to see how a workflow is set up to trigger a task when a claim is pending 14 days after claim creation. The administrator will receive a notification to review the claim status and to check if all necessary documents have been gathered. When this is complete, the administrator can submit the claim for approval.

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Similar to the email example above, letters can also be automatically triggered based on claim events. The image below shows that when a claim is created, an Initial Notification letter is always created, and if the claim status is still pending 14 days later, a letter will automatically generate to make the claimant aware that there are outstanding documents required before the claim can be processed.

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Other typical scenarios include:

  • an Email containing Payment details is automatically sent to the customer when a Payment is approved,
  • a Letter can be created containing a summary of the Claim Details when the Claim is created and attached to the claim,
  • a Task can be created when an Attachment is added through the Employee Portal with a specific subject and due date, or
  • a Task can be created when a Benefit Claimed has remained Pending on an Open Claim for more than ten business days.

These are just a few examples of what can be achieved using this self-service workflow set-up. Claims processing workflows can help improve customer service as well as improving claim processing efficiency.