Claims Processing

The Claims Processing section of the Agency Management System (AMS) Wiki offers detailed guidance on managing and processing insurance claims within the brokerage. This essential function ensures timely and accurate resolution of claims, maintaining client satisfaction and compliance with insurance policies.

Overview

Efficient claims processing is critical for the reputation and operational success of an insurance brokerage. The AMS streamlines this process by providing tools for filing, tracking, and resolving claims, facilitating communication between the insured, brokers, and carriers.

Filing a New Claim

1. Navigate to Claim Doctype: From the AMS dashboard, select "Claims" under Core Functionalities.

2. Create New Claim: Click the "New" button to open the claim submission form.

3. Enter Claim Details:

   • Claim Number: Automatically generated or manually entered unique identifier.

   • Insured: Link the claim to the corresponding insured entity.

   • Policy: Associate the claim with the specific policy under which it is filed.

   • Type: Specify the type of claim (e.g., property damage, liability).

   • Filed Date: Record the date the claim was filed.

   • Description: Provide a detailed description of the claim, including any relevant incidents.

4. Documentation: Attach any relevant documents, photos, or reports that support the claim.

5. Save and Submit: Review all details for accuracy, then click "Save" and "Submit" to file the claim.

Claim Review and Investigation

1. Assign to Adjuster/Agent: Assign the claim to a customer service agent or claims adjuster for review and investigation.

2. Investigation Process:

   • Contact Insured: Initiate communication with the insured to gather additional details or clarification.

   • Review Documentation: Examine attached documents and any additional evidence collected during the investigation.

   • Assessment: Determine the validity of the claim and assess the extent of the liability or damages.

3. Update Claim Record: Record investigation findings, update the claim status (e.g., Under Review, Approved, Denied), and document the rationale for the decision.

Resolving Claims

1. Resolution Decision: Based on the investigation, decide whether the claim will be approved or denied.

2. Communicate Decision: Notify the insured of the decision, providing clear explanations and next steps if the claim is approved or denied.

3. Payment Processing: For approved claims, initiate the payment process, detailing the amount to be paid and any deductibles applied.

4. Claim Closure: Once resolved, update the claim status to "Closed," ensuring all documentation is complete and filed appropriately.

Tracking and Reporting

1. Claims Dashboard: Utilize the AMS dashboard to monitor the status of all claims, identifying any bottlenecks or trends.

2. Search and Filters: Use search functionality and filters to locate claims based on status, type, insured name, and other criteria.

3. Claims Reports: Generate reports for a comprehensive analysis of claims data, including resolution times, types of claims filed, and adjuster performance.

Tips for Effective Claims Processing

• Timeliness: Ensure claims are processed promptly to maintain client trust and satisfaction.

• Accuracy: Maintain thorough and accurate records at every stage of the claims process to support decision-making and compliance.

• Communication: Keep open lines of communication with the insured and other stakeholders, providing updates and clear explanations throughout the process.

Support and Resources

For additional assistance with claims processing or to learn more about advanced features and best practices, consult the Support and Resources section of the wiki. Here, users can access technical support, user forums, and detailed guides to enhance their claims management capabilities.