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- Health Insurance Claims
- Process
- Policy review to issuance
Policy review to issuance
Policy issuance starts with an identifiable policyholder and ends with a reviewed policy and an operation receipt that matches the issued effect. The owner prepares terms; an independent reviewer makes the decision. The claims team then has a stable policy context for later losses.
Step by step
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Set policy context Policy Operations Specialist
Policy Operations Specialist links the party, organization and owner, then checks the effective date and premium.
- Links party, owner and applicable terms
- Updates Organizations, Policyholders, Team members, Policies, Policy coverages
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Review policy Preauthorization Reviewer
The reviewer checks the current revision, coverage lines and any endorsement before approval.
- Preserves reviewer, reason and source revision
- Updates Policies, Review decisions, Record attachments
ApprovalA person approves before the work moves on. -
Record issuance Policy Operations Specialist
Policy Operations Specialist records the issued state, issue date and carrier identifier when available.
- Retains issue state and later effective changes
- Updates Policies, Policy endorsements
-
Reconcile the receipt Finance Reconciler
Finance Reconciler checks that the operation receipt identifies the same policy revision and effect.
- Checks operation key and expected revision
- Updates Operation receipts, Policies
Who does what
Roles and permissions- Policy Operations Specialist
- Prepares the policy.
- Preauthorization Reviewer
- Makes the independent review decision.
- Finance Reconciler
- Investigates receipts.
- Claims Assessor
- Reads the issued terms later.
Set up Health Insurance Claims your way.
Start free, then use Proto to change fields, steps and approvals before your team goes live.