Claims Intake Specialist
Records reported losses and supporting evidence for review.
Can
- Manage Claims, record attachments
- View Policies, policy coverages, Policyholders
Starts on: Claims requiring assessment
- Health Insurance Claims
- Roles and permissions
Who can do what in Health Insurance Claims
Give intake, reviewers and finance distinct responsibility for each claim decision.
Who can do what
| Role | Policy and coverage | Policyholder and organization | Preauthorization review | Claims assessment | Benefit settlement | Review and evidence |
|---|---|---|---|---|---|---|
| Claims Intake Specialist | View | View | Edit | Edit | Edit | Edit |
| Claims Assessor | View | — | View | Edit | Edit | View |
| Claims Decision Reviewer | View | — | View | Approve | Approve | View |
| Policy Operations Specialist | Edit | Edit | — | Edit | — | — |
| Preauthorization Reviewer | View | — | Approve | View | — | Edit |
| Finance Reconciler | Edit | — | Edit | View | Edit | Edit |
| Admin | View | Edit | View | View | View | Edit |
Each role in detail
Claims Assessor
Checks claim evidence against the policy and prepares a decision case.
Can
- Manage Claims
- View claim decisions, Policies, policy coverages, record attachments
Starts on: Claims requiring assessment
Claims Decision Reviewer
Makes an independent benefit decision on a reviewed claim.
Can
- Manage claim decisions
- View Policies, policy coverages, record attachments
Reviews and approves
- Approve Claims
Starts on: Claims decision board
Policy Operations Specialist
Maintains policyholder, coverage and policy records before review.
Can
- Manage Policyholders, Policies, policy coverages, policy endorsements
- View Organizations, premium receipts
Starts on: Submitted preauthorizations
Preauthorization Reviewer
Reviews submitted requests and records the insurer-confirmed outcome.
Can
- Manage Preauthorizations, review decisions
- View Policies, record attachments
Reviews and approves
- Approve Preauthorizations
Starts on: Submitted preauthorizations
Finance Reconciler
Verifies payment and premium evidence and investigates operation exceptions.
Can
- Manage claim payments, premium receipts, operation receipts
- View Claims, claim decisions, Policies
Starts on: Settled and closed claims
Admin
Maintains staff identities and organization access.
Can
- Manage Users, team members, Organizations
- View Policies, Claims, operation receipts
Set up Health Insurance Claims your way.
Start free, then use Proto to change fields, steps and approvals before your team goes live.