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- Marine Insurance System
- Process
- Claim settlement
Claim settlement
An approved claim is ready for payment reconciliation, not already settled. A claim payment holds the amount actually paid, payment date, provider event and verification result. It references both the claim and the decision approving the benefit. The settlement workflow requires a unique verified payment against an approved decision before changing the claim to Settled.
Step by step
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Check approval Authorized Underwriter
Authorized Underwriter reads the claim and its Approve decision, including the authorized benefit.
- Identifies authorized benefit
- Updates Claims, Claim decisions
-
Record payment Authorized Underwriter
Authorized Underwriter associates the provider event, amount and paid date with the same claim and decision.
- Retains paid amount and provider identifier
- Updates Claim payments, Claims
-
Verify event Authorized Underwriter
Authorized Underwriter compares the payment with actual provider evidence and marks its verification result.
- Distinguishes verified payment evidence
- Updates Claim payments
-
Settle claim Authorized Underwriter
Authorized Underwriter confirms the unique verified payment and moves the claim from Approved to Settled.
- Changes claim state after actual payment
- Updates Claims, Claim payments
Who does what
Roles and permissions- Authorized Underwriter
- Reconciles the benefit and payment.
- Auditor
- Inspects payment and decision evidence.
- Admin
- Oversees access.
Set up Marine Insurance System your way.
Start free, then use Proto to change fields, steps and approvals before your team goes live.