Claim assessment

Step by step

1. Report the loss Claims Specialist

   Claims Specialist links the claim to the policy and records the claim number, loss and report dates, claimed amount and evidence summary.

   • Create the policy-linked claim
   • Updates Claims, Policies

2. Check the policy Claims Specialist

   Claims Specialist reads the policy status, effective period, coverage lines and relevant endorsements for the loss date.

   • Read terms effective at loss date
   • Updates Policies, Policy coverages, Policy endorsements

3. Assess the case Claims Specialist

   Move the claim from Reported to Assessment while reviewing the evidence and amount. Ask the claimant or internal team for more detail where needed.

   • Move Status to Assessment and examine loss evidence
   • Updates Claims

4. Send for review Claims Specialist

   Move the claim to Review with a clear summary of the policy position and evidence. Claims Authorizer should receive the same claim and policy context.

   • Move Status to Review
   • Updates Claims

5. Decide the benefit Claims Authorizer

   Claims Authorizer approves, declines or requests evidence in a claim decision, recording the reason, approved amount and authorizing identity. A final approval or decline changes the claim's disposition.

   • Record Decision, Reason and approved benefit USD; set disposition
   • Updates Claim decisions, Claims
   ApprovalA person approves before the work moves on.

Claims Specialist

Prepares and assesses the case; Claims Authorizer decides the benefit; Policy Operations can clarify policy and endorsement history.