You are here:
Explore Claims Management in Digital Insurance
Configure claim products and design the first notice of loss intake processes for your users. Provide claims adjusters with a unified view of claims and financial information, helping them effectively evaluate and process claims. Implement financial controls and automate the entire processing workflow with APIs and workflow rules.
- Claims Management Editions and Permission Sets
Give users access to Claims Management features. Review the supported edition and permission sets for Claims Management. - Set Up Insurance Claim Products
Define the insurance claim products that you sell to customers, including their classifications, categories, and attributes. Define rules that determine how your insurance claims are processed. - Product Attribute Scope Mapping
As a claim admin, you can configure a product with product attribute scopes. These scopes are used to enforce policy limits, such as deductibles, copays, limits, coinsurance, and out-of-pocket max on attributes associated with coverage and root products. These attributes have specific definitions that make sure that the claims management system enforces their policy limit requirements. To use a coverage or root attribute in claims with specific tracking to enforce a policy limit, create it as a record in the Product Attribute Scope entity and add it to either or both the root coverage and policy coverage overrridden attributes. Use the Product Attribute Scope to track the consumption of policy limits, such as deductibles, copays, coinsurance, and out-of-pocket maximums, through a claim for a policy. - Context Definitions for Insurance Claims
Improve the efficiency of sharing and using business application data with Context Service. This service helps your business users boost application performance by optimizing data access and eliminating redundant inputs. When an application requests data, Context Service gathers all required information from the database and loads it. It then delivers the necessary data to the appropriate processes to meet the application's needs. - Claim Workflow Rules
Claim workflow rules are the guidelines set up by the insurance company to process and evaluate insurance claims. They are used for consistent processing of the claims, improved customer satisfaction, robust compliance, and enhanced operational efficiency. - Manage Claim Participants and Claim Items
The Claim Participant Lightning web component (LWC) offers a detailed, hierarchical view of claim participants and their associated items. Add, edit, view, or delete Claim Participants and Claim Items of type Damage or Injury. Configure dynamic and extended attributes for each Claim Item. View the complete attribute details for each Claim Item in the side panel to gain a thorough understanding of the specifics of each claim. - Claim Financials Component Overview
The Claim Financials lighting web component (LWC) is the central workspace where claim adjusters manage all financial aspects of a claim. This process starts after the First Notice of Loss (FNOL), after the system has created the foundational claim records, such as coverages, participants, and involved items. This component provides the capabilities needed to evaluate and then settle the claim. - Considerations for Claims Financials
Review these considerations related to Claims Financials. - Custom Setup for Calculating Adjustments and Processing Limits
Insurers can extend or override the default adjustment and limit processing logic based on their specific product configuration, locale-specific compliance needs, or customer specific rules, while maintaining consistency within the core claim adjudication workflow. - APIs for Insurance Claims Management
Enhance your insurance claims management with APIs. These APIs integrate seamlessly with Omniscripts to help you efficiently manage claim data. - Invocable Actions for Insurance Claims Management
Use the invocable actions in Salesforce Flows to manage claims. - Claim Credit Usage Considerations
Use of Insurance Claims Management impacts the consumption of credits used for billing in these usage types.
Did this article solve your issue?
Let us know so we can improve!
