Claims Configuration

In This Topic...

The Configuration menu includes sections for general claims settings and adding reference data for use throughout the system.

Adjuster Auto-Assignment

An adjuster can be assigned to a claim manually, or they can be assigned automatically in response to certain events.  Adjuster Auto-Assignment rules define which adjusters are available when the time comes to assign the claim.

The system evaluates the rules in the following events.

  • The user selects one or more claims in the Claims list and clicks the Assign Adjuster button.
  • The claim is submitted.
  • A custom Workflow Event occurs.

When evaluating rules, all conditions must be met for the adjuster to be considered available for a claim.

  • The rule must be active.
  • The trigger must evaluate as True.
  • When a custom Workflow Event occurs, that event must be included in the Workflow Events field for the rule.

If multiple adjusters are available, the adjuster with the least number of open claims will be selected.

If no adjusters are available, the claim will remain unassigned.

As the rules are evaluated each time an evaluation event occurs, a claim may be reassigned. This ensures that any changes to the claim are taken into account.

Note that the assignment of an adjuster can trigger custom events.  For this reason, custom events based on adjuster assignment cannot be selected for auto-assignment rules, which could cause a loop.

Creating a New Adjuster Auto-Assignment Rule

  1. In the main menu, select Claims, Configuration, then Adjuster Auto-Assignment.  A list of all available assignment rules is displayed.

    2. Tip: By default, only Active rules are displayed.  Clear the filter in the Status column to view all rules.

  2. Click Add.  The Adjuster Auto-Assignment Management window opens.
  3. Complete the necessary information.  Fields marked with a red asterisk * are required.

    4. Adjuster

    Select an adjuster.  The list includes all available users that have been defined as adjusters.

    Trigger

    Select a trigger to control if the adjuster is available or not under this rule.  Only triggers attached to claims workflows are listed. "Universal" triggers are not available for selection.

    Workflow Events

    One or more custom Workflow Events can be selected.  When events are selected, the rule is only applicable when one or more of those events occur.  If no events are selected, the rule is applicable for the default events of submitting the claim or when using the Assign Adjuster button.

    Description

    Enter a description for the rule.
  4. Click Add & New to save the details and clear the form to enter another rule, click Add & Close to save and return to the Configure Adjuster Auto-Assignment list, or click Close to return to the Configure Adjuster Auto-Assignment list without saving the rule.

    5. The Status panel is added to the page once the rule has been saved.

    Active

    Marks the rule as active and available for use.  If unchecked, the rule will no longer be applied.

    Created By

    Identifies the date and time the rule was created, and the user who created it.

    Last Modified By

    Identifies the last date and time the rule was changed, and the user who made the changes.

Viewing and Modifying an Adjuster Auto-Assignment Rule

  1. In the main menu, select Claims, Configuration, then Adjuster Auto-Assignment.  A list of all available assignment rules is displayed.

    2. Tip: By default, only Active rules are displayed.  Clear the filter in the Status column to view all rules.

  2. Click a link in the Adjuster Name column to view the rule details.  If there are a large number of available rules, see the Using Grids section for help on finding the appropriate rule.
  3. See the section on Creating a New Adjuster Auto-Assignment Rule for a detailed description of the fields.
  4. Click Save & New to save the details and clear the form to enter another rule, click Save & Close to save and return to the Configure Adjuster Auto-Assignment list, or click Close to return to the Configure Adjuster Auto-Assignment list without saving the rule.

Deactivating an Adjuster Auto-Assignment Rule

If necessary, an adjuster auto-assignment rule can be deactivated. This option can be used if the adjuster will be unavailable for a period of time.

The rule remains in place and can be reactivated at any time.

  1. In the main menu, select Claims, Configuration, then Adjuster Auto-Assignment.  A list of all available assignment rules is displayed.

    2. Tip: By default, only Active rules are displayed.  Clear the filter in the Status column to view all rules.

  2. Locate the rules to be deactivated.  If there are a large number of available rules, see the Using Grids section for help on finding the appropriate rules.
  3. Check the boxes for all rules to be deactivated.
  4. Click Deactivate, then confirm the deactivation when prompted to do so.  All selected rules are deactivated.  If the Configure Adjuster Auto-Assignment list is defaulted to only show active rules, they disappear from the list.

Tip: Individual rules can also be deactivated or reactivated directly through the Adjuster Auto-Assignment Management window.  See the section on Viewing and Modifying an Adjuster Auto-Assignment Rule for details.

Deleting an Adjuster Auto-Assignment Rule

If an adjuster will no longer be handling claims in the system, the auto-assignment rules can be deleted permanently.  This does not affect the adjuster user account or any claims already assigned to that adjuster.

  1. In the main menu, select Claims, Configuration, then Adjuster Auto-Assignment.  A list of all available assignment rules is displayed.

    2. Tip: By default, only Active rules are displayed.  Clear the filter in the Status column to view all rules.

  2. Click a link in the Adjuster Name column to view the rule details.  If there are a large number of available rules, see the Using Grids section for help on finding the appropriate rule.
  3. Click Delete to delete the rule.