Configuring a Claims Workflow

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A workflow is a collection of fields, panels, and screens that define how the end users will navigate and enter data for claims. This is the final step in the workflow design process, although additional configuration is required at the claims configuration level to process a First Notice of Loss (FNOL). Note that only a single claims workflow can be used in this module.

Once the claims workflow is published, the Payments screen is automatically included. This screen contains a default set of fields, panels, and grids, and can be used to log and manage the payments related to the current claim. For information on the Payments screen, see the Other Claims Features section.

From the main menu, select Product Design, then Workflow Containers. A list of available containers is displayed.
Click Add to create a new container. The Workflow Container page opens and the General Information panel is displayed.
Enter the information. Fields marked with a red asterisk * are required.

Name	Enter the name of the workflow container. This is the configuration name, used to select this container in other configurations. This name does not appear in the workflow itself.
Code	This is an internal reference code. A code can be entered manually, or one will be automatically generated when the workflow is saved.
Functional Area	Select what areas of the system will be using this workflow container and its associated resources. This selection also determines which Standard Containers will be automatically shared to the current container.
Common	The resources will be available across all areas.
Policy	The resources will be exclusive to the policy module.
Claims	The resources will be exclusive to the claims module.
Description	A description can be provided for the workflow container. This information is only displayed here and in the Workflow Containers list.

Select Claims as the Functional Area.
Select an action.
- Click Save to save the workflow container and remain on the page.
- Click Save & Close to save the container and return to the Workflow Containers list.
- Click Close to return to the Workflow Containers list without saving the workflow container.

The Status panel becomes available once the workflow container has been saved.

Active	Marks the workflow container as active and available for use. Inactive containers will still be functional in existing configurations, but cannot be selected for new configurations.
Created By	Identifies the date and time the workflow container was created, and the user who created it.
Last Modified By	Identifies the last date and time the workflow container was changed, and the user who made the changes.

Saving the Workflow Container navigates the user to the Workflow Container page, where the fields, panels, and screens needed for the claims workflow. Create these resources as necessary.
Once the data capture elements have been configured, create a Workflow. Complete the necessary information. Fields marked with a red asterisk * are required.

Name	Enter the name of the workflow. This is the configuration name, used to select this workflow in other configurations. This name does not appear in the workflow itself.
Code	This is an internal reference code which is generated by the system when the workflow is saved.
Type	Select the type of workflow. This setting cannot be changed once the workflow has been saved.
Steps	A core workflow, organized into steps and screens.
Tabs	A tabbed workflow for use with tab grids.
Target System	Select where the workflow should be used.
Policy	The workflow is meant for use in the policy module.
Claims	The workflow is meant for use in the claims module.

Select Steps as the workflow type, and select Claims as the target system.
Proceed with saving and publishing the workflow. For additional information, see the Managing Workflows section.

Required & Recommended Fields

A field to capture the Date of Loss must be configured before a user can process a First Notice of Loss (FNOL). It is also recommended, though not required, to configure a second field to capture the Date Reported. Once these fields are populated by the user, the data will be displayed within the Claim Information Widget and additional actions will become available to the user.

Note: The following configuration is an example and is not intended as an absolute solution.

From the navigation menu, select Product Design, then Workflow Containers. A list of available containers is displayed.
Open the appropriate container for the claims workflow, or create a new workflow container. For additional information, see the Configuring a Claims Workflow section.
From within the Workflow Container Menu, select Workflow Management page, then Fields. A list of available fields within the workflow container is displayed.
Click Create. Configure two date picker fields, one for the Date of Loss data and one for the Date Reported data. For information on configuring fields, see the Managing Fields section.

All fields marked with a red asterisk * are required.

For each field, navigate to the Business Rules panel.

Enter the appropriate placeholder in the Bind To field found in the Business Rules panel. This links data input by the user to the appropriate fields in the Claim Information widget.
- Date of Loss field: [[Claim/DateOfLoss]]
- Date Reported field: [[Claim/DateReported]]

For information on claims placeholders, see the Full Placeholders List for Claims Information section.

Select an action.
- Click Add to save the field and remain on the Field Management page.
- Click Add & Close to save the field and return to the Fields page.
- Click Close to return to the Fields page without saving.

Fields Configured with Bind To Business Rule

Fields with a Core Field Code are available for the Bind To option in the Business Rules section when managing fields. This option allows the field to be mapped to a core field in the system. This field displays the current value of the core field, and any changes to this field are saved to the core field. Additionally, when creating new fields to map to the Claims core fields, users can set a default value.

The following fields are available to be set for Bind To in the Claims module and the value entered is mapped to a Claims core field:

Claim/DateOfLoss
Claim/DateReported
Claim/ReportedPolicyNumber
Claim/CauseOfLoss
Claim/DescriptionOfLoss
Claim/AuditNumber
Claim/ParentClaimNumber
Claim/LossAmount/Amount (The core field is named “LossAmount_Amount”.)
Claim/LossAmount/Currency (The core field is named “LossAmount_Currency”.)

When creating a new field, a default value can be set using either a constant or an expression value. The below are some examples of default values using a constant or expression.

For date fields, a constant value can be set, such as "2020-01-01" or an expression like "TodayXML()". Additionally, the default value's expression can be set to a placeholder such as [[Claim/DateCreated]], which sets the field value to the date the claim was created.
For decimal fields, a default value can be set as a constant such as 20.00, or an expression can be used to calculate the default value of the decimal.
For text fields, the default can be a constant or expression value.
For text fields that map to currency fields, like LossAmount_Currency, the system verifies that the provided code is a valid currency in the Claims module. If not, the default is ignored.

Managing Option Lists for the Claims Workflow

Certain steps in the claim submission process require the configuration of multiple options for the user to choose from. Option Lists can be created to define these choices.

The configuration steps vary depending on the purpose of the Option List. Core Option Lists require a minimum amount of configuration but must be identifiable by their system reference code. Alternately, custom Option Lists provide a greater amount of flexibility but must be linked to a field configured within the claim submission workflow before they become available for selection to the user.

Core Option Lists in the Claims Module

An Option List is required for each of the core system lists that support the claim processing life-cycle. Once a core Option List is configured with the appropriate resource code and the workflow is published, the list options are automatically populated in the appropriate sections of the system.

The following core Option Lists are supported by the system.

Claim Payment Categories / Types
1. Indemnity
2. Expense
3. Salvage
4. Recovery
Claim Payment Reversal Reasons
Claim E-mail Attachment Types
Claim Sub-Statuses
Claim Note / Task Categories

Note: As of release 2.5.121, claim Sub-Statuses have been migrated from the claims General Settings Menu to the Claim Sub Statuses option list. Sub-Statuses can be added, modified, and deleted as with any other custom Option List. Following each modification, the workflow must be published.

To identify the naming convention required to generate the appropriate resource code for each core Option List, please see the description provided for the Name field below.

Custom Option Lists in the Claims Module

Custom Option List can also be configured and linked to custom field(s) within the submission workflow, making the list of options available for selection to the user at a specified point during the submission. For additional information on linking a custom Option List to a field in the workflow, see the Linking Custom Option Lists to the Claims Workflow section below.

Creating a New Option List

Open the appropriate Workflow Container that has been configured with Claims as the Functional Area. For instructions on finding and opening a container, see the section on Managing Workflow Containers.
In the Workflow Container Menu widget, open the Lookups group and select Option Lists. The Option Lists page opens with a list of all available option lists within the current container and any shared containers.

Some columns have been hidden.

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

If there are a large number of available option lists, see the Using Grids section for help on finding the appropriate lists.

Select an action.

Click a link in the Name column to view an existing option list.
Click Create to add a new option list.
Check the boxes for one or more option lists and click Deactivate to disable the selected lists. An option list can also be deactivated from the Option List Management page. Inactive lists will still be functional in existing configurations, but cannot be selected for new configurations.

On viewing or creating an option list, the Option List Management page opens.
The panels and fields are described below. Fields marked with a red asterisk * are required.

Name

Enter the name of the list.

Note: When configuring a core Option List, the system must be able to identify each resource by its system code. For this reason, one of the following naming conventions must be used.

Option List Type	Naming Convention
Indemnity Payment Types	Claims Payment Category Indemnity
Expense Payment Types	Claims Payment Category Expense
Salvage Payment Types	Claims Payment Category Salvage
Recovery Payment Types	Claims Payment Category Recovery
Claim Payment Reversal Reasons	Claim Payment Reversal Reasons
Claim Email Attachment Types	Attachment Type Code
Claim Note / Task Categories	Claims Note Categories

Code

This is an internal reference code which is generated by the system when the option list is saved.

Description

A description can be provided for the option list. This information is only displayed here and in the Option Lists list.

Correlated

This functionality is not supported for Option Lists configured for use within the claims module.

Parent Field

This functionality is not supported for Option Lists configured for use within the claims module.

Type	Select Static as the option list Type. All items in the list will need to be added in the Option List Items grid.
Resource Type	Select Custom as the Resource Type.

This version of the Option List Items panel is used when Static is selected as the option list Type. Each item to be included in the list must be entered individually.

Click in the field marked Please click here to add new row.
Enter the Label of the list item. This is the text that appears in the list in the workflow.
Enter a Code for the list item. This can be used to identify the list item for filters and conditions.

Spaces and special characters are not permitted, and will be removed from the code when the option list is saved.

If no code is provided, it will be generated by the system when the option list is saved.

Enter a Sequence number. This determines the item's position in the list, with lower numbers appearing first.

Tip: It is advisable to leave gaps between the sequence numbers, such as 5, 10, 15. This allows new items to be added to the list at a later date, inserted between existing items. Otherwise, the sequence numbers of existing items must be changed to allow for the new addition.

Click outside the row to add the item to the list. The row is marked with an added icon .
Repeat the previous steps to add additional list items.

To edit a list item, double-click in any field within the grid. On clicking outside of the row, the row is marked with a modified icon .

To delete a list item from the list, right-click on the item and select Delete. The row is marked with deleted icon .

Until the page is saved, all additions, edits, and deletions are temporary. To accept the marked changes, right-click in the grid and select Accept All Changes. To undo the marked changes, right-click in the grid and select Undo All Changes. Note that these options do not save the page.

When the page is saved, all marked changes are automatically accepted and saved.

Use caution when deleting list items or changing the Code. If the item has been used within the system, deleting it or changing the code could affect calculations and other resources.

The Status panel becomes available once the current option list has been saved.

Active	Marks the option list as active and available for use. Inactive lists will still be functional in existing configurations, but cannot be selected for new configurations.
Created By	Identifies the date and time the option list was created, and the user who created it.
Last Modified By	Identifies the last date and time the option list was changed, and the user who made the changes.

Select an action.

Click Add or Save to save the option list and remain on the page.
Click Add & Close or Save & Close to save the option list and return to the Option Lists list.
Click Close to return to the Option Lists list without saving the list.

Linking Custom Option Lists to the Claims Workflow

Once a custom option list has been configured, a field must also be created to link the option list to the claims workflow. A unique field is required for each option list.

Open the appropriate Workflow Container that has been configured with Claims as the Functional Area. For instructions on finding and opening a container, see the section on Managing Workflow Containers.
In the Workflow Container Menu widget, open the Workflow Management group and select Fields. The Fields page opens with a list of all available fields within the current container and any shared containers.

Some columns have been hidden.

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

If there are a large number of available fields, see the Using Grids section for help on finding the appropriate fields.

Select an action.

Click a link in the Name column to view an existing field.
Click Create to add a new field.
Check the boxes for one or more fields and click Deactivate to disable the selected fields. A field can also be deactivated from the Field Management page. Inactive fields will still be functional in existing configurations, but cannot be selected for new configurations.

On viewing or creating a field, the Field Management page opens.
The panels and fields are described below. Fields marked with a red asterisk * are required.

Name	Enter the name of the field. This is the configuration name, used to select this field when connecting it to other elements of the workflow. This name does not appear in the workflow itself.
Code	This is an internal reference code which is generated by the system when the field is saved.
Description	A description can be provided for the field. This information is only displayed here and in the Fields list.
External Code	This functionality is not supported for this configuration.
Control Type	Select a field Control Type that supports multiple options:
	Combo Box Drop Down Include Exclude List Multi-Select
Option Lists	Depending on the purpose of this field, select the appropriate option list.
Size	Select the size for the field.
Height	Select the height for the field.

For a complete description of all fields on the Field Management page, see the Managing Fields section.

Select an action.

Click Add to save the field and remain on the page.
Click Add & Close to save the field and return to the fields list.
Click Close to return to the fields list without saving the field.

Add the field to the Claims Workflow and publish the workflow. Once fully configured, the Option List Items are populated in the appropriate sections of the system and will be available to the user for selection.