Working with Claims

This chapter discusses how to:

Manage first notice of loss (FNOL) through a customer service representative.
View claims.

Managing FNOL Through a Customer Service Representative

This section discusses how to:

Initiate the FNOL.
Confirm policy details.
Create the FNOL.
Review the FNOL.

Pages Used to Manage FNOL Through a Customer Service Representative

Page Name	Object Name	Navigation	Usage
360-Degree View	RB_TD_AGENT_VIEW	Enter the customer's name, contact's name, social security number or tax identification number, or policy number on the 360-Degree View search page.	Review customer information.
View Policy	RBI_POLICY	Customer Accounts, Review Financial Accounts, View Policies On the 360-Degree View page, select a Policy from the Policies grid.	Confirm the details of the policy, including covered assets, coverages, limits, deductibles, and options before creating the FNOL.
First Notice of Loss	RBI_FNOL_PG	On the 360-Degree View page, select Add First Notice of Loss from the Actions field and click Go. Select the policy. On the Policy page, click the Create FNOL button. Financial Services, First Notice of Loss	Report a new FNOL including loss details.

Initiating the FNOL

Access the 360-Degree View page.

Actions

Select Add First Notice of Loss to access the Policy Details page to confirm details. Click the Create FNOL button on the toolbar to access the FNOL script.

First Notice of Loss

Click the First Notice of Loss link in the Activities tree to access an existing FNOL.

See Understanding the 360-Degree View for Industries.

Confirming Policy Details

Access the View Policy page.

A customer service representative can view the covered assets on the policy and the details about assets, coverages, deductibles, limits, and options.

Creating the FNOL

Access the Create First Notice of Loss page.

Note. These examples show a completed FNOL. You must set up an application form or branch script to create a FNOL. The name of this Application form page is RBI_FNOL_APFOR_PG1.

The system displays customer and policy information under Personal Details on the Create First Notice of Loss page.

Policy Number	Enter the policy number, which comes from the Financial Account component.
Policy Name	Enter the policy name, which comes from the Financial Account component.
Policy Status	Enter the policy status, which comes from the Financial Account component.
Beneficiary Name	Enter the beneficiary who is designated for the policy, if applicable.
Insured Name	Enter the name of the insured, who may or may not be the policy owner.
Registration Name	Enter the name that the insurer gave to the account while registering it.
Owner Name	Enter the policy owner's name.
State	Enter the state of issue for the policy.
Policy Number	Enter the policy number, which comes from the Financial Account component.
Save for Later	This field should not be used when you create a FNOL.
Driver's License	Enter the insured driver's license number.
DL Expiry Date (driver's license expiry date)	Enter the driver's license expiration date.
Accident Date	Enter the date of the accident.
Details	Enter details of the loss.

Note. The fields under Additional Information on the Create First Notice of Loss page are delivered as sample data. You can modify the page to meet your business needs.

At the end of the FNOL process, a FNOL number is given to the customer. It appears on the First Notice of Loss page. The FNOL number is mapped to one or more claim numbers.

Reviewing the FNOL

Access the First Notice of Loss page.

Transaction Type

Indicates the type of transaction, such as First Notice of Loss.

Policy Number

Policy number associated with the FNOL

Transaction Status

Indicates the status of the FNOL

Review Information

Link to application form or branch script completed to create this FNOL.

Related Actions

Business Project and actions associated with the claim. At the successful completion of all the tasks of this business project, a message is sent to the legacy system to create the claims.

Claims

Claims created as a result of this FNOL being created.

Reviewing Claims

This section discusses how to:

Review claims.
View claim details.
Add notes to claims.

Pages Used to Review Claims

Page Name	Object Name	Navigation	Usage
Review Claim	RBI_CLAIM_HEADER	Financial Services, Review Claim Click the Claim link on the 360-Degree View page.	View basic claim information, including claims resulting from reported FNOLs. Claim headers are created in PeopleSoft CRM using an inbound asynchronous EIP message from the legacy system. The claim header is saved in the PeopleSoft Enterprise CRM system.
Review Claim Details	RBI_CLAIM_HEADER	Click View Claim Details link on the Claim page.	View current details about the claim. Retrieve claim details from the legacy system through asynchronous messaging using the claim details EIP or using a synchronous message. The system can be configured to use the preferred mechanism.
Claim Notes	RBI_CLAIM_NOTES	Click Claim Notes tab on the Claim page.	Add notes or attachments to the claim.

Reviewing Claims

Access the Review Claim page.

Claim Number

Displays the unique identifier for the claim.

Status

The system displays the current status for the claim. The claim status is updated by the EIP.

Claim status is set up in Set Up CRM, Product Related, Financial Services, Claim Status. (To set up claim status, use the RBI_CLAIM_STATUS component.) Delivered values are Open, Closed, and Paid. These values are system data and must not be deleted.

Account Number

Displays the policy number for the claim.

Customer

Displays the customer's name. This should be the policy owner.

Contact Name

Displays the name of the contact who represents the customer, if applicable. This could be a contact for a consumer, company, partnership, or alternate capacity.

Claim Date

Displays the date when the claim was filed.

Description

Displays a brief description of the claim.

First Notice of Loss

FNOL that triggered the creation of the claim.

View Claim Details

Click to view detailed information about the claim.

Viewing Claim Details

Access the Claim - Claim Details page.

This page includes claim details, adjuster information, and payment information. The claim details EIP retrieves the information from the legacy system. The setup of the claim details EIP determines what information appears on the Review Claim Details page.

See Understanding Enterprise Integration Points for Policy and Claims Presentment.

Adding Notes to Claims

Access the Claim Notes page.

This page enables the agent to add notes and attachments to the claim.

Actions	Select Add First Notice of Loss to access the Policy Details page to confirm details. Click the Create FNOL button on the toolbar to access the FNOL script.
First Notice of Loss	Click the First Notice of Loss link in the Activities tree to access an existing FNOL.

Transaction Type	Indicates the type of transaction, such as First Notice of Loss.
Policy Number	Policy number associated with the FNOL
Transaction Status	Indicates the status of the FNOL
Review Information	Link to application form or branch script completed to create this FNOL.
Related Actions	Business Project and actions associated with the claim. At the successful completion of all the tasks of this business project, a message is sent to the legacy system to create the claims.
Claims	Claims created as a result of this FNOL being created.

Claim Number	Displays the unique identifier for the claim.
Status	The system displays the current status for the claim. The claim status is updated by the EIP. Claim status is set up in Set Up CRM, Product Related, Financial Services, Claim Status. (To set up claim status, use the RBI_CLAIM_STATUS component.) Delivered values are Open, Closed, and Paid. These values are system data and must not be deleted.
Account Number	Displays the policy number for the claim.
Customer	Displays the customer's name. This should be the policy owner.
Contact Name	Displays the name of the contact who represents the customer, if applicable. This could be a contact for a consumer, company, partnership, or alternate capacity.
Claim Date	Displays the date when the claim was filed.
Description	Displays a brief description of the claim.
First Notice of Loss	FNOL that triggered the creation of the claim.
View Claim Details	Click to view detailed information about the claim.