Table 25. Workflows for Siebel Claims
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FINS Claims Add Reserve Position to Claim Team |
Adds an adjuster position to a claim. For each adjuster for the current reserve, it checks if the position is part of the claim team, and if not, it adds the position to the claim team. |
Adjuster field in the Claims, then the Reserves view |
FINS Claims Call Evaluate SIU Potential Process |
Calls the FINS Claims Evaluate Fraud Potential and FINS Claims Calculate Fraud Score BRPs and displays a popup message. |
Evaluate SIU Potential button in MyClaims view |
FINS Claims Call Evaluate Subrogation Potential Process |
Calls the FINS Claims Evaluate Subrogation Potential and FINS Claims Calculate Combined Score BRPs to initialize the real-time rule score and calculate the subrogation combined score. |
Evaluate Subrogation Potential button in MyClaims view |
FINS Claims Get Policy Details Process |
Creates a new revision of the policy and returns the new policy ID. |
Get Policy button in Claims, then the Loss Details -Auto view |
FINS Claims ISO Search Request |
Sends a search request to the ISO database. |
Submit button in ISO Database Search view |
FINS Claims ISO Search Response |
Updates Siebel Insurance with the results from the ISO database search. |
Submit button in ISO Database Search view |
FINS Claims OFAC Data Import Process |
Imports the OFAC XML data to the Siebel database. |
Submit Payment button in Claims, then the Payments view |
FINS Claims Open Reserve Process |
Opens the reserve for a claim. |
Open Reserve button in Claims, then the Reserves view |
FINS Claims Payment Create Activity Alert Sub Process |
Creates an activity of type Alert, and assigns it to the subrogation or fraud unit. |
Submit Payment button in Claims, then the Payments view |
FINS Claims Payment Validation Sub Process |
Validates the payment record (Submit Payment Validation Ruleset) and also checks that it is not a duplicate payment. |
Submit Payment button in Claims, then the Payments view |
FINS Claims Approval Manager Process |
Checks whether the Inbox item is approved. If so, updates the proper Status value in the original request. |
Submit Payment button in Claims, then the Payments view |
FINS Claims Payments Create Payments Process |
Creates the bundled Payment record based on the selected invoice records. |
Generate Payment button in Claims, then the Invoices view |
FINS Claims Payments Inbox Action SubProcess |
Checks whether additional approvals are required when a user approves an Inbox item. |
Inbox screen for payment approval |
FINS Claims Payments Inbox Drilldown Process |
Fetches the proper payment when the user clicks on the Inbox item and invokes a view navigation subprocess. |
Inbox screen for payment approval |
FINS Claims Payments Inbox GotoView SubProcess |
Navigates to the Claim Payments view with the given payment information. |
Inbox screen for payment approval |
FINS Claims Payments Status Update SubProcess |
Checks whether the Inbox item is approved. If so, updates the proper Status value in the original request. |
Inbox screen for payment approval |
FINS Claims Payments Query Payments GotoView SubProcess |
Navigates to the Claims Payments view. |
Submit Payment button in Claims, then the Payments view |
FINS Claims Submit Payment Check Draft Authority Limits SubProcess |
Checks whether the payment limits for the user are exceeded. If so, sends the item to the appropriate supervisor's Inbox for approval. |
Submit Payment button in Claims, then the Payments view |
FINS Claims Submit Payment Check OFAC Status SubProcess |
Checks the imported OFAC data for the payee. |
Submit Payment button in Claims, then the Payments view |
FINS Claims Submit Payment Process |
Invokes the main submit payment process. |
Submit Payment button in Claims, then the Payments view |
FINS Claims Submit Payment Updated Reserves |
Updates the Claims Reserve totals during the processing of a claims payment. |
Submit Payment button in Claims, then the Payments view |
FINS Claims Submit Payment Validate Reserves SubProcess |
Checks to verify that there is enough reserve in the Claims Reserve totals before allowing the workflow to process a claims payment. |
Submit Payment button in Claims, then the Payments view |
FINS Claims Void Payment Process |
Cancels a payment that was generated successfully during the Submit Payment process. Sets the payment status to void and reverses the reserve outstanding made during the Submit Payment process. Also, creates an activity for the logged in user indicating that a payment has been cancelled. |
Void button in Claims, then the Payments view |