1. Siebel Insurance Guide
  2. Assigning Claims to a Specialist Unit (End User)

Assigning Claims to a Specialist Unit (End User)

The following buttons are available in the Claims List screen for evaluating the fraud and subrogation (that is, recovery) potential of a claim:

  • Evaluate Subrogation Potential. Evaluates the subrogation potential of the claim.

  • Evaluate SIU Potential. Evaluates the fraud potential of the claim.

  • Details. Captures the claims combined score details.

During implementation, the customer can write a business service or enable the Analytics application to drive the logic behind these evaluation buttons. When the user clicks either the Evaluate Subrogation Potential or Evaluate SIU Potential button, Siebel Insurance takes the value from the Details button, which captures the claims combined score details, and performs the calculation that determines the value in the Subro Potential or Suspicious Claims indicator in the Claims form respectively. Each indicator has ten bars each representing 10% and colors are displayed in the bars according to the value in the field beside the bars, which can have a value from 0 through 1.

The following buttons are available for assigning claims to appropriate specialist units:

  • Notify SIU. Assigns the claim to the special investigation unit (SIU)

  • Notify Subro. Assigns the claim to the subrogation unit

After the Assignment Manager assigns the claim, an Alert applet in the Home page displays details of the claim. The user can then drill down on the alert to go to either the SIU dashboard view or the Recovery dashboard view, as appropriate.

Note: The Assignment Manager component must be running. To check that it is running, navigate to the Administration - Server Configuration, Servers, then Components screen, and check for Assignment Manager and Batch Assignment entries in the list.

For information about managing claims through the recovery process, see Managing Recovery Information (End User). For information about managing suspicious claims through the investigative process, see Managing Fraud Information (End User).

This task is a step in Process of Managing Claims.

To assign a claim to a subrogation unit

  1. Navigate to the MyClaims screen.

  2. Drill down on a claim.

  3. Select a record, and click the Notify Subro button.

    The claim is assigned to the subrogation unit.