Daily Claims Productivity Per User

The Claims Productivity Per User operational report allows users to monitor and assess daily claims productivity per user.

Objective

• Monitor workload: Track the number of claims each user processes daily to ensure balanced task distribution.

• Assess productivity: Evaluate individual performance and efficiency, including same-day processing.

• Identify training needs: Identify users who may require additional support or guidance such as those with high rework (multiple submissions on a single claim).

• Support planning: Provide insights for staffing, scheduling, and resource allocation decisions.

The report displays only claims whose last updated date falls within the last 90 days from the current system date. No dynamic fields from the base entity are associated with this view because the data represented is aggregated and intended for summary reporting purposes.

Reporting View Fields

The following lists the reporting fields for the Daily Claims Productivity Per User.

Table 1. Reporting View Fields

Field Name	Description	Searchable?
Last Updated Date	The date based on the claim’s last updated date (submit or finalize) for the daily productivity summary.	Yes
User ID	Unique identifier of the user who performed the activity.	Yes
User Name	Displays the user’s name (including internal system users).	Yes
Total Submitted Claim Count	Total claims count submitted by the user on the specific date (counts every submission, including reworks).	No
Total Distinct Submitted Claim Count	Total finalized claims count by user on the specific date.	No
Total Finalized Claim Count	Total finalized claims count by user on the specific date.	No
Total Distinct Finalized Claim Count	Total distinct claims count finalized for the user on the specific date (derived from total finalized count, signals rework if high total vs. low distinct).	No
Total Claim Line Count	Total Claim lines count from the total distinct finalized claim count column.	No

Use Cases for Summarized Counts

The following use cases show how the report aggregates data from claim history.

Use Case 1: Multiple Submissions and Finalizations

• The same user submits and finalizes the same claim multiple times on the same day.

• Different users submit and finalize the same or different claims on the same day.

• Different users submit and finalize different claims on the same day.

• Provides transparency in crediting finalizations, pend or recycled claims get distinct submitted counts to avoid inflation.

Use Case 2: Technical Error - Same User Fixes

• Claim CLA101 hits a technical error after submission.

• The original user John fixes and restarts the claim the next day, leading to finalization.

• Credit for technical error claims counts for the original submitter (or fixer if the same user), even without a new submit entry on the fix day.

Use Case 3: Technical Error - Different User Fixes

• Claim CLA101 hits a technical error after John’s submission.

• Another user (Sam, who did not submit it) fixes and restarts the claim the next day, leading to finalization.

• Original users receive credit.

• The fixer (Sam) receives no credit for his fix and submission.

Use Case 4: Reprocessing Claim

• A claim undergoes reprocessing (for example, for corrections), which does not create a submit history entry.

• Credits appear under the system user for finalizations.

Use Case 5.1: Claim Status Manual Change

• John submits claim CLA165

• Sam performs a Pend Status Manual Change on the same claim, resubmits or processes it, and the claim is finalized.

• Sam gets credit of submission & finalization

Use Case 5.2: Other than Claim Status Manual Change

• John submits claim CLA165

• Sam performs a Pend Status Manual Change on the same claim, resubmits or processes it, and the claim is finalized.

• Sam gets credit of submission & finalization

Use Case 6: Callout Claim

• A callout event (system rule trigger) occurs during the processing of Alex’s submitted claim (CLA167).

• The user (Alex) receives credit for finalizations, even though the system user handles the callout.

Sample Claim Data Table

The following table shows raw data from claim history tables to explain the use cases. This data is not displayed in the report, it shows how submissions and finalizations aggregate.

Use Case	User Display name	Claim Submitted Date	Claim Submitted Id	Claim Finalized Date	Claim Finalized Id
1	John	03 Nov 2025	CLA001, CLA001	03 Nov 2025	CLA001, CLA001
	Sam	03 Nov 2025	CLA001, CLA001, CLA100	03 Nov 2025	CLA001, CLA001, CLA100
2	John	04 Nov 2025	CLA101	-	-
	John	05 Nov 2025	-	05 Nov 2025	CLA101
3	Sam	05 Nov 2025	-	05 Nov 2025	CLA101
4	Internal System User	05 Nov 2025	-	05 Nov 2025	CLA110, CLA111, …​ CLA160
5.1	John	06 Nov 2025	CLA165	-	-
	Sam	07 Nov 2025	CLA165	07 Nov 2025	CLA165
5.2	John	06 Nov 2025	CLA165	-	-
	Sam	07 Nov 2025	CLA165	07 Nov 2025	CLA165
6	Alex	07 Nov 2025	CL0051_7_1_9	07 Nov 2025	CL0051_7_1_9

Result of Use Cases

The following table shows how the sample data aggregates into report counts.

Claim codes are not displayed in the report. The example above is provided to illustrate how the data are summarized.

Date	User Display Name	Total Submitted Claim Count	Total Distinct Submitted Claim Count	Total Finalized Claim Count	Total Distinct Finalized Claim Count
Use Case 1:
03 Nov 2025	John	2 = (CLA001, CLA001)	1 = (CLA001)	2 = (CLA001, CLA001)	1 = (CLA001)
03 Nov 2025	Sam	3 = (CLA001, CLA001, CLA100)	2 = (CLA001, CLA100)	3 = (CLA001, CLA001, CLA100)	2 = (CLA001, CLA100)
Use Case 2:
04 Nov 2025	John	1 = (CLA101)	1 = (CLA101)	0	0
05 Nov 2025	John	0	0	1 = (CLA101)	1 = (CLA101)
Use Case 3:
05 Nov 2025	Sam	0	0	0	0
Use Case 4:
05 Nov 2025	Internal System User	0	0	50 = (CLA110, CLA111, …​ CLA160)	50 = (CLA110, CLA111, …​ CLA160)
Use Case 5.1
06 Nov 2025	John	1 = (CLA165)	1	0	0
07 Nov 2025	Sam	1 = (CLA165)	1	1 = (CLA165)	1 = (CLA165)
Use Case 5.2
06 Nov 2025	John	1 = (CLA165)	1	0	0
07 Nov 2025	Sam	1 = (CLA165)	1	1 = (CLA165)	1 = (CLA165)
Use Case 6:
07 Nov 2025	Alex	1 = (CL0051_7_1_9)	1 = (CL0051_7_1_9)	1 = (CL0051_7_1_9)	1 = (CL0051_7_1_9)

Sample Output for the Report

The report displays aggregated counts only (no claim IDs). The following table shows a sample result in descending date order.

Date	User Display Name	Total Submitted Claim Count	Total Distinct Submitted Claim Count	Total Finalized Claim Count	Total Distinct Finalized Claim Count	Total Distinct Finalized Claim Line Count
07 Nov 2025	Alex	1	1	1	1	1
07 Nov 2025	Sam	1	1	1	1	1
06 Nov 2025	John	1	1	0	0	0
05 Nov 2025	Internal System User	0	0	50	50	50
05 Nov 2025	John	0	0	1	1	1
04 Nov 2025	John	0	0	1	1	1
03 Nov 2025	Sam	3	2	3	2	2
03 Nov 2025	John	2	1	2	1	1

Authorization

• To retrieve data for this report, the user must have a grant to access the view CLA_REP_CLAIM_COUNT_PER_USER_VW.

• To access the JET user interface pages, the user must have access to function code CO0023.