Claims Inquiry and Update Claim
Application component: Claims Management
App type: Transactional, Reuse Component
Line of business: Operations
Leading industry: Insurance
Solution capability: Claims Notification (S/4)|Claims Processing (S/4)
Description:  With this app, you can - in the role of a claims handler – view information related to an auto claim.  Note   You cannot create, edit, or delete any claims data with this app. This app supports only the display of claims data.   The focus is on the line of business Auto Insurance based on the sample product International Auto Insurance. Line-specific information of other lines of business is not supported in the standard delivery but may be handled for specific customers during implementation based on the described extension concepts.   
Inquire and update Claims from Claims Management System
Key features:  Search Criteria You can search for existing claim documents using search criteria like Claim Number, Product Name, Status, Contract Number, Policy Number, Date of Loss, Claim Handler Name, License Plate, and Name of Policyholder. Depending on the results of your search, the system displays the claims in the form of a list report. You can navigate to the Claim Details screen by clicking individual claim records in the list report.  Display of Claim Data The Claim Details screen consists of a page header section and an information section for the claim details with tab navigation. The following information is displayed in the page header section: Note The page header is collapsible. This will help you to focus on the actual page content, while ensuring that important header information and actions are readily available.    Claim number   Product name   PolicyholderNote To view details of the policyholder, click the policyholder's name. Details of the policyholder and a list of the related apps appear in a popover. You can navigate to these related apps by clicking their names.    Incident type   Complexity as classified by the claim handler   Claim bundle   Status and status reason   Pending tasks (the number of pending tasks within the total number of tasks in the claim) Note You can find further details of the pending tasks on the Pending Task tab in the information section containing the claim details.   Claim handler   Liability rate (expressed as the policyholder's percentage and shown as a Harvey Ball chart)   Incurred loss, expenses, and recovery Note You can find the graphical representation (micro chart) of the details of the incurred loss, expenses, and recovery in the header. Further details are available on the Financial Overview tab in the information section containing the claim details.   Related apps You can navigate to other related apps from the list under Related Apps.    The following information is displayed in the information section containing the claim details with tab navigation:    Overview: On this tab, you can find information about the policy number and the contract number to which the claim belongs, vehicle information, the start and end date of the contract, and the license plate number of the vehicle. Note To view details of the contract, click the contract number. The contract snapshot appears. In the header, you can find contract details, such as the contract number, contract start and end date, insured vehicle, current version, policyholder, and policy number. You can also check information related to the coverages, insured risk, driver information, and available clauses on the corresponding tabs. Close this screen to return to the original screen.You can also access the latest policy details by clicking the policy number in the Contract Snapshot header. Select the Policy Inquiry app in the popover and the Policy Snapshot screen appears with the latest updated information for the policy.   There are two different sections on the Loss Details tab:  Loss Details: You can check details such as the date of loss, comments on loss location, description of loss, cause of loss, and loss location here. Note You can view comments on the loss location and a description of the loss in new screens by clicking the descriptions available under the fields in the form of a link.  Origin of Loss: You can find the details on the origin of the loss in the form of questions and the corresponding answers here.     Subclaim: On this tab, you can find a list of subclaims along with details such as type, status, claimant, and coverage for the subclaim type. You can also check the reserve and payment amounts for the listed subclaims using the Show Details button located here.  Note To view details of the claimant name, click the Claimant field. Note The subclaim record is expandable. Click the record you would like to expand. The screen splits into two, with a detail screen appearing on the right side of the screen.   Subclaim Details:   Overview: On this tab, you can find information about compensability, subrogation/recovery potential, potential fraud, salvage, litigation and negotiation.    On the Damaged Objects tab, you can check the corresponding details for the damaged vehicle, injured person, and damaged property.  Damaged Vehicle: You can find information about the license plate, vehicle identification number, vehicle description, construction year, annual mileage, and vehicle value. Note To view details of the damaged vehicle, such as the damage details, questionnaire, and service provider, click the corresponding record. The screen splits again, with a detail screen appearing on the right side of the screen. Close this screen to return to the original screen.  Injured Person: You can find information about the injured person, such as name, date of birth, address, and their relationship to the policyholder. Note You can select an injured person from the list and click the corresponding record to view an overview for this injured person, including the diagnosis and questionnaire for this injured person. Damaged Property: You can check the details of the damaged property, such as claim/subclaim, building type, construction year, primary building material, and claimant here.    Payments and Reserves: You can find four sections on this tab:  Subclaim - Financial Overview: You can find transaction details, such as the reserves, payment amount, and transaction date. Subclaim - Financial Overview - Chart: You can view the payments and reserves for the subclaim in a graphical format.Note A stacked bar chart is defined as the default chart. You can switch to your own chart type by selecting a chart of your choice using the chart function. Loss Reserves: You can find information about the loss reserves, such as the reserve type, reserving method, initial reserve amount, incurred loss, payment amount, pending reserve, and reserve amount. Loss Payments: You can find information about the loss payments, such as the payment type, amount, status, payer/payee, payment method, payment details, parked, and final payment.     Performer: Details such as role name, object type of performer, performer (ID), and performer name are available in this section.      Damaged Objects: You can find the list of damaged objects here that are not assigned to any subclaim.   Payments and Reserves: This tab contains the following five sections:  Financial Overview: You can get a financial overview of the claim in the form of Losses, Expenses, and Recovery data. Claims - Financial Overview: You can find information about the financial transactions related to the claim, such as payment amount, reserve amount, and transaction date. Financial Transaction - Chart: You can view the financial transaction data related to the claim, such as the reserve and outgoing payment amount, in a graphical format. Note A stacked bar chart is defined as the default chart. You can switch to your own chart type by selecting a chart of your choice using the chart function. Expense Reserves: You can find the list of reserves here along with details such as reserve type, reserve method, initial reserve, gross reserve, total payment, pending reserve, and total reserve amount. Expense Payments: You can check the list of expense payments here with payment type, amount, status, payer, and payment method. Payment details and parked and final payments are also available in the corresponding payment record.    Performer: On this tab, you can find a list of performers along with role, object type, performer, and performer name.   Activities: This tab contains the following three sections: Coverage Referrals: You can view all the coverage referrals for the claim, such as the claim/subclaim, coverage referral, status of the coverage referral, reason, and overruling reason. Pending Task: You can view the list of pending tasks in the claim with related information, such as claim/subclaim, task description, creation date, due date, and who is assigned the task.  Notes: You can view the notes recorded during the claim process and the related details, such as the claim/subclaim, title, note subject, status, creation date, and person who created the note. Note The notes record is expandable. Click the record that you would like to expand. The screen splits into two, with a detail screen appearing on the right side of the screen.      
Business roles: Insurance Claims Handler
Insurance Claims Handler : 
Processes insurance claims by capturing and investigating the circumstances of the loss and ensuring fair settlement of valid claims. Is responsible for adjudicating claims in a timely manner and maintaining high levels of customer satisfaction.