Maintain Participants
Application component: Claims Management
App type: Transactional
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 - create a subclaim with the essential key information and also update the existing subclaims or drafts. 
Maintain Participants of a Claim
Key features:  Search Criteria On the initial screen of the app, you can search for existing subclaims or drafts (that are saved automatically during the creation of subclaims) using the following search options:   Filter by editing status You can filter the subclaims based on their editing status: All, Own Draft, Locked by Another User, Unsaved Changes by Another User, and Unchanged.   Search for specific data using direct input You can search for subclaims by entering the claim number, subclaim number, or claimant name, for example. Enter the data directly in the corresponding field and then choose Enter.    Display of Subclaim Data The system displays a list of the subclaims that meet the search criteria in the search results. You can check the following information here in the form of a list report:  Claim number Subclaim number Claimant name Subclaim status  Note If you enter a claim in the search criteria, it should contain at least one subclaim to display the search results.  Creating a Subclaim You can create a subclaim in this app with minimal information. Click the Create Subclaim button on the right side of the initial screen. The Subclaim Overview screen appears with the General Information and Subclaim Details tabs. You can enter the following data here:  General Information tab: On this tab, you can provide details in the Claim Number, Subclaim Type, Coverage, Claimant, Liability, and Status Reason fields. Enter the claim number for which the subclaim is to be created. You can use the input help to search with the available parameters. Then choose Enter.Note Based on the claim number, the system displays the relevant values in the input help for the Subclaim Type and Coverage fields.  Enter the subclaim type and coverage in the corresponding fields. You can use the input help to search with the available parameters. Note If the selected subclaim has only one coverage, the Coverage field is updated automatically.   Enter the claimant details. The relevant options are displayed when you start typing in the Claimant field or you can use the input help to search for the required claimant.   A value is entered in the Liability field automatically depending on the configuration of the subclaim type.    Select a status reason from the dropdown list. The Status Reason field populates this dropdown list based on the claim and subclaim details provided.     Subclaim Details tab:  This tab has three checkboxes for Potential Fraud, Litigation, and Negotiation. Set the checkboxes as required.  The Compensable field is a non-editable field and is filled automatically based on the Business Rule Framework plus (BRFplus) available in the claim.   Select the value for the Salvage field from the dropdown list: Completed, No Salvage Potential, Open, and Salvage Potential Identified. The value No Salvage Potential is selected by default.   Select the value for the Subrogation/Recovery Potential field from the dropdown list: Does Not Exist and Exists.     Click the Create button at the bottom of the screen to create a subclaim with the above data.  Editing a Subclaim Select the subclaim or its draft version that needs to be edited from the list of search results. The Subclaim Overview screen appears.  The header contains details about the claim number, subclaim type, subclaim number, and status.  Click the Edit button on the top right of the screen to update the subclaim details. Note   You can also edit the subclaim from the Claims Inquiry and Update Claim app. On the Subclaim tab, there is an Edit button for each subclaim. Click this button to navigate to the Subclaim Overview screen of the respective subclaim in the Maintain Subclaim app.   You can update the data only for the fields that are accessible in the Subclaim Details section of the app, which includes a specific set of subclaim details.   Closing or Reopening a Subclaim   Closing a subclaim: You can close a particular subclaim using the Close Subclaim button. Search for the required subclaim on the initial screen and select it to navigate to the Subclaim Overview screen. Click the Close Subclaim button. The selected subclaim will be closed and the subclaim status is changed to Closed in the header.   Reopening a subclaim: You can use the Open Subclaim button to reopen any subclaim that has been closed. Select the subclaim to be reopened from the search results and navigate to the Subclaim Overview screen. Click the Open Subclaim button. The selected subclaim will be reopened and the subclaim status is changed to Reopened in the header.   
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.