Claims Processing 

Purpose

This process describes how a claim is processed for an employee. There are two types of claims that can be processed, a bill and a receipt.

In the case of a bill, the service provider sends the bill directly to the company. The company pays the service provider the entire sum and recovers the co-payment amount (if applicable) from the employee during payroll. If any non-reimbursable amount is applicable for that claim, this amount is also recovered from the employee.

In the case of a receipt, the claim is validated and the amount is reimbursed to the employee after taking into account the co-payment options.

Prerequisites

The employee must be enrolled in a claim plan before the claim can be processed. This is done using the Enrollment function.

Process Flow

  1. This process is triggered either when an employee hands in a claim (for example, a receipt) to the HR department or when a service provider sends a bill to the company.
  2. You enter the relevant claim for the employee.
  3. The system automatically validates the claim. Validation follows three steps. The claim is further processed only if the claim passes the steps below:
    1. The employee is enrolled in the claim plan as of the claim date.
    2. The amount of money to be claimed is correct.
    3. The dependents for whom the claim is submitted are also correct.
  1. After going through the validation process, any one of three events can take place.

The result of the HR intervention could result in the claim having to be modified in some way and this leads back to Step 3.
  1. Once the claim has passed its validation, it is ready for payment through the payroll system. This is achieved by accounting a claim.

Result

The required records are created in the various infotypes so that the claim amount can be settled during payroll.