Integration with an External Document Vendor

You can use the services of an external document vendor to create forms and to create and publish documents based on claim data. You can download these forms and archive them with the claim.

This enables you to improve the quality, efficiency, and accuracy of communication with your customers. Regulatory compliance is thereby ensured.

For more information, see Using an External Document Vendor

External Claim Investigation

You can send claims to an external service provider (such as ISO ClaimSearch, UNIWAGNIS) for claim investigation if potential fraud is suspected, for example.

For more information, see External Claim Investigation.

Regulatory Reporting

You can report claim data to the US regulatory authorities such as the National Council on Compensation Insurance (NCCI) or the Insurance Services Organization (ISO) and thus comply with your reporting obligations.

For more information, see Regulatory Reporting.

Claim Handler

With this role you can access a universal worklist and a personalized list of My Claims . You can also use a key figure monitor to keep an eye on your own activities.

Claim Center Agent

With this role you can postprocess inbound first reports of injury (FROI) and then convert them into a claim. This process maps exception handling in automatic claim creation.

Performer Assignment Based on Your Organizational Structure

You can use the function of Role-Based Performer (RBP) to have automatic performer assignment on the basis of the settings in SAP Organizational Management. Certain assignment strategies are available.

You therefore have a high degree of flexibility in assigning your employees to the relevant tasks, depending on responsibility and availability. For more information, see Automatic Performer Assignment via Organizational Management.

Print Claim File

You can compile an electronic claim file for a claim and then print this in one step. This electronic claim file can comprise data on the whole claim or just on certain parts.

You can use this claim file for all business activities outside of your insurance company, for example at a trial.

For more information, see Printing and Archiving Claim File.

Analysis of Financial Transactions in Financial Overview

As the name implies, the financial overview gives you an overview of all relevant financial transactions for a claim. This includes payments, reserves, recovery, subrogation, and salvage.

For more information, see Overview of Financial Transactions.

Payment

This Business Function provides you with the following additional functions for processing payments:

Single Invoice

This Business Function provides you with a check for duplicates in invoice entry .

Subrogation/Recovery

This Business Function provides you with the following additional functions for processing subrogation/recovery:

Special Rights

This Business Function provides you with the following additional functions for special rights:

Correspondence

This Business Function provides you with the following additional functions for correspondence:

Workers Compensation

This Business Function provides you with the following additional functions for Workers Compensation:

Care Insurance: Checks for Ongoing Care

For more information, see Capture of Ongoing Care under  Activities System Checks Before Approval of Benefit Decision .

Specification of country and region of jurisdiction in the claim overview

In the claim overview the system displays the country and region of jurisdiction. The system takes the country and region specified in the contract.

Delivery of value requests of the Business Rule Framework (BRF) for claim data

For more information, see Value Requests for Claim Data.