Incoming claims are checked for insurance coverage and form completeness before registration.
When a claim is received, it is first checked whether the claimant is insured by the organization. If not, the claimant is informed that the claim must be rejected. Otherwise, the severity of the claim is evaluated. Based on the outcome, relevant forms are sent to the claimant. Once the forms are returned, they are checked for completeness. If the forms provide all relevant details, the claim is registered in the Claims Management system. Otherwise, the claimant is informed to update the forms. Upon reception of the updated forms, they are checked again.
| Activity | Actor |
|---|---|
| Check Coverage | Claims Team |
| Evaluate Severity | Claims Team |
| Send Forms | Claims Team |
| Check Completeness | Claims Team |
| Register Claim | Claims Team |