Bridge
User Guide - Claims
Version 2.4.83
Version 2.4.83Bridge User GuideUser Guide - Claims
Table of Contents
Table of Contents
Introduction
Guide
Claims Workflow
Claims Screen Elements and Navigation
Moving Through the Claims Workflow
Sequential Navigation and Common Controls
Jumping Directly to a Screen
Common Screens Widget
Notes
Documents
Attachments
E-mails
Audit Trail
Financial Summary
Claim Actions Widget
Selecting the Policy for a Claim
Assigning an Adjuster
Claim Information Widget
Selecting the Claim Status
Policy Information Widget
Viewing Policy Information
Viewing Policy Participant Information
Claim Parties Widget
Attaching a Claim Party
Creating a New Claim Party From Within a Claim
Editing a Claim Party From Within a Claim
Claims Search / List
Other Claims Features
Managing Claim Payments
Adding a Payment to a Claim
Viewing and Modifying a Claim Payment
Reversing a Claim Payment
Setting the Reserve and Estimate Values for a Claim
Creating and Managing Notes and Follow-ups in a Claim
Adding a Note or Follow-up to a Claim
Viewing and Editing a Note or Follow-up
Deleting a Note
Marking a Follow-up as Resolved
Generating and Managing Claims Documents
Generating a Claim Document
Viewing Saved Documents
Managing Claim Attachments
Attaching Files to a Claim
Viewing and Editing a Claim Attachment
Deleting a Claim Attachment
Certifying Claim Attachments
Sending and Managing Claim E-mails
Viewing the E-mail History
Sending E-mails
Reviewing Claim Changes in the Audit Trail
Viewing the Claim Financial Summary Report
Claims Configuration
Adjuster Auto-Assignment
Creating a New Adjuster Auto-Assignment Rule
Viewing and Modifying an Adjuster Auto-Assignment Rule
Deactivating an Adjuster Auto-Assignment Rule
Deleting an Adjuster Auto-Assignment Rule
Document Templates
E-mail Templates
Creating a New E-mail Template
Viewing and Modifying an E-mail Template
Deactivating an E-mail Template
Deleting an E-mail Template
Claims General Settings
Navigating Claims General Settings
General Settings – Claim Numbering
General Settings – Claim Sub-Statuses
Creating a New Claim Sub-Status
Viewing and Modifying a Claim Sub-Status
Deactivating a Claim Sub-Status
General Settings – Party Roles
Creating a New Party Role
Viewing and Modifying a Party Role
Deactivating a Party Role
General Settings – Scheduled E-mails
General Settings – Additional Settings
Automatic Claim Payment Rules
Payment Integration Rules
Creating a New Payment Rule
Viewing and Modifying a Payment Rule
Deactivating a Payment Rule
Deleting a Payment Rule
Professional Service Companies
Creating a New Professional Service Company
Viewing and Modifying a Professional Service Company
Custom Validation Rules
Creating a New Custom Validation Rule
Viewing and Modifying a Custom Validation Rule
Deleting a Custom Validation Rule
Workflow Events
Creating a New Workflow Event
Viewing and Modifying a Workflow Event
Deactivating a Workflow Event
Deleting a Workflow Event
Configuring Claims Documents
Creating a New Claims Document Configuration
Viewing and Modifying a Claim Document Configuration
Deactivating a Claim Document Configuration
Managing Templates Within a Claim Document Configuration
Configuring Claims E-mails
Creating a New Claims E-mail Configuration
Viewing and Modifying a Claims E-mail Configuration
Deactivating a Claims E-mail Configuration
Deleting a Claims E-mail Configuration
Index
Version 2.4.83Bridge User GuideUser Guide - Claims
Version 2.4.83Bridge User GuideUser Guide - Claims
Introduction
Welcome to the Bridge insurance access portal. The system provides a full workflow, from the administration of products and coverage, to the submission and management of individual policies.
Access to all features, options, and data are controlled by the settings in your user account. This guide is for users with claims management rights, covering all aspects of configuring, submitting, and managing claims.
This guide assumes the user is familiar with the general functions of the system. For instructions on logging in and using common features throughout the system, see the User Guide - Introduction document.
Guide
Click a link to jump to the appropriate section.
Claims Workflow / Submitting a First Notice of Loss.Claims List / View and manage claims.
Other Claims Features / Working with features associated to individual claims. Includes payments, notes, documents, attachments, and e-mails.
Configuration / Configure settings for the claims system.
Version 2.4.83Bridge User GuideUser Guide - Claims
Claims Workflow
In the event of an insured loss, the Claims module is used to submit and process a claim from the initial entry to final payment.
- The claims process begins with a First Notice of Loss (FNOL). Under the Claims menu, select First Notice Of Loss. A new claim is created and the claims workflow screen opens.
The claims form is in the center of the screen, with widgets on either side containing additional information and controls. See the Claims Screen Elements and Navigation section for detailed descriptions of the screen components.
- Work through the steps of the claim form, completing all necessary information. Fields marked with a red asterisk *are required.
- Once enough information has been provided and saved, the Select Policy link may become available in the Claim Actions widget. This allows the claim to be associated to a specific policy valid at the date of loss. This step may be optional, or may be required before submitting the claim.
- Once the first notice of loss is complete, click Submit Claim. The claim is assigned to an agent for handling.
- Take note of the Claim No displayed in the Claim Information widget. This will be used to access the claim in the future.
- To open an existing claim for review, open the Claims menu and select Search / List. The Claims page opens, listing all available claims.
- Locate the Claim No in the System Number column and click the link. The claims workflow screen opens.
Version 2.4.83Bridge User GuideUser Guide - Claims
Claims Screen Elements and Navigation
This section details the layout and functions of the claims screen. This can be reviewed in advance of creating a claim, or can be used as a reference source when viewing or creating a claim.
The primary claims form is displayed in the center of the screen, with additional panels called Widgets to the left and right providing information and controls.
Click on a section of the screen below to jump to the appropriate section.
Version 2.4.83Bridge User GuideUser Guide - Claims
Moving Through the Claims Workflow
The workflow is divided into Steps displayed in the progress bar above the form. Each Step may contain several individual Screens, displayed in the Navigation widget.
The coloring of the steps indicate the current status.
/ Completed Step: / Once all screens in a step have been completed and saved, that section of the progress bar changes to blue./ Incomplete Step: / Any steps that have not yet been completed are shown in grey.
/ Current Step: / When viewing a particular screen, the current step is highlighted in dark blue or dark grey, depending on whether the step is completed or not.
Sequential Navigation and Common Controls
All screens in the workflow are organized in a specific order. The Next and Previous buttons at the bottom of the page are used to move through the workflow sequentially, one screen at a time, while the Save button updates the current screen without moving. Additional options may be available, depending on the configuration of the workflow.
Next / Saves the current screen and moves to the next screen in the workflow.Clicking Next performs the recalculation and validation process. Calculated fields are refreshed and all data is checked against any rules defined for the completed screen. Some rules may provide warnings or information, while others require corrections to the data before allowing you to proceed to the next screen. Messages at the top of the page provide information about any validation results.
Previous / Moves to the previous screen in the workflow. This is used to look back through previous screens, either for review or to make changes. Clicking Previous does not save the current screen. If any changes have been made, a message appears warning that changes will be lost.
Moving back through previous screens does not perform any validation or recalculate any values. However, using the Save or Next buttons activates the same validations and calculations that were performed the first time through each screen.
Save / Saves the current screen and performs all validations and calculations that are associated with the current screen. This can be used to refresh calculations without having to proceed to the next screen and then return.
Jumping Directly to a Screen
The Navigation widget provides instant access to the entire workflow. While navigating through the workflow, the current step is expanded and all available screens within that step are displayed. All completed steps and screens are marked with a green checkmark icon, while incomplete steps and screens are marked with a red circle icon.
To jump to a different screen in the current step, click the name of the screen in the list. To jump to a screen in a different step, click the step name to expand the list of screens, then click the required screen.
Changes are not saved when jumping to a different screen. Use the Next or Save buttons to save the current screen before navigating away.
/ Note: When jumping forward to Incomplete steps and screens, be aware that some fields may be dependent on fields that were skipped over. Some values may not be completely calculated, and validations may require that the skipped fields be completed before proceeding.The Payments screen is a standard system screen, available if you have the necessary administration rights. See the section on Managing Claim Payments for more information.
Version 2.4.83Bridge User GuideUser Guide - Claims
Common Screens Widget
The Common Screens widget provides access to a variety of information related to the current claim.
Not all options are available at all times, and access to each option may be restricted if the user does not have the necessary security roles.
Notes
Notes can be added to a claim to provide additional information or to serve as a reminder if any actions need to be taken at a later date (Follow Ups).
The Notes option in the Common Screens widget opens the Notes and Follow-ups list. The list contains all notes currently attached to the claim, and options for creating and managing notes.
For more information, please see the section on Creating and Managing Notes and Follow-ups.
Documents
The system can produce a wide variety of documents, customized for the current claim and product. These may be generated manually, or automatically based on certain criteria within the claim.
The Documents option in the Common Screens widget opens the Documents list. The list contains all generated documents currently attached to the claim, and options for generating new documents.
For more information, please see the section on Generating and Managing Claims Documents.
Attachments
Files can be attached to a claim in order to provide additional information or to document details of the coverage. Many file types are supported, particularly image and document files.
The Attachments option in the Common Screens widget opens the Attachments list. The list contains all files attached to the current claim, and options for creating and managing attachments.
For more information, please see the section on Managing Claim Attachments.
E-mails
As e-mails are sent in relation to a claim, they are stored in the system.
The E-mails option in the Common Screens widget opens the E-mails list. The list contains all e-mails sent from the current claim, and the option to send new e-mails.
For more information, please see the section on Sending and Managing Claim E-mails.
Audit Trail
The system logs most activities related to a claim, with the old values, new values, dates and times, and the user who made the changes. This information is available through the Audit Trail report.
The Audit Trail option in the Common Screens widget opens the Audit Trail window.
For more information, please see the section on Reviewing Claim Changes in the Audit Trail.
Financial Summary
As reserves, estimates, and payments are created and modified in relation to a claim, a summary report is available to see a comparison of the totals.
The Financial Summary option in the Common Screens widget opens the Claim Financial Summary window.
For more information, please see the section on Viewing the Claim Financial Summary Report.
Version 2.4.83Bridge User GuideUser Guide - Claims
Claim Actions Widget
The Claim Actions widget lists the available actions that can be taken on the claim in its current status. Below are some general descriptions of each action.
The available actions are determined by the type of transaction, the status of the transaction, the availability of items to work with (such as e-mails and documents), and the user's security roles.
If no actions are available for the current claim, the Claim Actions widget is not displayed.
Select Policy / Once the Date of Loss has been specified for the claim, click Select Policy to choose the appropriate policy for the claim. The Policy Selection window opens. See Selectingthe Policy for a Claim for details.Submit Claim / Once all necessary claim information has been provided, click Submit Claim to submit the claim for processing.
Depending on the details of the claim, an adjuster may be assigned automatically.
Assign Adjuster / Click Assign Adjuster to select or replace the adjuster for the claim. See Assigning an Adjuster for details.
Create Payment / Click Create Payment to enter a payment for policy participants or claim parties. This is the same as entering a payment on the Payments screen. At least one policy participant or claim party must be attached to the claim for this option to be available. See Adding a Payment to a Claim for details.
Selecting the Policy for a Claim
Once the Date of Loss has been provided, displayed in the Claim Information widget, the Select Policy option becomes available in the Claim Actions widget. This option opens the Policy Selection window.
Date of Loss / This field displays the date of loss provided for the claim.Policy Number / To select the appropriate policy for the claim, enter at least the first three characters of the policy number or assured name. Only policies that are valid for the date of loss will be available.
Click Save & Close to save the policy selection and close the window, or click Close to close the window without selecting a policy.
Once a policy has been selected, the Policy No: is displayed in the Policy Information widget.
Assigning an Adjuster
Submitting a claim may automatically assign an adjuster, replacing any previous adjuster assignment. The adjuster may be changed manually after automatic assignment.
If an adjuster has not already been assigned to a claim, click Assign Adjuster to add an adjuster to a claim. The Adjuster window opens.
Adjuster / Select the adjuster to attach to the claim. The list includes all available users that have been defined as adjusters.Click Save & Close to save the selection and close the window, or click Close to close the window without saving.
Version 2.4.83Bridge User GuideUser Guide - Claims
Claim Information Widget
The Claim Information widget displays information about the current claim.
The widget displays the following information:
Claim No / The system claim number.Status / The current status of the claim.
Date Reported / The date that the claim was entered into the system.
Date of Loss / The reported date of loss.
Adjuster / Displays the adjuster assigned to the claim.
Selecting the Claim Status
To change the status and sub-status of a claim, click the Status link. The Claim Information details window opens.
Claim Status / Select one of the preset system statuses.Sub-Status / Select one of the custom status options.
Click Save & Close to save the settings and close the window, or click Close to close the window without saving.
Version 2.4.83Bridge User GuideUser Guide - Claims
Policy Information Widget
Once a policy has been associated to the claim, the Policy Information widget provides access to the policy information and policy participants.