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Claims Management Program Day One ABLE Claims Administrator Training November 2014.

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Presentation on theme: "Claims Management Program Day One ABLE Claims Administrator Training November 2014."— Presentation transcript:

1 Claims Management Program Day One ABLE Claims Administrator Training November 2014

2 Claims Administrators Training Program ABLE Assessor Training 2 | TimingDay One Job AidSlide no 09.00 – 09.20 Introduction, & Housekeeping 09.20 – 09.30 Learning Outcomes / Content Covered / Module Format PowerPoint Pack 09.30 – 09.45 Introduction to Claims Management Program PowerPoint Pack 9:45 – 10:00 Log in (Able and EDGe) 10:00 – 10.15 Navigating the Able Claims Management System Navigation 10.15 – 10.30 Break 10.30 – 11.30 Navigating the Able Claims Management System cont. (Status Flow, Tasks) Navigation Tasks 11.30 – 12.30 Sending Claim Forms Outbound Correspondence 12.30- 01.30Lunch 01.30 – 02.30 Managing Concurrent Claims Concurrent Claims 2:30 - 3:00 Index Inbound Documents Inbound Correspondence 03.00 – 03.15 Break 03.15 – 04.30 Recap & Final Questions

3 Claims Administrators Training Program ABLE Assessor Training 3 | TimingDay Two Job AidSlide no 09.00 – 09.30 Refresh 09.30 – 10.15 Payment Creation Payments 10.15 – 10.30 Break 10.30 – 11.30 Payment Letter Creation and Forms Payments 11.30 – 12.30 Payment Authorisation Payments 12.30- 01.30Lunch 01.30 – 02.30 Payment Expenses Payments 02.30 – 03.30 Workarounds Payments 03.00 – 03.15 Break 03.15 – 04.30 Recap, Quiz, Final Questions Evaluation

4 4 Part 1 Context / High Level Process Learning Outcomes Context / scenario setting High level process overview Part 2 System demonstration and practise Process demonstration and practise Process variations and practise Part 3 Consolidation activities A series of practical activities for you to complete. What each module will cover

5 5 The Claims Platform Claims Administrator course will take you through the use of the new ABLE Claims Platform system, claim, customer and workflow management functionality. By the end of this session you will be able to: Navigate, search and enter transactions in ABLE Send Claim Forms Manage Concurrent Claims Index Inbound Documents Process Payments What you will learn

6 Introduction to the Claims Management Program 6 | ABLE Administrator Training Understand what the Claims Management Program is and how Able fits into it

7 Customers are not supportive of the insurance industry as a whole Confusion Reigns Insurance and finances are difficult to understand and hard to keep track of The game you never win Life insurance is a lose-lose game. Either something terrible happens, or you never get any tangible benefit form your policy The gamble Ironically, relying on insurance induces more anxiety than it offers peace of mind Insurance is replaceable People perceive life insurance to be replaceable with other sources of cash such as property or savings Protect (me from) my family Some people saw insurance as a means to protect their family; others saw it as a way to help them maintain independence My life changes, insurance doesn’t People’s lifestyles, worries and financial needs change over time, while insurance premiums only go one direction: up You handle it Really good services go beyond cutting a cheque; it takes stuff off people's plates Reciprocity Trust can only be attained through proof of experience. Feel flexible; be flexible People want to know and feel like their options are editable as they move through life Wellness includes financial health People believe holistic health encompasses physical, emotional, and financial well-being Simplicity is everything In the confusing world of financial products, less is more LEARNING INSIGHTSRESONANCE INSIGHTS Through talking with consumers, we came to understand what people really thought about Insurance… Page 7 |

8 How does the Able fit in with what else is happening? Tagline or document title 8 | Case reviews Working with Banyan Health Solutions and ICS to undertake targeted case reviews. Looking at ways to achieve positive outcomes for both AMP and our customers. Pilot Trial our new Claims Approach and ensure we deliver on our customer experience. Learn from our experience and refine the design of the workflow, policies, processes and tools. Trial new roles to help us determine the capabilities we need to build across our business – knowledge, skills, attributes. Able Platform Implement our new Claims Platform to provide: Single claims platform for all products within AMP Better visibility of whole customer profile – open claims, claim history Collaborative approach to managing claim across AMP Future ability for external parties to access claim info via portal.

9 AMP has embarked on a multi-year journey to design and embed a new approach to claims management Phases 2014: Confirm our strategy and objectives. Design and pilot a model which will deliver a new customer claims experience. Phase 1 Phase 2 2016 Ensure the new claims approach is successfully embedded and remains sustainable. Evolve and continuously improve the claims experience thorough feedback and review. Strategy and model to deliver a new customer claims experience confirmed Collaborate and refine approach with a broad range of internal and external stakeholders 2015: Invest and implement new technology and carry out extensive training to support the delivery of a new customer claims experience. Page 9 |

10 The Claims Program has three key areas to enhance customers’ and advisers’ claims experience We are here Q2 2014Q3 2014Q4 2014Q1 2015Q2 2015 Enable the Business with a new technology Platform Establish the foundation Design the new Deploy the newTransition and Embed Drive Cultural, People Capability and Case Management process change Deliver immediate improvements to AMP claims experience. Test and refine our new Claims Approach through file reviews 1 2 3 Foundation Model Platform Q3 2015 Page 10 |

11 Benefits of Able Integration with CRM (Customer) and PAS (Policy)records Claim Number allocated from notification stage Virtual file replaces paper file Online access to single claim file, by multiple users simultaneously Workflow drives process (some manual intervention) Tasks can have SLAs associated with them Outbound correspondence created, indexed and stored within Able Inbound documents indexed and stored for retrieval in Able Intelligent reporting and analytics Tagline or document title 11 |

12 Retail IP Products in scope for Release 1 Claims Philosophy 12 | IP IPA IPB IPC IPD DII RDI RII TSC SCG SCI TSC TIP TI2 TI5 BOI BEC RBE RBEN

13 13 | ABLE Assessor Training Able Claims Management System A demonstration of the key features and applications of Able

14 Tagline or document title 14 | Log in to the Able training environment using your LAN ID & Password To Log in: Enter http://claims.com.au/FINEOS772 in a browser.http://claims.com.au/FINEOS772 The login screen displays Enter your Username and Password Click Login Log in (Able and EDGe) Activity Refer to Job Aid: Navigation

15 15 | Navigating the Able Claims Management System Glossary What ABLE terms will be new to you? Refer to your Navigation Job Aid Glossary. Let’s discuss the meanings of the following terms… ClaimSystem Party Widget ParticipantTab CaseTask Sub CaseManaged Requirement ClaimStatus BenefitProcess eForm Validation Refer to Job Aid: Navigation

16 Pilot Onboarding v2.0 – Group IP 16 | Let’s take a break

17 Navigating the Able Claims Management System Activity You will be provided with some Case ID’s and other information to help you navigate and practise moving around the Able system. Tagline or document title 17 | Home Screen Party / Claimants / Cases and other Data Case and Associated Tabs Tasks, Validation and Managed Requirements Able Workflow Process Tool

18 Tasks Activity Tagline or document title 18 | A Task is a work item that Team Leaders route to a user’s work queue for completion. All work belonging to a user displays in work queues. You can also pull down tasks to your queue using the Get Next Task button. The different types of tasks are represented by Task Types. Refer to Job Aid: Tasks A task can have the following status: Open: An Open task is a task that you can edit On Hold: An On Hold task is a task that a user has chosen to suppress because the user cannot immediately perform the task Closed: A Closed task is a task that has been completed and you cannot edit. Cancelled: A Cancelled task is a task that was created in error and does not display in the work queue

19 Pop Quiz Question 1 Pilot Onboarding V1.0 – Retail IP 19 | Where do you click to activate a second Able session?

20 Pop Quiz Question 1 Answer Pilot Onboarding V1.0 – Retail IP 20 | Where do you click to activate a second Able session? A: Click the icon in the top right hand corner

21 Pop Quiz Question 2 Pilot Onboarding V1.0 – Retail IP 21 | How do I search for a case?

22 Pop Quiz Question 2 Answer Pilot Onboarding V1.0 – Retail IP 22 | How do I search for a case? A: Open Case / Existing Case Tab / Enter Case No / Search

23 Pop Quiz Question 3 Pilot Onboarding V1.0 – Retail IP 23 | Where would you go to see your tasks?

24 Pop Quiz Question 3 Answer Pilot Onboarding V1.0 – Retail IP 24 | Where would you go to see your tasks? A: The My Tasks Tab

25 Pop Quiz Question 4 Pilot Onboarding V1.0 – Retail IP 25 | How do I go home?

26 Pop Quiz Question 4 Answer Pilot Onboarding V1.0 – Retail IP 26 | How do I go home? A: Click the House Icon in the top left hand corner

27 Pop Quiz Question 5 Pilot Onboarding V1.0 – Retail IP 27 | How do I search for a claimant?

28 Pop Quiz Question 5 Answer Pilot Onboarding V1.0 – Retail IP 28 | How do I search for a claimant? A: Select Open Party / Enter Claimant’s Last Name & DOB or Last Name & Policy

29 29 | Send Claim Forms Hi-level Process As a Claims Administrator you will receive the Issue CA- Issue Claims Forms task from a Claims Assessor, including instructions related to sending the party forms and letters as required. 1. Open CA- Issue Claims Forms task from queue 2. Review Assessor Instructions 3. Validate party details 4. Complete EDGe steps to generate letter 5. Complete interview now (Inow) questions 6. Preview the letter 7. Edit the letter 8. Quality check the letter 10. Close Issue Claims Forms task 9. EDGe Submit the letter Send Outbound Correspondence including forms and letters to Customers to Request Initial Claim Forms. Refer to Job Aid: Outbound Correspondence

30 Tagline or document title 30 | We will now demonstrate in the system an example of Actioning the CA-Issue Claim Forms task starting by going to our Tasks queue and open the Task. Action CA-Issue Claim Forms task Send Claim Forms Activity You can now have a go yourself starting by going to your Tasks queue and open the CA- Issue Claim Forms Task.

31 Pilot Onboarding v2.0 – Group IP 31 | Let’s take a break

32 Tagline or document title 32 | Manage Concurrent Claims Hi-level Process 1. Check policy details in CRM, Figtree & Able 2. Complete Claim intake for both claims in Able 3. Add Figtree details to Issue Claims Form task 4. Team Lead allocates Issue Claim Form task to Admin Stage One – Claims Assessor This is what the Claims Assessor will have done to prepare the work before it comes to you A customer has called the Claims Assessor. The customer has IP and TPD policies with AMP. The customer wants to claim against their IP and TPD policy. IP is supported in the Able system, whereas TPD is supported by Figtree. The Assessor will now need to manage these claims concurrently in Able and Figtree. Refer to Job Aid: Concurrent Claims Understand how to concurrently manage Income Protection Claims in Able and TPD Claims in Figtree

33 Tagline or document title 33 | Manage Concurrent Claims Hi-level Process 1. In Figtree set up Able case reference 2. In Able add Figtree number to the General Description field 3. In Able select Initial Claim Form document and confirm correspondence 4. In EDGe amend letter to add Figtree reference and selected forms 5. In Figtree create required Figtree form and overwrite the Figtree claim no. with the Able case no. 6. Post Initial Claim Forms 7. In Able close the Initial Claim Form task Stage Two – Claims Administrator Trigger : Your Claims Admin Team Leader issues the CA-Issue Claims Forms task to your work queue…

34 Tagline or document title 34 | We will now demonstrate in the system an example of actioning the CA-Issue Claims Forms task. You will receive this task in your work queue. To open it, double click and then click on the case hyperlink to open the case. Action open the CA-Issue Claims Forms task Manage Concurrent Claims Activity Have a go yourself starting with going to your work queue and opening a CA-Issue Claims Forms task.

35 Tagline or document title 35 | Manage Concurrent Claims Hi-level Process 1. Backscan Figtree forms to the case that came in via internet mail 2. Manage requirements 3. Initial Assessment 4. Accept Benefit / Accept Benefit with Committee Review 5. Update Figtree claim and raise Payment task Stage Three – Claims Assessor Once you have closed the Initial Claims form task, the Assessor can action the following…

36 Tagline or document title 36 | Manage Concurrent Claims Hi-level Process 1. Set up Payment / Payment letter for Figtree claim 2. Close Figtree claim 1. Payment Creation 2. Payment Authorisation Stage Four A&B – Claims Administrator Stage Four A Stage Four B Trigger : Once the Claims Assessor issues the Payment task, your Admin Team Leader will allocate the Payment task in Figtree.

37 Pilot Onboarding v2.0 – Group IP 37 | Let’s take a break

38 38 | 1. From the My Tasks indexing queue you can Get Next Task 2. Select Do Task, the Indexing Service screen displays 3. To open the document, select Open Images 4. Search for case and attach the imaged docs Index Inbound Documents Hi-level Process 5. Claim Number auto populates 6. Nominate the doc type i.e. AMP. Initial Claim Form, Inbound 7. Enter Doc Title and description 8. Doc is now attached to the claim Refer to Job Aid: Inbound Correspondence Indexing unclassified documents in Able

39 Index Inbound Documents Activity Tagline or document title 39 | We will now demonstrate in the system an example of actioning the Document Unclassified task Indexing documents in Able Have a go yourself

40 End of Module ABLE Claims Assessor Training 40 |


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