Insurance Claims

Add a customer to an insurance policy as the insured entity by using the Insurance claims application.

Create a task for an Insurance claims case to help prioritize and plan your claim work better.

Create a task in a Individual Life Claims case to help prioritize, check the case progress, and plan your claim work. An example is that you can request additional supporting documentation.

Add a document list definition to a service definition by using the Insurance claims application so that you can define the required documents that a customer needs to provide for a particular claim.

Add a related list of an insurance policy table to an insurance product model table by using the Insurance claims application. Adding a related list displays the customer insurance policies for a particular insurance product.

Create a task as a processor, adjuster, or manager to help prioritize and plan your claim work better.

Create a task as a processor, adjuster, or manager to help prioritize and plan your claim work better.

Adjusters can work on claim tasks from the Claim Workspace.

In Individual Life Claims, if you have the sn_ins_claim_indl.dbn_adjuster role you can view a summary of your claims work in the landing page. You can work on your claim tasks from the claim workspace.

Adjusters can work on claim tasks from the claim workspace.

View the associated claims and relevant knowledge articles by using the Agent assist contextual search. You can find related information on your Individual Life Claims case to assist in understanding and completing your case.

Define the coverages for an insurance policy by using the Insurance claims application. You can define what coverages types and coverage options apply to a customer's insurance policy.

Approve an assigned claim reserve or a payment amount that is higher than an adjuster's approval authority for Insurance claims cases. A reserve or payment may be rejected if the requested amount doesn't support the findings from the claim investigation.

A claims manager can approve claim reserve and payment amounts.

A claims manager can approve claim reserve and payment amounts.

Approve an assigned claim reserve or a payment amount that is higher than an adjuster's approval authority for Individual Life Claims cases.

You can apply the decision table rules and subflow or flow that executes the decision table to automate claims processes in the Insurance claims application.

Associate the service definition of a case with the incident and adjuster task service definitions by using the Claim Incident Configuration [sn_ins_claim_incident_config] table in the Insurance claims application.

You can create a Claim Incident [sn_ins_claim_property] table that records the details of a particular claim in the Insurance claims application.

This section describes the claim task form, which displays the information about the claims tasks, which are created and assigned to users to complete the work to resolve the insurance claims.

The Commercial Lines Claims application enables your organization to quickly set up the various stages of the claim process. This process, which starts from the first notice of loss to the claim closure, enables your processors, adjusters, and special investigation agents to manage commercial insurance claims.

The Commercial Lines Claims application installs automated workflows that you can configure for any claims tasks. These workflows create cases and routes any tasks accordingly.

Several types of components are installed with activation of the sn_ins_claim_cml plugin, including plugins, tables, and user roles.

Several types of components are installed with the activation of the Individual Life Claims application.

Several types of components are installed with activation of the sn_ins_claim_pers plugin, including plugins, tables, and user roles.

Several types of components are installed with the activation of the Insurance claims application.

Configure the fraud score ranges by using the UI Builder. You can configure certain fields, such as the Ranges field, in the fraud information page of the CSM Configurable Workspace, so that you can set the score range.

Review the components that are installed with the Commercial Lines Claims application and modify as needed for your organization's business needs.

Configure the components that are installed with the Individual Life Claims application to meet your organization's claims requirements. Examples include long-term care, disability, or critical illness.

Review the components that are installed with the Personal Lines Claims application and modify as needed for your organization's business needs.

Learn how an insurance policy defines the specific protections or risk coverages for your customers by using the Insurance claims application.

Create a service definition category in Insurance claims to properly classify and handle claims that are related to a particular benefit.

Create a service definition for each claim type in your Insurance claims workflow. You can also create a service definition to generate adjuster tasks in the workflow.

Create an access control list (ACL) for a claim incident table by using the Insurance claims application. By creating an ACL, you ensure that users with specific roles can interact with tables for particular claim incidents.

Create an access control list (ACL) for a table that extends the Insurance Policy (sn_bom_ins_policy) table by using the Insurance claims application. By creating an ACL, you ensure that users with specific roles can interact with tables for a particular insurance policy.

Begin the claim process by initiating an individual life claim case on behalf of the claimant.

Initiate an Insurance claims case on behalf of a claimant by using the Insurance claims application. When a customer calls in to report a claim, a claim intake specialist follows this procedure to capture important details and initiate a case.

Create a policy record in the system that represents the agreement between the insurance provider and the customer by using the Insurance claims application.

Create a table that extends the Insurance Policy (sn_bom_ins_policy) table in the Insurance claims application. You use this table to hold all the information about insurance policies of a particular type that you sold to your customers. Creating tables helps to ensure that each type of policy is properly organized and maintained within the system.

Create a Claim Incident [sn_ins_claim_property] table for your business needs and the type of claims that you’re processing by using the Insurance claims application.

A first-notice-of-loss representative or processor can begin the claim process by initiating a commercial claim case on behalf of your customer.

A first-notice-of-loss representative or processor can begin the claim process by initiating a personal claim case on behalf of your customer.

Create a role to enable an authorized agent to access tables that extend the Insurance Policy (sn_bom_ins_policy) table by using the Insurance claims application. By creating a role, you ensure that only authorized agents can view the policies that are relevant to their roles.

Create roles to access claim incident tables by using the Insurance claims application. This way, you can ensure that only authorized users can access the claim incidents that are relevant to their roles.

Create a service definition for each claim type by using the Insurance claims application.

Create a coverage specification in the Insurance claims application so that you can outline the scope and limits of the protection that is provided by an insurance policy.

Create an insurance product model for an insurance policy that is sold to a customer by using the Insurance claims application. The insurance product model defines the product type, which customers that the policy is for, and the coverage specifications.

Before using the Insurance claims application, make sure that you have the customer data for your individual and business customers on your instance so that you can associate the policies with your customers and create incidents for them.

Discuss details of an Insurance claims case with additional users that have access to the claim record. Use this feature to collaborate with other Insurance claims users and create or view an ongoing sidebar discussion for a case.

Discuss details of a claim with additional users that have access to the claim record.

Discuss details of a claim with additional users that have access to the claim record.

Associate a discussion with an Individual Life Claims record so that other users have access to the claim record.

If any conkeyrefs are broken, re-add them from the doc/source/reuse/domain-separation/domain-separation-overview.dita file.In the short description, edit the first sentence to state whether domain separation is supported or not and add the application name. Keep the conkeyref at the end that describes domain separation.Domain separation is supported for Insurance claims. Domain separation enables you to separate data, processes, and administrative tasks into logical groupings called domains. You can control several aspects of this separation, including which users can see and access data.

If any conkeyrefs are broken, re-add them from the doc/source/reuse/domain-separation/domain-separation-overview.dita file.In the short description, edit the first sentence to state whether domain separation is supported or not and add the application name. Keep the conkeyref at the end that describes domain separation.Domain separation is supported for the Individual Life Claims application. Domain separation enables you to separate data, processes, and administrative tasks into logical groupings called domains. You can control several aspects of this separation, including which users can see and access data.

Enable the claim workspace page on the claim case so that a claims manager or adjuster can view the page in Individual Life Claims.

Enable Fraud score and Claim summary pages on the claim case so that a claims manager, adjuster, or processor can view them.

Enable and set conditions for Fraud score and Claim summary variant pages so that a claims manager, adjuster, or processor can view them.

Individual life claims contain personal or sensitive data fields that may require encryption. As an administrator for Individual Life Claims, you should take precautions to ensure that these fields are encrypted with Column Level Encryption. That way, you help to preserve the data privacy of your organization.

A special investigations agent can review a claim to determine whether a claim is fraudulent.

A special investigations agent can review a claim to determine whether a claim is fraudulent.

Learn how the first-notice-of-loss (FNOL) representatives, processors, adjusters, special investigation agents, and managers can use the Commercial Lines Claims application to create and manage commercial insurance claims.

Learn how your first-notice-of-loss (FNOL) representatives, adjusters, and managers can use Individual Life Claims to create and manage individual life insurance claims.

Learn how to create and configure a claims workflow for your organization by using the Insurance claims application. Your first notice of loss (FNOL) representatives, adjusters, processors, and managers can use this claims workflow to create and manage claims.

Learn how the first-notice-of-loss (FNOL) representatives, processors, adjusters, special investigation agents, and managers can use the Personal Lines Claims application to create and manage personal insurance claims.

Grant the Insurance claims contributor (sn_ins_gen_claim.fnol_representative) and agent (sn_ins_gen_claim.processor) roles with access to an insurance policy table by using the Insurance claims application. This way, the users with these roles can view the policy details when they’re processing claims.

Review claims in a case to verify the documents, evaluate the claim coverages, determine the claim payment details, and approve the settlement for a claim.

The Individual Life Claims application enables your organization to set up the various stages of the individual life claim process quickly, starting from the first notice of loss to the claim closure.

Learn about the components and properties that are installed with the Individual Life Claims application.

The Individual Life Claims application installs automated workflows that you can configure for any individual life claims tasks. These workflows create cases and routes any tasks to different departments in your organization.

If you have the admin role, you can install the Commercial Lines Claims application (sn_ins_claim_cml).If the application does NOT include demo data or it does NOT install related applications and plugins, delete or revise the following sentence:The application installs related ServiceNow Store applications and plugins if they aren’t already installed.

If you have the admin role, you can install the Individual Life Claims application (sn_ins_claim_indl). The application includes demo data and installs related ServiceNow Store applications and plugins that aren’t already installed.

If you have the admin role, you can install the Insurance claims application (sn_ins_gen_claim). The application includes demo data and installs related ServiceNow Store applications and plugins that aren’t already installed.

If you have the admin role, you can install the Personal Lines Claims application (sn_ins_claim_pers). The application includes demo data and installs related ServiceNow Store applications and plugins if they are not already installed.

Manage the archive rule that is provisioned in the Claim Case [sn_ins_gen_claim_case] table of the Insurance claims application so that your organization can meet your claim case archiving requirements.

ServiceNow Financial Services Operations for Insurance offers several applications that support automated claims processing across different lines of business.

You can set up the workspace and dashboards for each persona by using the Insurance claims application.

Learn about the components and properties that are installed with the Insurance claims application.

In the Insurance claims application, you can view summaries of your claims work in the landing page. You can also work on your claim tasks from the claim workspace.

The ServiceNow Insurance claims application provides a flexible framework that enables you to set up a comprehensive end-to-end claims workflow easily. A travel insurance claim flow is included as an example in this application.

In Financial Services Operations, the Insurance Policy (sn_bom_ins_policy) table is the base table for all insurance policies. Whenever a new type of policy is introduced in Insurance claims, you create a dedicated table for that insurance policy type.

Use an insurance product model to customize the essential features, terms, conditions, and coverages that an insurance policy offers by using the Insurance claims application. You must first establish an insurance product model before you can create an insurance policy.

Link the insurance product model and claim case service definition by using the Insurance claims application. Without this link, the system doesn’t know which policies are relevant to the case service definition.

Link the coverage types and coverage options to a coverage specification in the Insurance claims application. This way, you associate all the available coverage types and options to the coverage specification and define the protections and risks that are covered by an insurance policy.

Review a claim to verify the documents, evaluate the claim coverages, determine the claim payment details, and approve the settlement for a claim.

A processor can initiate a claim, review a claim to verify it and after an adjuster’s evaluation, complete fulfillment tasks and close a claim.

The Personal Lines Claims application enables your organization to quickly set up the various stages of the claim process, starting from first notice of loss to claim closure.

The Personal Lines Claims application installs automated workflows that you can configure for any claims tasks. These workflows create cases and route any tasks accordingly.

Learn how a claim in the Insurance claims application is driven by the policy snapshot throughout its life cycle. The Policy Snapshot table stores a copy of an insurance policy that can be used in a claims case.

Process claims cases in the Insurance claims application. As a claims processor, you can review and verify insurance claims, complete the fulfillment tasks after an adjuster's evaluation, and close a claim.

A processor can initiate a claim, review a claim to verify it, and after an adjuster’s evaluation, complete fulfillment tasks and close a claim.

View a pending task to prioritize your claim work.

Learn how to set up an insurance policy by using the Insurance claims application. Each new type of insurance policy requires that you create a dedicated table for that specific insurance policy type.

Set up the policy data for the Insurance claims application by importing the policy data into your instance, or by using remote tables to reference the policy data.

You can install and configure the Individual Life Claims application so that the first-notice-of-loss (FNOL) representatives, adjusters, and others can begin servicing the individual life claims.

Plan and configure your implementation of the Insurance claims application by following the tasks in the configuration overview.

Install and configure Personal Lines Claims so that your first-notice-of-loss (FNOL) representatives, processors, adjusters, and others can begin servicing your personal insurance claims.

Grant the sn_bom.fnol_representative and sn_ins_gen_claim.processor roles with access to a claim incident table by using the Insurance claims application. This way, the users with these roles can read and write entries in a claim incident table during the claim creation process.

Use decision tables to define the claim automation rules in the Insurance claims application. You can review and update these rules to suit your claims workflow.

Use the Agent assist contextual search to view associated claims and relevant knowledge articles.

Use the Agent assist contextual search to view associated claims and relevant knowledge articles.

View the associated claims and relevant knowledge articles by using the Agent assist contextual search.

Learn which roles use the Commercial Lines Claims application to create, investigate, and manage an insurance claim from the first notice of loss (FNOL) to the claim closure.

Learn which roles use the Individual Life Claims application to create, investigate, and manage an insurance claim from the first notice of loss (FNOL) to the claim closure.

Learn which roles use the Insurance claims application to create, investigate, and manage an insurance claim from the first notice of loss (FNOL) to claim closure.

Learn which roles use the Personal Lines Claims application to create, investigate, and manage an insurance claim from the first notice of loss (FNOL) to the claim closure.

Generate a fraud score, and view the fraud score page to get detailed insight into a claim's fraud score and history.

Managers, adjusters, and processors can view the Claim summary page to see claim case snapshots.

Update and close the adjuster tasks of a claim case.

An adjuster can review a claim to verify documents, evaluate claim coverages, determine claim payment details, and approve settlement for a claim.