Managing Personal Lines Claims

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.

With the Personal Lines Claims application, FNOL representatives can submit claim requests, while processors and adjusters can work on the cases for the following personal policy case types.

Personal case types

The following are personal case types available.

• Personal auto policy
• You can also create case types for personal lines claims by extending a case type from the personal claim base case.

Workspace

Processors, adjusters, and other roles use Workspace to work on all aspects of insurance claim cases. With Workspace, users with these roles can do the following tasks:

• Monitor the workload and performance
• Focus on high-priority items
• Easily navigate across tasks

For more information, see Workspaces.

The following table shows which Workspace users can use the Personal Lines Claims application.

Table 1. Workspace users for Personal Lines Claims

Role	Description
Claims admin	Configures Workspace per the business requirements. For more information, see Configure CSM Configurable Workspace.
Claims manager	Approves reserve and payment requests, and views the analytics and Process Mining dashboards.
First notice of loss representative workspace
First notice of loss representative	Creates claim cases on behalf of customers, and uploads relevant documents.
Processor workspace
Claims processor	Works on claim cases and tasks to resolve cases that are managed by them.
SIU workspace
Special Investigation Unit (SIU) agent	Works on potential fraud claim investigation tasks.
Adjuster workspace
Adjuster	Evaluates a claim by reviewing the claim documents, coverages, reserves, and payments.

Claim participants

You can add any person or company as a participant for a claim. The participant can be an entity in the policy or a third-party.

The insurance processor adds participants to a claim during the First Notice of Loss activity, and can assign them a role (such as reporter or witness).

FSO insurance applications store claim contact information in the following Insurance Claims Core tables:

• The Claim Participant table [sn_ins_claim_profile] stores details about all participants involved in the claims process.
• The Participant Role table [sn_ins_claim_participant] stores information on the participant's role in the claim (such as if they are the injured or insured).

For more information, see Insurance Claims Core tables.