Work on personal claim adjuster tasks

  • リリースバージョン: Australia
  • 更新日 2026年03月12日
  • 所要時間：5分

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

    始める前に

    Role required: sn_ins_claim_pers.auto_adjuster
    重要:
    To access the Claim workspace, Fraud score, and Summary adjuster workspace related tabs, you must activate the CSM default record page. By default, the page is set to inactive. To determine the default page for displaying records in CSM Configurable Workspace, see CSM Configurable Workspace record pages

    Update and close the adjuster tasks of the claim case.

    手順

    1. Navigate to All > Financial Services Operations > Workspace.
    2. Open the task one of the following ways.
      OptionSteps
      From the landing page Select a task from the All open claims list.
      From the Personal auto claim adjuster tasks list
      1. Select the lists icon (lists icon).
      2. In the Lists tab, under Personal auto claim adjuster tasks, select All.
      3. In the list, select the task that you want to open.
    3. Finish the work that is required to complete the evaluation or settlement task in your claims system.
    4. Work on the adjuster task by completing various actions from the claim workspace.
      Claim taskClaim workspace actions
      To add a document verification task
      1. Select Add document verification task.
      2. Fill in the required fields.
      3. Select Save.
      To verify a document Select Verify to verify the document or Reject to reject the submitted document for verification.
      To add claim coverage
      1. Select Add coverage.
      2. Select Claim coverage and any of the following required:
        • Claim property
        • Claim participant
      3. Select Save.
      To add a reserve or payment
      1. In Coverages and financials, select one from the Claim coverage list:
        • Add reserve
        • Add payment
      2. Fill in the required fields.
      3. Select Save.
      To add an ad-hoc claim task
      1. From the Tasks list, select Add claim task.
      2. Fill in the required fields.
      3. Select Save.
      To submit a reserve or payment amount for approval Select Approve to approve or Reject to reject the reserve or payment amount.
      1. In Coverages and financials, for a reserve or payment in the Claim coverage list, select Pending.
      2. Select Submit.
      To refer a claim for fraud evaluation Select Send to SIU.
      To submit a claim settlement decision
      1. Select Settle claim.
        • Select Approve claim to approve the claim and send for fulfillment.
        • Select Deny claim to reject the settlement.
      2. Enter comments for the settlement decision.
      3. Select Submit.
    5. オプション: Within a task, in the Work notes field, enter any comments that are related to your findings.
      Manually posted comments and system-generated work notes add to the Activity stream for the task and claim case.

    タスクの結果

    Depending on the current stage of the case:
    • When the adjuster accepts the task, the task status sets to Work in progress.
    • When the adjuster submits a reserve or payment, if the amount is within their authorization limit, it is auto approved.
    • If the adjuster settles the claim, the claim case automatically closes, with the case status set as Closed complete, and claim stage moved to Closed rejected. System-generated work notes stating the rejection automatically add to the Activity stream for the task and claim case.
    • If one of the adjuster related tasks is approved, a task triggers to the claim processor to close the case. System-generated work notes stating the approval automatically add to the Activity stream for the task and claim case.