Main Steps in Processing a Claimant/Customer Case

This section outlines the key stages involved in handling a customer case, from initial intake to resolution and follow-up.

Standad Work Process Flow

1. Request from Claimant

• Receive the claim request/form directly from the claimant.

• Establish initial case details and generate a unique reference or ticket number.

1. Assignment of Case

• Assign the case to the appropriate team or individual.

• Ensure clear ownership and responsibility for the case’s progress.

1. Start Work with the Case

• Begin the work process by pressing the “Start” button in the case view.

• Preliminary review of the claim.

• Familiarize oneself with any existing documentation or relevant data.

1. Gathering and Clarification of Case Information

• Conduct direct communication with the claimant to confirm details.

• Request and collect all necessary documents and information from the claimant and other parties (e.g., insurer).

• Clarify any ambiguities to ensure comprehensive understanding of the claim.

1. Payout and Compensation Preparation

• Evaluate the claim and determine appropriate compensation or payout.

• Finalize calculations, prepare payment documents, and secure necessary approvals.

1. Case Closing

• Complete any final tasks related to the claim, including obtaining signatures and confirming resolution with the claimant.

• Generate and issue any fee invoices for services rendered.

1. Archiving the Case

• Compile and organize all documentation into a final case file.

• Provide the completed case file to the insurer (the service provider’s client) for record-keeping and compliance.

• Mark the case as closed in internal systems and store securely for future reference.