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.
Request from Claimant
Receive the claim request/form directly from the claimant.
Establish initial case details and generate a unique reference or ticket number.
Assignment of Case
Assign the case to the appropriate team or individual.
Ensure clear ownership and responsibility for the case’s progress.
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.
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.
Payout and Compensation Preparation
Evaluate the claim and determine appropriate compensation or payout.
Finalize calculations, prepare payment documents, and secure necessary approvals.
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.
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.
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