Skip to main content

Claims Management

Learn how to process and manage insurance claims in InsureFlow.

Creating a New Claim​

Step 1: Initiate Claim​

  1. Navigate to "Claims" in the main menu
  2. Click "New Claim" button
  3. Select the client for whom you're filing

Step 2: Enter Claim Details​

Basic Information​

  • Claim Type: Choose the type of claim (Auto, Health, Property, Life, etc.)
  • Policy Number: Associated policy number
  • Insurer: Select the insurance company
  • Date of Incident: When the incident occurred
  • Date Reported: When it was reported to you

Incident Details​

  • Description: Detailed description of what happened
  • Location: Where the incident occurred
  • Police Report Number: If applicable
  • Witnesses: Names and contact info of witnesses

Claim Amount​

  • Estimated Amount: Initial estimate of damages
  • Deductible: Policy deductible amount
  • Coverage Limits: Policy coverage limits

Step 3: Upload Documentation​

Upload supporting documents:

  • Photos of damage
  • Police reports
  • Medical records (for health claims)
  • Repair estimates
  • Other relevant documents

Step 4: Submit Claim​

  1. Review all information
  2. Click "Submit Claim"
  3. System generates claim number
  4. Confirmation sent to client and insurer

Tracking Claims​

Claim Status​

Claims can have the following statuses:

  • Submitted: Claim sent to insurer
  • Under Review: Insurer is reviewing
  • Additional Info Needed: More documentation required
  • Approved: Claim approved for payment
  • Denied: Claim was denied
  • Closed: Claim process completed

Viewing Claim Progress​

  1. Go to Claims list
  2. Click on a claim number
  3. View timeline and status updates
  4. Check communications history

Managing Claims​

Adding Notes​

  1. Open the claim
  2. Click "Add Note"
  3. Enter your note
  4. Click "Save"

Uploading Additional Documents​

  1. Open the claim
  2. Go to "Documents" section
  3. Click "Upload"
  4. Select files and upload

Communicating with Insurer​

  1. Open the claim
  2. Click "Send Message"
  3. Type your message
  4. Attach files if needed
  5. Click "Send"

Updating Claim Amount​

  1. Open the claim
  2. Click "Update Amount"
  3. Enter new amount
  4. Provide reason for update
  5. Save changes

Claim Resolution​

Approved Claims​

When a claim is approved:

  1. Review settlement amount
  2. Notify client
  3. Coordinate payment
  4. Close claim when complete

Denied Claims​

If a claim is denied:

  1. Review denial reason
  2. Assess appeal options
  3. Discuss with client
  4. File appeal if warranted

Appeals Process​

To appeal a denied claim:

  1. Click "File Appeal"
  2. State reasons for appeal
  3. Upload additional evidence
  4. Submit appeal
  5. Track appeal status

Reporting​

Generate Claim Reports​

  1. Go to Reports section
  2. Select "Claims Report"
  3. Choose date range
  4. Select filters (status, type, insurer)
  5. Generate report

Export Data​

Export claims data for analysis:

  1. Go to Claims list
  2. Apply filters as needed
  3. Click "Export"
  4. Choose format (CSV, PDF, Excel)
  5. Download file

Best Practices​

  • Submit claims promptly
  • Provide complete documentation
  • Follow up regularly
  • Keep clients informed
  • Document all communications
  • Maintain organized files
  • Review policies before filing

Common Issues​

Missing Documentation​

If documentation is missing:

  • Contact client for missing items
  • Set deadline for submission
  • Document efforts to obtain info

Delayed Response from Insurer​

If insurer is not responding:

  • Follow up via multiple channels
  • Document all contact attempts
  • Escalate if necessary
  • Keep client informed

Claim Amount Disputes​

If there's a dispute over amount:

  • Review policy coverage
  • Get independent estimates
  • Negotiate with adjuster
  • Consider mediation if needed