Overview
With the Claim Review Process, each claim may be assigned a Reviewer. It is the Reviewer’s role to perform the QA Review on a Claim at the appropriate point in the Claim Life Cycle. This document will walk you through the steps of setting up your system and utilizing a common workflow for the Claim Review Process.
I. Configuring Users
Only a user that has been designated as a Reviewer can be assigned as a Reviewer on files. To designate a user as a Reviewer:
1. Go to the Personnel Manager page.
2. Click on the name of the User you want to make a Reviewer.
3. Click the section FileTrac Settings to jump to this location on the page.
4. Check the box next to Reviewer.
5. Click to Save & Close.
A. Setting a Default Reviewer for a User (Optional)
You may also choose to assign a Default Reviewer for a user. By selecting a Default Reviewer, the selected reviewer will be assigned as the reviewer for every file a particular user is assigned to as the primary adjuster. To set a default reviewer for a user:
1) Go to the Personnel Manager page.
2) Click on the name of the User you want to assign a Default Reviewer to:
3) Click on Filetrac Settings to jump to this section on the page.
4) Click the drop-down arrow next to Default Reviewer and select the Reviewer that will be assigned to review this User’s claims.
5) Click Save & Close.
If you will be setting up “Review Teams” consisting of Reviewers and Supervisors, you will want to designate the Supervisors in their User profile and set them as the 'Default Supervisor' for each reviewer on their team. (This is done the same way you setup the default reviewer above, except you will give the Supervisor designation to the correct User and then open the Reviewers profile to set the Default Supervisor.)
II. Setting Alerts for Reviewer Team and Adjusters (Admin User Only):
After you have set up your Reviewers and Supervisors, Alerts for these Users will then need to be configured. If you do not have access to add Alerts, you will need to contact an Admin from within your company to assign the Alerts.
1. From the Personnel Manager page, click on the Bell Icon 
(Alerts button).
2. On the User Alerts page, select the User that you want to add the Alerts for,or or you may select Role Alerts if you want to set alerts for all users within a particular role.
To quickly locate the Review alerts, hold down the Control Key while clicking on the letter “F” for find and type “Review” in the search bar. You will be able to toggle through to find the alerts.
We Recommend the following Alerts be used with the Reviewer feature:
3. Check the box for each alert you wish to add to this User or User Role.
4. Click the Add button and the Alerts will appear in the upper box.
5. Click Save Changes:
Repeat these steps until you have added the necessary Alerts for each User/User Role.
III. Review Settings
Review Settings can be enabled by an Admin within your company in order to allow the Claim status to automatically update depending on which step of the Review process the claim is in. This will also automatically update the Claim Date Due according to the settings set up for that Status.
To enable the Review Settings:
1. Click on the Settings tab.
2. Click Review Settings
3. Select the Claim Status Type from the drop-down menu for the corresponding stage of Review.
If a Claim Status Type that you wish to use does not appear in the drop-down menu list, it will need to be added by following the directions in the below link:
Status Types in Settings & Companies : FileTrac Support (freshdesk.com)
4. Click Save Changes
IV. Adding Reviewers to Claims:
1. Reviewers can be added to Claims during the file setup process on the New Claim page or after a file has been setup in the system on the Edit Claim page.
a. Select the Reviewer manually from the Assigned Reviewer drop-down list or
b. Check the Automatically Set to Adjuster’s Reviewer checkbox to automatically select the Reviewer for the assigned adjuster. This option will only work if a default reviewer has been selected for this Adjuster via the Personnel Manager tab (see Section I, A above).
2. Click Save (New Claim Page) or Update Claim (Edit Claim Page) at the bottom of the page.
V. Marking Claim 'Ready for Review' (Workflow)
Below is an overall general process of handling a file that needs to be reviewed within FileTrac. Please note that there are several variables that come into play, and you will want to figure a workflow that will work best for your Company.
After the work on a file has been completed, the file should be marked as Ready for Review via the below steps:
1. Go to the Notes page for the specified file via the Manage Claims page (or click on Note from the Alert).
2. Check the Ready for Review checkbox.
3. Type a Diary Note (if needed).
4. Click the Save Comment button.
Files that have been marked Ready for Review will appear in the Reviewer Alerts for the Reviewer assigned to the file.
VI. Claim in Review (Workflow)
A claim that has been marked Ready for Review cannot be CLOSED until it has been reviewed and APPROVED.
The Reviewer assigned to the claim will receive a notification on the Alerts page that the claim is ready to be reviewed.
1. Go to the Notes page for the specified file via the Manage Claims page (or click on Note from the Alert).
2. Check either the Reviewed: APPROVED checkbox or the Reviewed: Revision Required.
3. Type a Diary Note (if needed).
4. Click the Save Comment button.
