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Claim Review Process

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.

Table of Contents:

I. Configuring Users/Designating Roles

II. Setting Alerts for Reviewer Team and Adjusters (Admin User Only)

III. Review Settings (Admin User Only)

IV. Adding Reviewers to Claims

V. Marking Claim 'Ready for Review' (Workflow)

VI. Reviewing the Claim (Workflow)

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'.

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.  

Setting 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 setup your Reviewers and Supervisors, you can configure the Alerts for these Users.

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 you have the option to select “Role Alerts” if you want to set alerts for all users with 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: 

*The above list can be downloaded via the attachment at the bottom of this article. 

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 Alerts you want for each User or User Role.

III. Review Settings (Admin User Only):

'Review Settings' can be enabled 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.

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'.

1. Go to the Notes page for the file that is ready to be reviewed or click on Note from the Alerts page.

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. Reviewing the Claim (Workflow)

The Reviewer assigned to the claim will receive a notification on the Alerts page that the claim is ready to be reviewed. 

The Reviewer will be able to jump directly to that claim from the Alert to begin reviewing the file. 

1. Go to the 'Notes' page for the file that has been Reviewed or click on Note from the Alerts page.

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.

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Alert List for Downloading:

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