Claims Management Program Day One ABLE Claims Administrator Training November 2014.

Claims Management ProgramDay One ABLE Claims Administrator Training

November 2014

ABLE Assessor Training

Claims Administrators Training Program

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Timing Day One Job Aid Slide no

09.00 – 09.20 Introduction, & Housekeeping

09.20 – 09.30 Learning Outcomes / Content Covered / Module Format PowerPoint Pack

09.30 – 09.45 Introduction to Claims Management Program PowerPoint Pack

9:45 – 10:00 Log in (Able and EDGe)

10:00 – 10.15 Navigating the Able Claims Management System Navigation

10.15 – 10.30 Break

10.30 – 11.30Navigating the Able Claims Management System cont.

(Status Flow, Tasks)

Navigation

Tasks

11.30 – 12.30 Sending Claim Forms Outbound

Correspondence

12.30- 01.30 Lunch

01.30 – 02.30 Managing Concurrent Claims Concurrent

Claims

2:30 - 3:00 Index Inbound DocumentsInbound

Correspondence

03.00 – 03.15 Break

03.15 – 04.30 Recap & Final Questions

ABLE Assessor Training

Claims Administrators Training Program

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Timing Day Two Job Aid Slide no

09.00 – 09.30 Refresh

09.30 – 10.15 Payment Creation Payments

10.15 – 10.30 Break

10.30 – 11.30Payment Letter Creation and Forms

Payments

11.30 – 12.30 Payment Authorisation Payments

12.30- 01.30 Lunch

01.30 – 02.30 Payment Expenses Payments

02.30 – 03.30 Workarounds Payments

03.00 – 03.15 Break

03.15 – 04.30Recap, Quiz, Final Questions

Evaluation

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Part 1 Context / High Level Process

• Learning Outcomes

• Context / scenario setting

• High level process overview

Part 2 System demonstration and practise

• Process demonstration and practise

• Process variations and practise

Part 3 Consolidation activities

• A series of practical activities for you to complete

.

What each module will cover

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The Claims Platform Claims Administrator course will take you through the use of the new ABLE Claims Platform system, claim, customer and workflow management functionality.

By the end of this session you will be able to:

• Navigate, search and enter transactions in ABLE

• Send Claim Forms

• Manage Concurrent Claims

• Index Inbound Documents

• Process Payments

What you will learn

Introduction to the Claims Management Program

6 | ABLE Administrator Training

Understand what the Claims Management Program is and how Able fits into it

Customers are not supportive of the insurance industry as a whole

Confusion ReignsInsurance and finances are difficult to understand and hard to keep track of

The game you never winLife insurance is a lose-lose game. Either something terrible happens, or you never get any tangible benefit form your policy

The gambleIronically, relying on insurance induces more anxiety than it offers peace of mind

Insurance is replaceablePeople perceive life insurance to be replaceable with other sources of cash such as property or savings

Protect (me from) my familySome people saw insurance as a means to protect their family; others saw it as a way to help them maintain independence

My life changes, insurance doesn’tPeople’s lifestyles, worries and financial needs change over time, while insurance premiums only go one direction: up

You handle itReally good services go beyond cutting a cheque; it takes stuff off people's plates

ReciprocityTrust can only be attained through proof of experience.

Feel flexible; be flexible People want to know and feel like their options are editable as they move through life

Wellness includes financial healthPeople believe holistic health encompasses physical, emotional, and financial well-being

Simplicity is everythingIn the confusing world of financial products, less is more

LEARNING INSIGHTS RESONANCE INSIGHTS

Through talking with consumers, we came to understand what people really thought about Insurance…

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Tagline or document title

How does the Able fit in with what else is happening?

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Case reviews

Working with Banyan Health Solutions and ICS to undertake targeted case reviews.

Looking at ways to achieve positive outcomes for both AMP and our customers.

Pilot

Trial our new Claims Approach and ensure we deliver on our customer experience. Learn from our experience and refine the design of the workflow, policies, processes and tools.

Trial new roles to help us determine the capabilities we need to build across our business – knowledge, skills, attributes.

Able Platform

Implement our new Claims Platform to provide:

• Single claims platform for all products within AMP

• Better visibility of whole customer profile – open claims, claim history

• Collaborative approach to managing claim across AMP

• Future ability for external parties to access claim info via portal.

AMP has embarked on a multi-year journey to design and embed a new approach to claims management

Phases2014:

Confirm our strategy and

objectives. Design and pilot a model

which will deliver a new customer

claims experience.

Phase 1 Phase 2

2016Ensure the new claims approach

is successfully embedded and remains sustainable.

Evolve and continuously improve the claims experience thorough feedback

and review.

Strategy and model to deliver a new customer claims experience confirmed

Collaborate and refine approach with a broad range of internal and external

stakeholders

2015: Invest and implement new

technology and carry out extensive training to support the delivery of

a new customer claims experience.

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The Claims Program has three key areas to enhance customers’ and advisers’ claims experience

We are here

Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015

Enable the Business with a new technology Platform

Establish the foundation Design the new Deploy the new Transition and Embed

Drive Cultural, People Capability and Case Management process change

Deliver immediate improvements to AMP claims experience. Test and refine our new Claims Approach through file reviews

1

2

3

Foundation

Model

Platform

Q3 2015

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Benefits of Able

• Integration with CRM (Customer) and PAS (Policy)records

• Claim Number allocated from notification stage

• Virtual file replaces paper file

• Online access to single claim file, by multiple users

simultaneously

• Workflow drives process (some manual intervention)

• Tasks can have SLAs associated with them

• Outbound correspondence created, indexed and stored

within Able

• Inbound documents indexed and stored for retrieval in Able

• Intelligent reporting and analytics

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Claims Philosophy

Retail IP Products in scope for Release 1

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IP

• IPA• IPB• IPC• IPD• DII• RDI• RII

TSC

• SCG• SCI• TSC• TIP• TI2• TI5

BOI

• BEC• RBE• RBEN

13 | ABLE Assessor Training

Able Claims Management System

A demonstration of the key features and applications of Able

Tagline or document title 14 |

Log in to the Able training environment using your LAN ID & Password

To Log in:

Enter http://claims.com.au/FINEOS772 in a browser.

The login screen displays

Enter your Username and Password

Click Login

Log in (Able and EDGe) Activity

Refer to Job Aid: Navigation

http://claims.amp.com.au/FINEOS772

http://claims.amp.com.au/FINEOS772

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Navigating the Able Claims Management System Glossary

What ABLE terms will be new to you?

Refer to your Navigation Job Aid Glossary.

Let’s discuss the meanings of the following terms…

Claim System

Party Widget

Participant Tab

Case Task

Sub Case Managed Requirement

Claim Status

Benefit Process

eForm

Validation

Refer to Job Aid: Navigation

Pilot Onboarding v2.0 – Group IP 16 |

Let’s take a break


Navigating the Able Claims Management SystemActivity

You will be provided with some Case ID’s and other information to help you navigate and practise moving around the Able system.

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• Home Screen• Party / Claimants / Cases and other Data• Case and Associated Tabs• Tasks, Validation and Managed Requirements• Able Workflow Process Tool


TasksActivity

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A Task is a work item that Team Leaders route to a user’s work queue for completion. All work belonging to a user displays in work queues.You can also pull down tasks to your queue using the Get Next Task button.The different types of tasks are represented by Task Types.

Refer to Job Aid: Tasks

A task can have the following status:Open: An Open task is a task that you can editOn Hold: An On Hold task is a task that a user has chosen to suppress because the user cannot immediately perform the taskClosed: A Closed task is a task that has been completed and you cannot edit.Cancelled: A Cancelled task is a task that was created in error and does not display in the work queue

Pilot Onboarding V1.0 – Retail IP

Pop Quiz Question 1

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Where do you click to activate a second Able session?


Pop Quiz Question 1 Answer

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Where do you click to activate a second Able session?

A: Click the icon in the top right hand corner


Pop Quiz Question 2

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How do I search for a case?



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How do I search for a case?

A: Open Case / Existing Case Tab / Enter Case No / Search


Pop Quiz Question 3

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Where would you go to see your tasks?



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Where would you go to see your tasks?

A: The My Tasks Tab


Pop Quiz Question 4

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How do I go home?



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How do I go home?

A: Click the House Icon in the top left hand corner


Pop Quiz Question 5

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How do I search for a claimant?



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How do I search for a claimant?

A: Select Open Party / Enter Claimant’s Last Name & DOB or Last Name & Policy

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Send Claim FormsHi-level Process

As a Claims Administrator you will receive the Issue CA- Issue Claims Forms task from a Claims Assessor , including instructions related to sending the party forms and letters as required.

1. Open CA-Issue Claims Forms task from queue

2. Review Assessor

Instructions

3. Validate party details

4. Complete EDGe steps to generate

letter

5. Complete interview now

(Inow) questions

6. Preview the letter

7. Edit the letter

8. Quality check the

letter

10. Close Issue Claims Forms task

9. EDGe Submit the

letter

Send Outbound Correspondence including forms and letters to Customers to Request Initial Claim

Forms.

Refer to Job Aid: Outbound Correspondence


• We will now demonstrate in the system an example of Actioning the CA-Issue Claim Forms task starting by going to our Tasks queue and open the Task.

Action CA-Issue Claim Forms task

Send Claim FormsActivity

• You can now have a go yourself starting by going to your Tasks queue and open the CA-Issue Claim Forms Task.


Manage Concurrent ClaimsHi-level Process

1. Check policy details in CRM, Figtree & Able

2. Complete Claim intake for both claims in Able

3. Add Figtree details to Issue

Claims Form task

4. Team Lead allocates Issue Claim Form task to Admin

Stage One – Claims Assessor

This is what the Claims Assessor will have done to prepare the work before it comes to you

A customer has called the Claims Assessor. The customer has IP and TPD policies with AMP. The customer wants to claim against their IP and TPD policy. IP is supported in the Able system, whereas TPD is supported by Figtree. The Assessor will now need to manage these claims concurrently in Able and Figtree.

Refer to Job Aid: Concurrent Claims

Understand how to concurrently manage Income Protection Claims in Able and TPD Claims in Figtree



1. In Figtree set up Able case

reference

2. In Able add Figtree number to the General

Description field

3. In Able select Initial Claim Form document

and confirm correspondence

4. In EDGe amend letter to add Figtree

reference and selected forms

5. In Figtree create required Figtree form and overwrite the Figtree claim no. with the Able

case no.

6. Post Initial Claim Forms

7. In Able close the Initial Claim

Form task

Stage Two – Claims Administrator

Trigger : Your Claims Admin Team Leader issues the CA-Issue Claims Forms task to your work queue…


• We will now demonstrate in the system an example of actioning the CA-Issue Claims Forms task.

• You will receive this task in your work queue. To open it, double click and then click on the case hyperlink to open the case.

Action open the CA-Issue Claims Forms task

Manage Concurrent ClaimsActivity

• Have a go yourself starting with going to your work queue and opening a CA-Issue Claims Forms task.



1. Backscan Figtree forms to the case that came in

via internet mail

2. Manage requirements 3. Initial Assessment

4. Accept Benefit / Accept Benefit with Committee Review

5. Update Figtree claim and raise Payment task

Stage Three – Claims Assessor

Once you have closed the Initial Claims form task, the Assessor can action the following…



1. Set up Payment / Payment letter for

Figtree claim

2. Close Figtree claim

1. Payment Creation

2. Payment Authorisation

Stage Four A&B – Claims Administrator

Stage Four A

Stage Four B

Trigger : Once the Claims Assessor issues the Payment task, your Admin Team Leader will allocate the Payment task in Figtree.

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1. From the My Tasks indexing

queue you can Get Next Task

2. Select Do Task, the Indexing Service

screen displays

3. To open the document, select

Open Images

4. Search for case and attach the imaged docs

Index Inbound Documents Hi-level Process

5. Claim Number auto

populates

6. Nominate the doc type i.e. AMP. Initial

Claim Form, Inbound

7. Enter Doc Title and

description

8. Doc is now attached to the claim

Refer to Job Aid: Inbound Correspondence

Indexing unclassified documents in Able


Index Inbound DocumentsActivity

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• We will now demonstrate in the system an example of actioning the Document Unclassified task

Indexing documents in Able

• Have a go yourself

End of Module

ABLE Claims Assessor Training 40 |

Claims Management Program Day One ABLE Claims Administrator Training November 2014.

Documents

Transcript of Claims Management Program Day One ABLE Claims Administrator Training November 2014.