Smart Claims Engine supports key roles associated with your day-to-day use of the application. The table below describes the key access roles provided with the Smart Claims Engine.
|Junior claims examiner
|The junior claims examiner is a less experienced claims examiner responsible for resolving claims and performing other key claims operations tasks. The junior claims examiner typically does not have access to all the actions available on the Actions menu to resolve or adjust claims. The junior claims examiner uses the claims examiner portal.
|A claims examiner is a regular claims examiner responsible for resolving claims and performing other key claims operations tasks. The claims examiner does not have all the actions available to resolve claims.
|Senior claims examiner
|A senior claims examiner is a highly skilled claims examiner responsible for resolving claims and performing other claims operations tasks. The senior claims examiner typically has access to all the actions available on the Actions menu to resolve or adjust claims. The senior claims examiner uses the claims examiner portal.
|A claims supervisor is responsible for managing the work of a group of claims examiners. The claims supervisor may also resolve claims based on their skills/experience. The claims supervisor uses the claims manager portal.
|The claims manager is responsible for managing a team of claims examiners and their performance, ensuring that examiners meet their deadlines and quality metrics. The claims manager uses the claims manager portal. Dashboards on the claims manager portal show related statistics and other data.
|The business analyst is responsible for the configuration of the system, including event codes, action codes, and other delegated rules. Access to the SCE test suite is also provided by the business analyst portal. The business analyst uses the business analyst portal.
|The test analyst is responsible for testing the SCE to ensure that various configurations and decision tables provide the expected results. Access to the SCE test suite is also provided via the test analyst portal. The test analyst uses the test analyst portal.
|The system manager is responsible for approving system configurations and ensuring that the system is performing correctly. Dashboards on the system manager portal capture system performance and file intake statistics. The system manager uses the system manager portal.