Case management supports the entire life cycle of a claim including prior approvals,
claim entry, pre- validation and validation, auto adjudication, manual review, settlement, and
appeals. A warranty claim is a set of cases and subcases that are managed independently while
allowing the entire case structure view. Validation of the claim occurs at two points in the
- Pre-validation,when rules are executed before the claim is submitted to the adjudication
- Validation,which occurs during the claim adjudication, after the claim has been submitted
to the manufacturer.
Pega Warranty has a number of pre-configured rules that
implement a sample set of business rules:
PreValidationForPart, where a certain part number requires an invoice
PreValidationForMisc,where miscellaneous expense codes require an invoice
attached to the claim.
PreValidationForLabor,where labor hours cannot exceed the defined amount
for a particular labor activity.
ProductCheckInDate, where a date cannot be set in the future.
OdometerReading,where the odometer reading cannot be less than the last
reading on record for the vehicle.
CoverageExists,where the claim cannot be entered if there is no valid
coverage available. When these conditions are not met for any line, a warning icon
ClaimValidation subflow handles all the validations related to the
claim in the validate claim step.
When a claim passes through this flow, all the
exceptions related to the claim are flagged and added to the claim. This subflow also
determines the claim disposition as paid, denied, or manually assessed.
To review the
ClaimsValidation flow steps, enter
ClaimsValidation in the
Dev Studio header search text field and click it to open.