Insurance claim process intimation document verification approved rejected

Description:

The image is a PowerPoint slide that outlines a detailed process for handling insurance claims, including various decision points leading to the approval or rejection of a claim. The process flow includes the following steps:

1. New claim intimations:

The start of the process is when a claim is reported.

2. As per grid investigation/verification:

An initial review is to determine if further investigation is required.

3. Rejection:

A claim can be rejected if it does not meet certain criteria.

4. Mandatory requirements received:

Checks if all required documents have been submitted.

5. Approved:

The claim is approved after all checks are satisfied.

6. Follow up with investigator:

If the claim requires further investigation.

7. After receipt of requirements and reports:

Additional information is gathered for the decision-making process.

8. Security of documents and recommendation for decision of claim:

Ensuring document security and making a recommendation based on the findings.

9. Repudiation:

The claim is denied.

10. Document preparation and sent:

Preparing and sending the necessary documents after the claim decision.

11. Admission:

The stage before payment is where the claim is formally accepted.

12. Payment is prepared and sent to finance:

The process of arranging payment for an approved claim.

13. Cheques prepared and sent to claim:

Final payment is made to the claimant.

Use Cases:

This type of slide could be applicable in various industries that deal with claims or structured decision processes:

1. Health Insurance:

Use: Describing the claim review process for medical expenses.

Presenter: Claims Manager.

Audience: Claims Processors, Policyholders.

2. Automobile Insurance:

Use: Explaining accident claim verification and payouts.

Presenter: Insurance Adjuster.

Audience: Insurance Agents, Clients.

3. Property and Casualty Insurance:

Use: Outlining the steps for property damage claim handling.

Presenter: Property Claims Specialist.

Audience: Property Owners, Insurance Brokers.

4. Travel Insurance:

Use: Detailing the process for handling travel-related claims.

Presenter: Claims Department Trainer.

Audience: Travel Agents, Insured Travelers.

5. Life Insurance:

Use: Demonstrating the verification process for life insurance claims.

Presenter: Life Claims Analyst.

Audience: Beneficiaries, Financial Advisors.

6. Workers' Compensation:

Use: Presenting the claim adjudication process for workplace injuries.

Presenter: Workers' Comp Coordinator.

Audience: Employers, HR Professionals.

7. Warranty Services:

Use: Showing the process for claims on warranty services for products.

Presenter: Warranty Claims Officer.

Audience: Customers, Service Centers.