ClaimCenter - Overview & FNOL

Contents
01. What is Guidewire ClaimCenter?...................................................................................................................3
02. Who are all Participants in ClaimCenter?.......................................................................................................3
01. Customer Service Representative (CSR).....................................................................................................3
02. Adjuster (Claim Handler)............................................................................................................................3
03. Supervisor/Claims Manager.......................................................................................................................3
03. What are the core areas in guidewire?..........................................................................................................3
01. Configuration.............................................................................................................................................3
02. Integration.................................................................................................................................................3
04. What is a typical claim process?.....................................................................................................................3
03. Intake.........................................................................................................................................................4
04. Adjudication...............................................................................................................................................4
05. Payment.....................................................................................................................................................4
06. Recovery.....................................................................................................................................................4
05. Claim Processing............................................................................................................................................4
01. Create a claim.............................................................................................................................................4
02. Setup claim (Complete post FNOL activities)..............................................................................................5
03. Create exposures........................................................................................................................................6
04. Create reserves..........................................................................................................................................7
05. Complete activities.....................................................................................................................................8
06. Make claim as payable...............................................................................................................................8
07. Issue Checks.............................................................................................................................................10
08. Close the claim.........................................................................................................................................11
06. How many times ClaimCenter contacts Policy system (not policy center)?.................................................13
01. Policy Search............................................................................................................................................13
02. Policy Retrieval.........................................................................................................................................14
03. Policy Refresh...........................................................................................................................................15
07. What is segmentation?................................................................................................................................15
08. What is Claim File?.......................................................................................................................................16
09. Exercises.......................................................................................................................................................16
01. Create a claim, make it payable and close it by following all below 8 stages...........................................16
02. Add new input fields on loss details page................................................................................................17
01. What is Guidewire ClaimCenter?
Guidewire ClaimCenter is a claims management system that supports all lines of personal, commercial,
and workers' compensation insurance.

02. Who are all Participants in ClaimCenter?

Persons who use ClaimCenter are called ClaimCenter Participants, and they are most categorized as
below 3 roles, CSR, Adjuster, Supervisor.

03. Customer Service Representative (CSR)

Who creates claims using FNOL process

04. Adjuster (Claim Handler)

Who acts on claims created by CSR

05. Supervisor/Claims Manager

Who supervise users and approves the claims

06. What are the core areas in guidewire?

01. Configuration
Customizing the base application according to the insurance company needs.

 Date Tier – Entity and Type lists

 Application Tier – GOSU Class
 Presentation Tier - PCF

02. Integration
Integration deals with how to integrate with other systems.

 Messaging
 Web Services – Ex. Retrieve information about a given contact
 Batch Process
 Plugins – Ex. Claim number generator

03. What is a typical claim process?

In general claim is processed in four phases:
 04. Intake
Entering the details about a potentially covered loss into the system.

First Notice Of Loss is the event in which the carrier is informed of a potential covered loss.

For workers’ compensation claims it is also called as

First Report Of Injury (FROI) or First Notice Of Injury (FNOI)

Claim can be entered in different ways, from external portal, from importing the claims or from
guidewire new claim wizard.

05. Adjudication
Process of deciding if a claim must be paid or not, it is done in two phases.

 Investigation
 Loss Assessment

06. Payment
Process involves creating, approving and issues the checks.

07. Recovery
Recovery of the funds from third party, it is done in two ways.

 Subrogation
 Salvage

08. Claim Processing

Claim processing is done in the following stages in Guidewire.

01. Create a claim

Using FNOL a claim can be created
02. Setup claim (Complete post FNOL activities)
Based on segmentation rules workplan would be created. Post FNOL activities including updating
the initial FNOL details.
03. Create exposures
Exposure – An event that exposes to risk. It is used to track potential payments from a claim.

Every exposure is linked to one coverage (where the money is coming from) and one claimant
(where the money is going to).

Exposures can be created automatically or can be created manually by adjuster. Depending upon
the type of incident exposures can be multiple.
04. Create reserves
Reserve - Initial amount set aside for settling the claim. Reserve amount can be setup based on
rules or can be set manually by adjuster.
 Claim cost always divided into two parts, claim cost and expenses:

05. Complete activities

Available can be auto created and adjuster can manually create new activities.

06. Make claim as payable

07. Issue Checks
08. Close the claim

A claim cannot be completed/closed if there are any open exposures or open activities, or open
services and fault rating must be determined.
09. How many times ClaimCenter contacts Policy system (not policy
center)?
ClaimCenter connects to Policy System 3 times, during claim processing.

1. Policy Search
2. Policy Retrieval
3. Policy Refresh

01. Policy Search

When user clicks on ‘Search’ button in ‘Find Policy’ page, ClaimCenter will interact with Policy
System and fetches the data based on search parameters supplied or by default it will fetch first 25
records from policy system.
02. Policy Retrieval
After policy search, whatever the details we see about the policy like address, vehicles, coverage
are retrieved from policy system.
 03. Policy Refresh

04. What is segmentation?

Segmentation is determining the complexity of the loss.
05. What is Claim File?
Left side blue colored pane which has references about claim is called “Claim File”.

06. Exercises
01. Create a claim, make it payable and close it by following all below 8 stages
01. Create a claim – Complete FNOL activity
02. Setup claim - Complete post FNOL activities
03. Create exposures
04. Create reserves
 05. Complete activities
06. Make claim as payable
07. Issue Checks
08. Close the claim

02. Add new input fields on loss details page

Add below input fields on loss details page:

 First Name
 Last Name
 SSN Number
 Date of Birth