Claims

The Claims business feature in Open Cloud MDM provides a critical function for institutions, offering a comprehensive, enterprise-wide perspective on all claims related to a party and the relevant policy or contract. This feature is instrumental in identifying and managing potential issues, such as fraudulent claims, and in tracking financial transactions against personal belongings or assets.

Key Functionalities

1. Consolidated View of Claims: This feature provides a unified view of all claims associated with a particular party and the corresponding policy or contract, facilitating effective claims management and fraud detection.
2. Tracking Claims to Items or Holdings: Claims are linked to specific holdings or items, which are considered assets and liabilities. This linkage is vital for tracking financial disbursements against these items.
3. Comprehensive Claims Management: A claim in this context is understood as a request for benefits under an insurance agreement. It can encompass one or more claim items, which may arise from a single event but impact different policies, like household, car, or life insurance.
4. Lifecycle Management: The lifecycle of a claim can be extensive, sometimes outlasting the end date of the associated insurance agreement. This feature manages the entire lifecycle of a claim, regardless of its duration.
5. Dependency on Financial and Party Project Packages: The Claims feature is interdependent with Financial and Party project packages, indicating that claims can be associated with multiple policies and involve several parties.
6. Integration with the Holdings Feature: The Holdings feature, while dependent on the Party project packages, can exist independently of a party link. However, it is generally assumed that roles are associated with the holding.

Claims Example Use Cases

• Fraud Detection: By providing a consolidated view of all claims, the system can help identify patterns indicative of fraudulent activity.
• Multi-Policy Claims Management: In the event of a single incident affecting multiple assets (like a flood impacting a house and a car), the system can manage claims across different insurance policies seamlessly.
• Financial Tracking for Personal Belongings: Track financial transactions, such as insurance payouts, against personal belongings or assets, ensuring accurate accounting and management.
• Lifecycle Management of Claims: Manage claims from initiation to closure, even if they extend beyond the life of the insurance policy, ensuring comprehensive oversight.
• Integration with Other Systems: Leverage integrations with financial and party management systems to provide a more complete view of claims and related financial transactions.
• Asset and Liability Linkage: Link claims to specific assets and liabilities to provide a clear understanding of the financial implications of each claim.

The Claims business feature within Open Cloud MDM offers a powerful tool for managing insurance claims, providing a holistic view of claims associated with a party and their policies. This feature is essential for effective claims management, fraud detection, and financial tracking, ensuring a comprehensive approach to handling claims within an institution.