iWarranty eClaims module is an innovative and integrated approach to Warranty claims submittal and claims processing. eClaims is the central part of the warranty system that collects claims from dealers or servicers, ensures that the correct information is provided, receives approvals for payments, issues credit for valid claims, and stores the data needed by the rest of the warranty lifecycle management. eClaims helps improve administrative efficiencies, reduces overpayments and reduce cycle time from repair to payment, and makes it easy to enter and review the claims.

iWarranty eClaims module consists of

• Claims Entry
• Batch Claim load program
• Claim Tracking
• Claim Validation
• Claim Review and Processing
• Claim Processing Metrics, Reporting

Claims Entry

iWarranty web-based claim entry conforms to industry standards, such as standards in component, fault and failure codes, along with a Universal Claims Form (UCF) format that is used in many industries.  The online program can be used to enter a new claim or edit an existing claim.  All the claims are subject to extensive audits to ensure the accuracy and integrity of claim data being submitted.

Batch Claim Load Program

Batch claim load program stores the claims received from sources other than the web-based entry program in the same central claims database.  The load program uses a defined format for the input files and handles all standard claims processing data elements and any additional data elements needed by the manufacturers.  Service Exchange processes the existing files from sources such as the dealer's business system, and translates them to the file format accepted by this load program.   Claims submitted through the load program are accessible from the online screens for updates or modifications.

The load program invokes the same audit procedures as the Web entry program.  Detailed audit logs, listing error or rejection messages can be sent back via different means or can be viewed online using the Web interface.

Claim Tracking

eClaims allows the resolution of all claims to be tracked and monitored.  Users can check the progress of the claim, correct errors in pending claims, and then resubmit.  A claim with intermediate dispositions (waiting for more information or approval) allows authorized users to make appropriate modifications.

Claim Validation

Hundreds of detailed validation rules ensure that required claim information is provided and valid.  The audits can take the form of conditional checks, cross-referencing with related data sources, and links to fraud detection programs. Some of the claim validations inc

Claim eligibility under regular warranty policies or extended warranty/service contracts Labor hours to be adjusted by the system in accordance with standard labor hours for the repair procedure Duplicate and/or fraudulent claims Cross reference of causal parts, labor codes, and replacement parts to reduce inconsistent claims

The business rules and the actions associated with failure of the rules can be edited to refine these audits over time and perform a different set of edits based on the source of the claims  and claim type.  Business rules also allow the system to be flexible and adapt easily as the policies and needs of the organization change.  

Claims Review and Processing

Claims that pass all the appropriate audits are automatically approved and passed on to accounting for payment.  The system also determines those claims that can be immediately rejected.  The claims requiring review and explicit approval are queued for claims processors or analysts.  Claim reviewers can view the claims, make adjustments, and override any error conditions to approve the claims based on authority levels.  Claim submitters are notified of progress at all appropriate stages of claim processing.

Claim processors can initiate adjustments for paid claims and process adjustments initiated by the field personnel.  They also have ability to approve special policy exceptions with cost sharing by dealers or servicers and customers when a claim falls outside regular warranty policies.

Claim Processing Metrics, Reporting

A number of operational reports and metrics are provided and these reports cover processing metrics such as approval times, claim counts by different criteria, error counts by dealer, and labor adjustments made.  Generated reports can incorporate many different chart types and can easily be shared with the rest of the organization. Warranty Analysis powered by 4CS Service Intelligence provides robust and flexible reporting and analytical capabilities for all stake holders in the warranty process.