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At Magic Insurance Company begins processing casualty claims when the claims department receives a notice of loss from a claimant (usually by phone). The claim
At Magic Insurance Company begins processing casualty claims when the claims department receives a notice of loss from a claimant (usually by phone). The claim department selects the next blank pre-numbered 4-part proof of loss form, uses a local terminal to enter the basic information related to the claim (claimant information, claim number assigned) into the claims database to set up the claim and then sends the proof of loss form to the claimant with instructions to fill out the form and bring it with copies of documentation of the loss to an adjuster they assign to the claim. The claimant comes to the adjuster's office with proof of loss form (4 copies) on which the claimant must detail the cause, amount, and other aspects of the loss and provide any necessary documentation supporting the loss and claim amount. The adjuster must review and discuss the loss with the claimant and concur with the claimant on the estimated amount of loss (the form is signed by both the claimant and adjuster as evidence of agreement). The adjustor sends the first two copies of the signed proof of loss form with the documentation provided by the claimant to the claims department. The claimant gets copy 3 of the form. The adjustor keeps copy 4 and updates the claims database with the information from the form using a local terminal and then files this claim numerically (by claim number). ADJUSTER MUST REVIEW AND DISCUSS LOSS When the claims department receives the copies of the proof of loss forms and documentation, a claims processer is assigned. The claims processer pulls the claimant's insurance policy from its file (alphabetic) and reviews the information in the claimant's insurance policy against the claim documented on the proof of loss form, verifies the information the adjuster entered into the claims database and either authorizes or denies the claim. CLAIMS PROCESSOR REVIEWS INFORMATION IN INSURANCE POLICY If they deny the claim, they prepare a letter (3 copies) indicating why the claim was denied and send the original to the claimant. The second copy goes to the adjuster (the adjuster adds it to their claim file when they receive the letter). They file the third copy of the letter with copy 2 of the proof of loss form and documentation. They stamp copy 1 of the proof of loss form Denied" (with the clerk's signature) and send that to accounting. INDICATED WHY CLAIM WAS DENIED IF IT WAS If the claims department authorizes the claim, they stamp forward copy 1 of the proof of loss form Approved" (with the clerk's signature) and forward it to accounting. They file the copy 2 of the proof of loss form and documentation alphabetically. APPROVAL IF AUTHORIZED When the accounting department receives the copies of the approved or denied claims they update the claims database using a local terminal. They file the denied claims in a claim file by claim number. They file the approved claims in a file alphabetically by claimant Weekly, an accounting clerk uses a terminal to request the system to prepare payment checks for authorized, unpaid claims. The checks are 2-part forms. The accounting clerk separates the parts of the checks, attaches copy 2 to the proof of loss package from the authorized file and gives both the stack of proofs-of claim and the original checks to the controller. The controller reviews the documents and signs the checks. The controller returns the proof of loss packages to the accounting clerk who files them alphabetically. The controller gives the signed checks to the accounting manager, who, mails them to the claimants. ACCOUNTING RECIEVES APPROVAL OR DENIAL Attached is a narrative description of a process at the Magic Insurance Company. Using Lucidchart you are to document this process using the following techniques: Data Flow Diagram Prepare a Context Diagram O At Magic Insurance Company begins processing casualty claims when the claims department receives a notice of loss from a claimant (usually by phone). The claim department selects the next blank pre-numbered 4-part proof of loss form, uses a local terminal to enter the basic information related to the claim (claimant information, claim number assigned) into the claims database to set up the claim and then sends the proof of loss form to the claimant with instructions to fill out the form and bring it with copies of documentation of the loss to an adjuster they assign to the claim. The claimant comes to the adjuster's office with proof of loss form (4 copies) on which the claimant must detail the cause, amount, and other aspects of the loss and provide any necessary documentation supporting the loss and claim amount. The adjuster must review and discuss the loss with the claimant and concur with the claimant on the estimated amount of loss (the form is signed by both the claimant and adjuster as evidence of agreement). The adjustor sends the first two copies of the signed proof of loss form with the documentation provided by the claimant to the claims department. The claimant gets copy 3 of the form. The adjustor keeps copy 4 and updates the claims database with the information from the form using a local terminal and then files this claim numerically (by claim number). ADJUSTER MUST REVIEW AND DISCUSS LOSS When the claims department receives the copies of the proof of loss forms and documentation, a claims processer is assigned. The claims processer pulls the claimant's insurance policy from its file (alphabetic) and reviews the information in the claimant's insurance policy against the claim documented on the proof of loss form, verifies the information the adjuster entered into the claims database and either authorizes or denies the claim. CLAIMS PROCESSOR REVIEWS INFORMATION IN INSURANCE POLICY If they deny the claim, they prepare a letter (3 copies) indicating why the claim was denied and send the original to the claimant. The second copy goes to the adjuster (the adjuster adds it to their claim file when they receive the letter). They file the third copy of the letter with copy 2 of the proof of loss form and documentation. They stamp copy 1 of the proof of loss form Denied" (with the clerk's signature) and send that to accounting. INDICATED WHY CLAIM WAS DENIED IF IT WAS If the claims department authorizes the claim, they stamp forward copy 1 of the proof of loss form Approved" (with the clerk's signature) and forward it to accounting. They file the copy 2 of the proof of loss form and documentation alphabetically. APPROVAL IF AUTHORIZED When the accounting department receives the copies of the approved or denied claims they update the claims database using a local terminal. They file the denied claims in a claim file by claim number. They file the approved claims in a file alphabetically by claimant Weekly, an accounting clerk uses a terminal to request the system to prepare payment checks for authorized, unpaid claims. The checks are 2-part forms. The accounting clerk separates the parts of the checks, attaches copy 2 to the proof of loss package from the authorized file and gives both the stack of proofs-of claim and the original checks to the controller. The controller reviews the documents and signs the checks. The controller returns the proof of loss packages to the accounting clerk who files them alphabetically. The controller gives the signed checks to the accounting manager, who, mails them to the claimants. ACCOUNTING RECIEVES APPROVAL OR DENIAL Attached is a narrative description of a process at the Magic Insurance Company. Using Lucidchart you are to document this process using the following techniques: Data Flow Diagram Prepare a Context Diagram O
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