Direct link to a Customer's File #46

To ease the task of the Manager, Allegroupe will allow direct access to an employee’s file.

That is, all the information contained in its file will be available. Thus, enabling the administrator to make discerning decisions which are based on the information provided. From the employee’s file, he will be able to view the entire insurance contract, check a specific benefit or obtain the pertinent related information.

From a specific benefit, he can access the module directly where benefit plans are assigned.

When selecting the benefit plans association icon, the manager is able to query additional contract information relevant to claim management.

There, he will able to find very specific information as to specific benefits related with claim management.

Each individual plan describe here will have been created using the claim adjudication business rules creation module.

We can obtain a higher level of information by selecting the business rules managing module or by managing the DIN activity or each individual services.

The adjudication module is a very sophisticated tool enabling the creation of various plans. By using the business rules creation module, various plans and benefits can be created with action tables essentially. Therefore, it is useless and not necessary to call on a programmer to create new plans. The module is flexible enough to allow the creation of desired benefits and apply very specific adjudication rules to select the product or individuals.

In addition, each insured can be managed on an individual basis. Proper definition can be achieved through the respect for the insured of specific business rules. Once set these rules will be automatically managed by the Allegroupe adjudication module.

Aside from being able to access contract information, the administrator can query other accounting information in relation with the individual in question.

So, upon processing a claim directly with an employee at the counter, the administrator will be in a position to give him a summary of his coverage, billing details, cumulative reports or payroll contribution, and so forth.  

The current adjudication module request can be access and process by either the insure, the sponsor or the employee directly.

This is why Allegroupe is so flexible when comes time to process a claim, whether it is during a punctual visit with an employer or an employee, or when dealing with blocks of massive information to be processed.