Claims Management Software Flashcards
7 cards from real CCP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Claims Management Software flashcards as text
What is the primary purpose of a 'reserves adequacy' report generated by claims management software?
Answer: To assess whether set-aside amounts are sufficient to cover projected claim costs
Reserves adequacy reports compare current reserves against actuarial projections to identify under- or over-reserved claims.
Which feature helps claims software detect when the same individual files suspiciously similar claims across multiple policy periods?
Answer: Cross-claim analytics or link analysis
Cross-claim analytics or link analysis identifies patterns connecting claimants, providers, or incidents to flag potential fraud.
In claims management software, what is a 'roundtable review' workflow typically used for?
Answer: Routing complex or high-value claims for multi-adjuster collaborative evaluation
Roundtable workflows route large or complex claims to a group of senior adjusters and managers for joint review and strategy.
What does an electronic funds transfer (EFT) integration in claims software accomplish?
Answer: It enables direct deposit of claim payments to claimants' bank accounts
EFT integration allows the claims system to initiate ACH or wire transfers directly to claimant accounts, eliminating paper checks.
Which claims software feature ensures that settlement payments cannot be issued without required supervisory approval above a set dollar threshold?
Answer: Payment authority controls or approval workflows
Payment authority controls enforce tiered approval requirements so that settlements exceeding defined dollar limits require manager or executive sign-off.
What is the role of a 'litigation management' module within claims software?
Answer: Tracking defense counsel assignments, legal expenses, and case milestones for litigated claims
A litigation management module centralizes attorney assignments, invoice review, budgets, and court dates for claims that escalate to lawsuits.
In claims software, 'FNOL' data capture typically collects which of the following?
Answer: Date, location, description of loss, and initial claimant contact information
First Notice of Loss (FNOL) intake captures the essential incident details needed to open a claim file and initiate the investigation.