CCP Claims Management Software 3 — Questions and Answers
Question 1: What is the primary purpose of a 'reserves adequacy' report generated by claims management software?
- To list all open claims by adjuster
- To assess whether set-aside amounts are sufficient to cover projected claim costs (Correct answer)
- To track litigation expenses only
- To reconcile premium payments
Correct 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.
Question 2: Which feature helps claims software detect when the same individual files suspiciously similar claims across multiple policy periods?
- Document management index
- Cross-claim analytics or link analysis (Correct answer)
- Premium billing module
- Reinsurance cession report
Correct answer: Cross-claim analytics or link analysis
Cross-claim analytics or link analysis identifies patterns connecting claimants, providers, or incidents to flag potential fraud.
Question 3: In claims management software, what is a 'roundtable review' workflow typically used for?
- Processing micro-payments automatically
- Routing complex or high-value claims for multi-adjuster collaborative evaluation (Correct answer)
- Generating ISO ClaimSearch submissions
- Scheduling vehicle inspections
Correct 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.
Question 4: What does an electronic funds transfer (EFT) integration in claims software accomplish?
- It files claims electronically with state regulators
- It enables direct deposit of claim payments to claimants' bank accounts (Correct answer)
- It transmits FNOL data to field adjusters
- It generates proof-of-loss forms
Correct 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.
Question 5: Which claims software feature ensures that settlement payments cannot be issued without required supervisory approval above a set dollar threshold?
- Diary scheduling
- Payment authority controls or approval workflows (Correct answer)
- FNOL intake form
- ISO ClaimSearch submission
Correct 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.
Question 6: What is the role of a 'litigation management' module within claims software?
- Tracking defense counsel assignments, legal expenses, and case milestones for litigated claims (Correct answer)
- Generating marketing materials for claimants
- Scheduling independent adjuster field visits
- Auto-populating ACORD forms
Correct 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.
Question 7: In claims software, 'FNOL' data capture typically collects which of the following?
- Policy anniversary dates and premium amounts
- Date, location, description of loss, and initial claimant contact information (Correct answer)
- Adjuster performance scores and caseload metrics
- Reinsurance treaty percentages
Correct 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.
CCP Claims Management Software 3
What is the primary purpose of a 'reserves adequacy' report generated by claims management software?