Claim Specialist

Claim Specialist

After an email is sent to a Claims Specialist email inbox, a case is created in ZOHO. Follow the steps below to open, review, and close the case in ZOHO. Managers can review the Queue Management article to learn how to update the Claim Specialist Round Robin settings.

While navigating Case Views, you may notice a Delete option. Do not delete case views or cases. See your Supervisor for assistance.

Open Cases

  1. On the Zoho Toolbar , click CASES .
  2. On the left panel, click  Views  section, then click  All Views , and click  My Cases .
      1. My Open Cases  shows cases with an  Open  status. 
        To view all cases with any status, open  My Cases . 
      2. Once a case status is changed from Open to any other status,
        the case will appear in  My Cases  and your personal Custom View. 
      3. Add  My Open Cases  to  Starred Views  (Favorites):
        Open My Open Cases view, at the left of the title, click the empty 
        Star  to add to your  Starred Views  (favorites).
  3. Click the top  Case  to open it.
    Typically you will start your day with the oldest case first. 
  4. Update the following required fields:
    1. Subject : 
      Click the Edit icon to change the Subject to the team's required format. 
    2. Status.
    3. Status Reason Code .
  5. Swivel to  ServiceBench  and locate the  Service Job  using the  Service Job Number .
    1. Perform all research and resolution within ServiceBench.
      Review the  Service Job  history, determine the escalation reason and resolve using details provided.
    2. Add Job Comments in ServiceBench.
    3. Add Attachments in ServiceBench.
    4. Copy job comments if any to paste into Zoho.
  6. Swivel back to  Zoho:
    1. Reply to AE:
      1. Open the Case . 
      2. Click the Communication tab. 
      3. Click Reply All.
      4. Enter comments to AE and click Send.
    2. Add Internal Private Comments (Optional):
      1. At the top right of the page click the Comment icon. 
      2. Paste your ServiceBench comment and click Comment Private button to save.
        Do Not make the comment Public.
    3. Add   Followers:
      1. Under the Case Subject click  Followers. 
      2. Enter the name of the case follower in the  Search Agent  field.
      3. Select the correct name from the list.
    4. Remove Followers:  
      1. Under the Case Subject click  Followers. 
      2. Current followers will be displayed.
      3. Hover over the agent name and click Unfollow Case (-)  
    5. Update the  Status  and  Status Reason Code   
  7. Ready to Complete? 
    Update the Status:  Completed .
    1. Do not choose  Close Case  to complete the case. 
    2. Select a  Resolution Reason , and then click  Save .

Create Signature for Email Replies

  1. On the Zoho Toolbar , click  Setup  (gear) icon.
  2. Under the Customization section, click   Personal Settings.
  3. On the left panel under Personal Settings , click  Preferences. 
  4. Scroll down to Signature and click  Add Signature.   
  5. Enter your personal signature and click  Save . 

Overview

There are multiple Zoho Desk workflows created for the Claims Specialist teams.
  1. After an email is received in a Claims Specialist Outlook Inbox, a case is created and the email is attached on the Conversation tab. 
  2. During or after Service Initiation for specific trades within a specific state, a case is created and routed to the Claim Specialist team.
Routing Emails to Claims Specialist Outlook Inboxes to Zoho
  1. If the following conditions are met during (or after) Service Initiation, then a case is created
    and routed to Claims Specialist team:
    1. Email is sent to a Claims Specialist Inbox (approx 9 Outlook inboxes)
    2. Claim Specialist Inboxes are routed to Zoho Desk Inboxes
    3. Cases are created from emails received in Zoho
    4. Cases are assigned to the Claim Specialists Team
    5. Cases are routed (separated) into various Claim Specialist Lists (Queues).
Routing Nevada HVAC Med Emerg & Emerg to Claim Specialist
  1. If the following conditions are met during (or after) Service Initiation, then a case is created
    and routed to Claims Specialist team:
    1. State is Nevada (NV)
    2. Severity is Medical Emergency or Emergency
      (or upgraded to Medical Emergency and Emergency), and
    3. Trade is HVAC.

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