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.

    Helpful Links

    i-Knowledge Help System - Partner Teams
    i-Knowledge Help System - Internal Teams

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