Claims Management

Audience: Claims operators and benefits managers who adjudicate employee medical claims — plus anyone evaluating or supporting Claims Management.

Purpose: Front door to the Claims Management guide. It shows the screens at a glance, then points you to a single task, a rule, or why the module works this way.

Claims Management is the corporate benefits console. Operators review claims submitted by (or on behalf of) enrolled members, check plan eligibility advisories, and settle amounts against the member’s remaining allowance.

Pick the kind of help you need

The Academy organises every guide as learn, do, look up, understand.

New here? Start with the tutorial Set up Claims Management First-time setup — add organizations, panel hospitals, and benefit plans before enrolling members and processing claims.

How-to guides Get a specific task done 9

Create a benefit plan Create a claim on behalf Create an organization Filter and find claims Manage members Manage organizations Manage panel hospitals Process a claim View the claims dashboard

Reference Look up exact facts 1

Claim statuses

Tutorials Learn the whole flow by doing 2

Run a claims day Set up Claims Management

Explanation Understand the why 1

Why Claims Management

The screens

Dashboard — pending claims, approvals this month, enrolled members, settlement ratio, volume chart, and the pending queue.

Claims list — search, organization and category filters, service-date range, status chips, and the claim table.

Claim detail — summary, attachments, member balance, advisories, and Process Claim.

Setup surfaces

Before claims flow, register employers, panel hospitals, and benefit plans.

Organizations — register employer clients under Claims Management → Organizations.

Plans — allowances and enrollment codes under Claims Management → Plans.

Panel Hospitals — tenant network directory under Claims Management → Panel Hospitals.

How to get there

In the app sidebar: Claims Management → Dashboard (overview) or Claims Management → Claims (queue).

New tenant? Start with Set up Claims Management.

Screen	Intent path	Route
Dashboard	Claims Management → Dashboard	/corporate/dashboard
Claims	Claims Management → Claims	/corporate/claims
Members	Claims Management → Members	/corporate/members
Organizations	Claims Management → Organizations	/corporate/organizations
Plans	Claims Management → Plans	/corporate/policies
Panel Hospitals	Claims Management → Panel Hospitals	/corporate/panel-hospitals