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Personas and portal map

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Updated on August 31, 2021

Smart Claims Engine supports key roles associated with your day-to-day use of the application. The table below describes the key access roles provided with the Smart Claims Engine.

PersonaDescriptionPortal
Junior Claims ExaminerThe junior claims examiner is a low-level claims examiner responsible for resolving claims and performing other key claims operations tasks. The junior claims examiner does not have all the actions available to resolve claims.Claims Examiner
Claims Examiner A claims examiner is a regular claims examiner responsible for resolving claims and performing other key claims operations tasks. The claims examiner does not have all the actions available to resolve claims.Claims Examiner
Senior Claims ExaminerA senior claims examiner is a high-level claim examiner responsible is for resolving claims and performing other claims operations tasks. The senior claims examiner has all the actions available to resolve claims.Claims Examiner
Claims SupervisorA claims supervisor is a high-level claims examiner who has responsibility over a group of claims examiners to ensure that their work is completed on time. Claims Manager
Claims ManagerThe claims manager is responsible for managing claims examiners and team performance, ensuring that examiners meet their SLAs and KPIs. Dashboards are available on this portal showing work statistics and other data points. The claims manager portal is available for this role.Claims Manager
Business AnalystThe business analyst is responsible for the configuration of the system, including event codes, action codes and matching criteria. Testing capabilities are also available. The business analyst portal is available for this role.Business Analyst
Test AnalystThe test analyst is responsible for testing the claims engine to ensure that everything configured works correctly. The test analyst portal is available for this role. Test Analyst
System ManagerThe system manager is responsible for approving system configurations and ensuring that the system is performing correctly. Dashboards are available on this portal to show the performance of the system and the file intake statistics. The system manager portal is available for this role. System Manager
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