Claims are processed in an order of 3 scenarios:

  • 1 General Customer. Marks the ticket as pending, sends an alert and assigns the ticket to the agent. 
  • 2 General Customer Processing. Used after a claim is entered into HRMS and payment was authorized.
  • 2 Invoice. Claim has been entered in HRMS. Use if the Company needs to be invoiced to receive payment. Create an Email in Fresh desk to the company address in the Invoices group with the attached invoice. When payment is received use Scenario Invoice Payment Received to resolved the email and authorize payment in HRMS.
  • 2 Pull Funds. Claim is Entered in HRMS. Forward a request to pull funds with the attached invoice and use the scenario. Sets ticket as unassigned and all of claims management as watchers. When a response is received pull funds and authorize payment. 
  • 3a General Customer EFT. After payment is processed send the EFT and details of claim to the claimant with the EFT notice canned response. Use this scenario to close the ticket. 
  • 3b General Customer Mailed Cheque. Notify the claimant that their payment is mailed out and use this scenario to close the ticket. 


Order of events:

Claim received and organized --> Scenario 1 --> Enter Claim and if Payment is available authorize Payment --> Scenario 2

Processes Payment through HRMS --> Notify claimant of payment --> Scenario 3a if EFT or b if cheque.   


Claim received and organized --> Scenario 1 --> Enter Claim and if invoiced --> create company invoice email in fresh desk --> Scenario 2 Invoice on claimants ticket --> When company response received Authorize payment ---> Use Scenario Invoice Payment Received in Email --> Process Payment in HRMS --> Notify claimant of payment --> Scenario 3a if EFT or b if cheque.



Claim received and organized --> Scenario 1 --> Enter Claim and if Funds Pulled --> Use scenario 2 Pull Funds ---> When response received pull funds --> authorize Payment --> Process Payment --> Notify claimant of payment --> Scenario 3a if EFT or b if cheque.