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FS330SAP Claims Management Overview

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COURSE OUTLINE.

Course Version: 11Course Duration:

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© Copyright. All rights reserved. iii

Contents

vii Course Overview

1 Unit 1: SAP Insurance and SAP Claims Management, Introduction

1 Lesson: Describing the Position of SAP Claims Management in SAP for Insurance

1 Lesson: Explaining the Claims Lifecycle1 Lesson: Explaining the Six Major Steps in the Lifecycle of a Claim1 Lesson: Explaining the Access Modes

3 Unit 2: FS-CM Master Data

3 Lesson: Exploring the Claim3 Lesson: Explaining Claim Bundle3 Lesson: Using Business Partner

5 Unit 3: Access Modes

5 Lesson: Exploring the Access Modes5 Lesson: Explaining Claim Search

7 Unit 4: Claim Notification

7 Lesson: Explaining Claim Notification

9 Unit 5: Claim Handling

9 Lesson: Using Expert Mode9 Lesson: Explaining Participants9 Lesson: Explaining Damaged Objects / Injured Persons9 Lesson: Explaining the Subclaim9 Lesson: Explaining Claim Item9 Lesson: Explaining the Procurement Process10 Lesson: Assigning External Service Provider10 Lesson: Using the Functions for Negotiation10 Lesson: Using the Functions for Litigation10 Lesson: Handling Reserves10 Lesson: Explaining the Workers Compensation Benefit Calculator

11 Unit 6: Claim Fulfillment

11 Lesson: Explaining Compensation Calculation11 Lesson: Explaining Payments11 Lesson: Creating Payments11 Lesson: Explaining Further Payment Features11 Lesson: Explaining Payment Authorizations and Interface to FS-CD11 Lesson: Explaining the External Bill Review Process

© Copyright. All rights reserved. v

13 Unit 7: Claim Recovery

13 Lesson: Explaining Refund13 Lesson: Creating a Subrogation Case13 Lesson: Explaining Salvage13 Lesson: Tracking Incoming Payments13 Lesson: Explaining Multiple Insurance

15 Unit 8: Claims Management Supporting Features

15 Lesson: Handling Incoming Documents15 Lesson: Creating Outbound Correspondence15 Lesson: Using the Notes and Memo Pad15 Lesson: Explaining Business Rule Framework plus (BRFplus)15 Lesson: Explaining Activity Management and Workflow15 Lesson: Exploring the User Interface Configuration16 Lesson: Explaining Authorizations16 Lesson: Using Reporting

vi © Copyright. All rights reserved.

Course Overview

TARGET AUDIENCEThis course is intended for the following audiences:

● Application Consultant

● Business Process Architect

● Business Process Owner/Team Lead/Power User

● Enterprise Architect

● Industry Specialist

● Program/Project Manager

● Solution Architect

● User

© Copyright. All rights reserved. vii

UNIT 1 SAP Insurance and SAP Claims Management, Introduction

Lesson 1: Describing the Position of SAP Claims Management in SAP for InsuranceLesson ObjectivesAfter completing this lesson, you will be able to:

● Describe the Position of SAP Claims Management in SAP for Insurance

Lesson 2: Explaining the Claims LifecycleLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the claims lifecycle

Lesson 3: Explaining the Six Major Steps in the Lifecycle of a ClaimLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the six major steps in a lifecycle of a claim

Lesson 4: Explaining the Access ModesLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the access modes

© Copyright. All rights reserved. 1

Unit 1: SAP Insurance and SAP Claims Management, Introduction

2 © Copyright. All rights reserved.

UNIT 2 FS-CM Master Data

Lesson 1: Exploring the ClaimLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the meaning of a claim also in the context of product and policy

Lesson 2: Explaining Claim BundleLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the meaning of a claim bundle

Lesson 3: Using Business PartnerLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the basic principles of business partners and how they are used in SAP Claims Management


Unit 2: FS-CM Master Data


UNIT 3 Access Modes

Lesson 1: Exploring the Access ModesLesson ObjectivesAfter completing this lesson, you will be able to:

● Explore the access modes

Lesson 2: Explaining Claim SearchLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the capabilities of the claim search


Unit 3: Access Modes


UNIT 4 Claim Notification

Lesson 1: Explaining Claim NotificationLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain Claim Notification

● Explain the functionality of the duplicate check

● Explain the meaning of the policy snapshot

● Describe how and what data is captured during notification

● Explain how coverage is verified and the meaning of coverage referrals

● Explain the task overview

● Explain how performers and tasks are assigned


Unit 4: Claim Notification


UNIT 5 Claim Handling

Lesson 1: Using Expert ModeLesson ObjectivesAfter completing this lesson, you will be able to:

● Use the Expert Mode

Lesson 2: Explaining ParticipantsLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain participants and their use in a claim

Lesson 3: Explaining Damaged Objects / Injured PersonsLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the meaning of damaged objects and injured persons in claim handling

Lesson 4: Explaining the SubclaimLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the Subclaim and all assigned objects

Lesson 5: Explaining Claim ItemLesson ObjectivesAfter completing this lesson, you will be able to:

● Create claim items and add documents to them

Lesson 6: Explaining the Procurement ProcessLesson Objectives


After completing this lesson, you will be able to:

● Explaining the procurement process

Lesson 7: Assigning External Service ProviderLesson ObjectivesAfter completing this lesson, you will be able to:

● Assign external service providers

Lesson 8: Using the Functions for NegotiationLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the main negotiation functions

● Create a negotiation in expert mode

Lesson 9: Using the Functions for LitigationLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the main litigation functions

● Create a litigation in expert mode

Lesson 10: Handling ReservesLesson ObjectivesAfter completing this lesson, you will be able to:

● Handle Reserves

● Define the different types of reserves

● Set reserves manually

Lesson 11: Explaining the Workers Compensation Benefit CalculatorLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the workers compensation benefit calculator

Unit 5: Claim Handling


UNIT 6 Claim Fulfillment

Lesson 1: Explaining Compensation CalculationLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain and run the compensation calculation

Lesson 2: Explaining PaymentsLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain payments

Lesson 3: Creating PaymentsLesson ObjectivesAfter completing this lesson, you will be able to:

● Create payments

Lesson 4: Explaining Further Payment FeaturesLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain further payment features

Lesson 5: Explaining Payment Authorizations and Interface to FS-CDLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain payment authorizations and the interface to FS-CD

Lesson 6: Explaining the External Bill Review ProcessLesson Objectives



● Explain the external bill review process

Unit 6: Claim Fulfillment


UNIT 7 Claim Recovery

Lesson 1: Explaining RefundLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain refund

Lesson 2: Creating a Subrogation CaseLesson ObjectivesAfter completing this lesson, you will be able to:

● Create a subrogation case

Lesson 3: Explaining SalvageLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the salvage process

Lesson 4: Tracking Incoming PaymentsLesson ObjectivesAfter completing this lesson, you will be able to:

● Track incoming payments

Lesson 5: Explaining Multiple InsuranceLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the concept of multiple insurance


Unit 7: Claim Recovery


UNIT 8 Claims Management Supporting Features

Lesson 1: Handling Incoming DocumentsLesson ObjectivesAfter completing this lesson, you will be able to:

● Handle incoming documents

Lesson 2: Creating Outbound CorrespondenceLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the different ways to create outbound correspondence

Lesson 3: Using the Notes and Memo PadLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the use of notes and memo pad

Lesson 4: Explaining Business Rule Framework plus (BRFplus)Lesson ObjectivesAfter completing this lesson, you will be able to:

● Explain Business Rules Framework plus (BRFplus)

Lesson 5: Explaining Activity Management and WorkflowLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the activity management and its integration to BRFplus and to the workflow management

Lesson 6: Exploring the User Interface ConfigurationLesson Objectives



● Explore the flexibility of the user interface configuration

Lesson 7: Explaining AuthorizationsLesson ObjectivesAfter completing this lesson, you will be able to:

● Explain the principles of the SAP authorization concept

Lesson 8: Using ReportingLesson ObjectivesAfter completing this lesson, you will be able to:

● Name and explain the delivered reports

● Explain the integration to a Business Data Warehouse

Unit 8: Claims Management Supporting Features
