Financial authority limits

In BriteCore, financial authority limits are limits placed on claims adjusters to determine the monetary amount a claims adjuster is authorized to manage through the reserves the claims adjuster sets and the payments the claims adjuster issues. The limits are based on the claims adjuster tier level. Level of experience will determine the claims adjuster tier level that he or she is placed, which will determine the financial authority limits. For example, a claims adjuster with minimal experience may only be authorized to set a Loss reserve for $15,000, whereas a claims adjuster with more experience may be authorized to set a Loss reserve for $25,000.

The financial authority limits will determine the following:

  • The Loss reserve amount each claims adjuster tier level is authorized to set.
  • The Expense reserve amount each claims adjuster tier level is authorized to set.
  • The Loss payment amount each claims adjuster tier level is authorized to issue.
  • The Expense payment amount each claims adjuster tier level is authorized to issue.

Note: Expense includes Adjusting and Legal reserves and payments.

Individual and aggregate financial authority limits

Financial authority limits can be based on individual transactions and aggregate transactions. When limits are based on individual transactions, the limit only applies to one reserve change or one payment at a time.

For example, a claims adjuster has a Loss reserve limit of $15,000 and an Expense reserve limit of $5,000 and set the following reserves:

Loss: = $12,000

Adjusting = $5,000

Legal = $0

The claims adjuster would be within their limit because the individual transactions don’t exceed the either of the reserve limits.

When limits are based on aggregate transactions, the limit applies to the total available reserve or total paid.

For example, the same adjuster now increases the Loss reserve amount by $5,000. Now the total Loss reserve is $17,000.

Loss = $17,000

Adjusting = $5,000

Legal = $0

Although the transaction of increasing the Loss reserve by $5,000 would be within the Loss reserve limit, if the limits were based on individual transactions, the aggregate amount exceeds the claim adjuster’s Loss reserve authority limit. 

In BriteCore, financial authority limits are based on aggregate transactions. When reserves and payments are less than or equal to the claims adjuster’s limit, the reserve amounts set and payments issued will be saved.

Exceeding reserve and payment limits

When reserves and payments are greater than the claims adjuster’s limit, the amount entered won’t be saved. When a claims adjuster exceeds the reserve limit, one of the following messages will appear:

Figure 1: The message that appears when the Loss Reserve authority limit is exceeded.

 

Figure 2: The message that appears when the Expense Reserve authority limit is exceeded.

 

To send a notification to the supervisor, the claims adjuster will select Yes.

When a claims adjuster exceeds the payment authority limit the following message will appear:

Figure 3: The message that appears when the Payment authority limit is exceeded.

Implementation

Financial authority limits aren’t configured by default. BriteCore has developed roles, rules, permission levels, and advanced settings to configure financial authority limits when requested.

Roles, rules, and permission levels

To implement financial authority limits for your claims organization, you will need to identify the following:

  • The number of claims adjuster tier levels your company has. In identifying these, you define the roles that will be used with the financial authority limits rules and permission levels.
  • The Loss and Expense reserve limit ranges for each claims adjuster tier level. This will determine the limit of when a set reserve is approved or rejected.
  • The Loss and Expense payment limit ranges for each claims adjuster tier level. This will determine the limit of when a payment is approved or rejected.
  • How your company currently validates reserve limits and outgoing payment limits.

BriteCore will set permission levels for each claims adjuster tier level and will configure the reserve and payment limit ranges, based on the information you provided. If additional development is required, a development feature will be submitted on your behalf to the Rules or Claims team.

Table 1: Sample financial authority limit tier structure.

Permission levelReserve authority limit for LossReserve authority limit for ExpensePayment authority limit for LossPayment authority limit for Expense
Claims AdjusterEqual to or less than $15,000.Equal to or less than $5,000.Equal to or less than $15,000.Equal to or less than $5,000.
Claims SupervisorEqual to or less than $150,000.Equal to or less than $50,000.Equal to or less than $150,000.Equal to or less than $50,000.
Claims VPEqual to or less than $500,000.Equal to or less than $150,000.Equal to or less than $500,000.Equal to or less than $150,000.
PresidentEqual to or less than $1,000,000.Equal to or less than $1,000,000.Equal to or less than $1,000,000.Equal to or less than $1,000,000.

Advanced settings

When ready to bring the financial authority limits online, the following advanced settings will be enabled:

  • call-rules-on-payment-made: This setting enables rule calls to allow or deny when a payment is made. This setting must be set to True.
  • call-rules-on-reserve-change: This setting enables rule calls to allow or deny when a reserve change is made. This setting must be set to True.
  • rules-api-url: When you change the Setting Value to https://api.<<client>>.britecore.com, API rules will be called on reserve change or payment made.

User setup

To set up a user with financial authority limits, navigate to the user’s Information screen of the Contacts module. Assign the role Claims Adjuster to the user, if not already assigned. Navigate to the Permission Level dropdown in the Rules section. Select the permission level that matches the claims adjuster tier level. For example, if the claims adjuster is a tier level 3 adjuster, the permission level would be Claims Adjuster III.

Financial authority limit workflows

Figure 4: View of the financial authority limit Reserve Workflow.

 

Figure 5: View of the financial authority limits Payment Workflow.