Common questions during adjudication
There may be two issues involved in evaluating an insurer's responsibility regarding a loss. First. was there a policy in effect at the time of the loss? And, do any of the coverages on the policy cover the loss? Not onlv must a policy be in effect at the time ...
mini-programs that ClaimCenter invokes to perform an action or calculate a result
1.) Plugin has an interface
2.) Register in studio Plugins registry
Messaging
Async gw integration mechanism in which messages are sent to external systems and replied to.
Integration
Communication between gw apps and externals systems. CC uses diff Api's to communicate with
external systems.
Litigation
Resolution of disputes (lawsuits)
Adjudication
determine if pay claim and how much
Policy
contract between carrier and insured, carrier promises to cover insured for specific type of loss.
Coverage
type of loss listed on policy that carrier will cover.
Claim
event in which one or more (potentially) covered losses occurred.
Matter
set of data pertaining to a single (potential) lawsuit.
Check
transfer of money tracked by exposure to one/more individuals or organizations.
Reserve
amount of money set aside for expected payments related to exposure
Exposure
Object associated w/ claim to track potential payments from a claim.
,Subrogration
When an insurance company attempts to recoup expenses for a paid claim when another payer should
have been responsible.
Generics
make it possible to design classes and methods that defer the specification of one or more types until
the class or method is declared and instantiated by client code
Open Type System
extensible type system = custom type loaders
can dynamically inject types into the language and use new types as native objects in Gosu.
• API for plugging new types into Gosu Compiler
• metaprogramming - a variety of ways a program has knowledge of itself or can manipulate itself.
• uses different type loaders WSDL, XSD, and SQL
LOB/LOB Model
CC enables you to model the responsibilities of each business unit of an insurance carrier.
- base config six typelists that define LOB Model.
• LossType
• LOBCode
• PolicyType
• CoverageType
• CoverageSubtype
• ExposureType
*used to configure displays when entering a new claim and working with existing ones.
Primary Elements of Exposure
-Coverage
-Claimant
-Incident
-Reserves
4 Types of Data Model Configs
- Add new fields to entity
- Modify existing typelists
- Add new entities
- Add new typelists
Guidewire platform includes four main areas of technology
• Data model
• UI
• Business rules
• Integration APIs
,Claims Process
1.) Intake (FNOL)
2.) Adjudication
3.) Payment (issuing checks)
4.) Recovery (salvage/recover funds from at fault)
Startable Plugins
used to listen for incoming messages and processes them asynchronously (listen for external payment
system)
Predefined Plugins
used to implement customizable behavior for predefined points in the app (auth service plugin)
Messaging Plugins
send messages to external systems and process replies.
PCF
(object model) proprietary app framework used to create GW end-users interfaces
High Level Categories of PCF Elements
Widget (displayable elements of UI) and Location (place in app which user/app can navigate too.)
Atomic Widgets
atomic piece of interface content or functionality. (Display individual data values, or execute individual
actions) ie. Input, cell, button
Container Widgets
collection of atomic widgets and/or other container widgets. (ie. Detail View, Input Set, List View, Card
View, ListDetail View, Screen)
Detail View
manage a collection of related pieces of info that constitute a single "record".
List View
allow the user to view summary info about a collection of records. Organized as table.
Input Set
collection of inputs that can be reused by detail views
Card View
collection of cards, each with one or more detail/list views.
ListDetail View
, contains a list on top and detailed info about the selected list item on bottom.
Types of Validation in CC
-Validation which prevents invalid data from getting saved
-Validation which manages and enforces object maturity
Two "layers of entities in base app
App level entities (specific to given app ie. Claim) and platform level entities (common to all GW apps ie.
Activity, User).
Gosu enhancement
set of code that enhances the functionality of an existing GW type. (.gsx)
Steps to implement plugins
-Determine plugin requirements (implement interface?)
-Write/modify plugin class
- Move plugin code to proper directory
- Modify plugin registry element
- Deploy Changes
Claim Creation
- Claim Segmented
- Claim assigned group/user
- Claim Workplan (series of activities) generated/assigned
- Exposure segmented
- Exposure assigned group/user
- Exposure Workplan
- Initial Reserves created for exposure if possible thru business rules
5 Levels of maturity of Claim/Exposures
(Rules during adjudication process managed by CC rules engine)
-Load Save (level to import Claim)
-New Loss Completion (level to save claim)
-Valid for ISO (send to file w/ ISO) (configurable)
-Send to external system - (level to send to external systems) (configurable)
-Ability to Pay - (write payments against claim)
** Can also add additional levels.
Creating WebService
Custom Web Service-
- Create the gosu package and class
- Add the web service annotations
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