Training in a Box Series
Failed Payouts on Instant Claims
Start
Instant Claims Failed Payouts - Introduction
About this training
Welcome to "Training in a Box"! In this micro-learning course you will, with your squad, affirm the correct protocol for handling failed payouts on Instant Claims (ICs). This understanding is crucial for ensuring that we can quickly amend any issues with policyholders receiving payments on approved claims. Your skill keeps the claim process delightful for our policyholders, giving them a quick and easy solution to any snags they hit with receiving reimbursement. Here is the Agenda for the Discussion:
- Claim Advocate Responsibilities for IC Failed Payouts
- Pet Specialist Responsibilities for IC Failed Payouts
- Processing IC Failed Payouts with the Claim Information on File
To navigate through this course, you will find arrows at the top left of the screen to move forward and backwards. Let's dive in and enhance your expertise regarding Instant Claim failed payouts!
IC Failed Payouts - Starting the Claim
Claim Advocate and Pet Specialist Duties for Failed IC Payouts
When an instant claim has a failed payment, it needs a little manual assistance from our CLX team, both Claim Advocates and Pet Specialists. However, the claim will not be re-investigated by the Claim Advocate, their focus is determining which tasks need to be completed to close the claim properly. The goal of the Pet Specialist is assessing how to successfully issue the payment to the policyholder. Working together, we can resolve these claims as quickly as possible. Click on the number steps on the right to see the order in which things should be handled for an Instant Claim once the payment has failed, and then we'll move on to then next slide to discuss what to do when something isn't quite right with an instant claim that failed payment.
A failed payment task will be automatically created and assigned to the most available Pet Specialist-The claim will remain unassigned.
The assigned Pet Specialist must then determine why the payment failed and contact the policyholder to update the payment method.
The most available Claim Advocate will then be assigned to complete the claim adjusting tasks.
The Pet Specialist will contact the policyholder when their claim payment has successfully been sent and the claim will be closed.
IC Failed Payments - Information Needed to Complete the Claim
Information Needed for IC Failed Payout Claims
Sometimes you open an Instant Claim that got flagged for re-review due to the payment failing, and start to notice other things about the claim: What action should we take beyond re-issuing the payment to the policyholder? Click the text of each scenario below to reveal the answer.
Why do we not correct the claim beyond fixing payment?
1. The invoice submitted was actually cut-off and the line item prices aren't shown.
Proceed with issuing the payment for the claim, NOT reach out to the vet or the policyholder requesting a new invoice.
2. The claim is for an FMI, and the policyholder notes in the video they forgot to put their pup in her crate that morning-Their vet's recommendation to prevent FMIs.
Proceed with issuing the payment for the claim, do NOT reach out to the vet or the policyholder for previous medical records or try to make a change in the claim determination.
Click to Reveal Answer
3. You believe there are SIU red flags on the claim.
Reach out to your Lead so they can advise you on how to move forward.
IC Failed Payouts - Discussion
Clicking on each icon reveals a discussion question!
Think about 2 claims: One IC re-opened for failed payout, and another IC re-opened because items were not claimed correctly-Both of which have an invoice that isn't clear and complete. Why is it our protocol to just re-pay the first type, and the second type would require a new copy of the invoice before proceeding?
Think about your process for triaging ICs with failed payouts, as a Pet Specialist or as a Claim Advocate. Is there any investigation you currently do while reviewing the claim, that is not necessary to close the claim and would save time to forgo?
Thank you very muchfor your attention
Back to home
We do not request a clear copy of the invoice, request more medical records, or reach out to the PH for clarification because the claim has already been settled and the determination has been made! We must adhere to the claim decision that was already made, and our only job is getting the payment to the policyholder. It only delays closure to get a new invoice or find out if the claim was incorrectly approved.
TIAB - Failed Payouts on Instant Claims
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Created on September 8, 2025
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Transcript
Training in a Box Series
Failed Payouts on Instant Claims
Start
Instant Claims Failed Payouts - Introduction
About this training
Welcome to "Training in a Box"! In this micro-learning course you will, with your squad, affirm the correct protocol for handling failed payouts on Instant Claims (ICs). This understanding is crucial for ensuring that we can quickly amend any issues with policyholders receiving payments on approved claims. Your skill keeps the claim process delightful for our policyholders, giving them a quick and easy solution to any snags they hit with receiving reimbursement. Here is the Agenda for the Discussion:
To navigate through this course, you will find arrows at the top left of the screen to move forward and backwards. Let's dive in and enhance your expertise regarding Instant Claim failed payouts!
IC Failed Payouts - Starting the Claim
Claim Advocate and Pet Specialist Duties for Failed IC Payouts
When an instant claim has a failed payment, it needs a little manual assistance from our CLX team, both Claim Advocates and Pet Specialists. However, the claim will not be re-investigated by the Claim Advocate, their focus is determining which tasks need to be completed to close the claim properly. The goal of the Pet Specialist is assessing how to successfully issue the payment to the policyholder. Working together, we can resolve these claims as quickly as possible. Click on the number steps on the right to see the order in which things should be handled for an Instant Claim once the payment has failed, and then we'll move on to then next slide to discuss what to do when something isn't quite right with an instant claim that failed payment.
A failed payment task will be automatically created and assigned to the most available Pet Specialist-The claim will remain unassigned.
The assigned Pet Specialist must then determine why the payment failed and contact the policyholder to update the payment method.
The most available Claim Advocate will then be assigned to complete the claim adjusting tasks.
The Pet Specialist will contact the policyholder when their claim payment has successfully been sent and the claim will be closed.
IC Failed Payments - Information Needed to Complete the Claim
Information Needed for IC Failed Payout Claims
Sometimes you open an Instant Claim that got flagged for re-review due to the payment failing, and start to notice other things about the claim: What action should we take beyond re-issuing the payment to the policyholder? Click the text of each scenario below to reveal the answer.
Why do we not correct the claim beyond fixing payment?
1. The invoice submitted was actually cut-off and the line item prices aren't shown.
Proceed with issuing the payment for the claim, NOT reach out to the vet or the policyholder requesting a new invoice.
2. The claim is for an FMI, and the policyholder notes in the video they forgot to put their pup in her crate that morning-Their vet's recommendation to prevent FMIs.
Proceed with issuing the payment for the claim, do NOT reach out to the vet or the policyholder for previous medical records or try to make a change in the claim determination.
Click to Reveal Answer
3. You believe there are SIU red flags on the claim.
Reach out to your Lead so they can advise you on how to move forward.
IC Failed Payouts - Discussion
Clicking on each icon reveals a discussion question!
Think about 2 claims: One IC re-opened for failed payout, and another IC re-opened because items were not claimed correctly-Both of which have an invoice that isn't clear and complete. Why is it our protocol to just re-pay the first type, and the second type would require a new copy of the invoice before proceeding?
Think about your process for triaging ICs with failed payouts, as a Pet Specialist or as a Claim Advocate. Is there any investigation you currently do while reviewing the claim, that is not necessary to close the claim and would save time to forgo?
Thank you very muchfor your attention
Back to home
We do not request a clear copy of the invoice, request more medical records, or reach out to the PH for clarification because the claim has already been settled and the determination has been made! We must adhere to the claim decision that was already made, and our only job is getting the payment to the policyholder. It only delays closure to get a new invoice or find out if the claim was incorrectly approved.