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Claim Advocate Settles the Claim

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Created on October 22, 2025

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Transcript

Claim Advocate Settles the Claim

If the automated EOB is supported, the Claim Advocate can complete the remaining task settleing the claim. The claim is only fully closed when all tasks are marked as complete. You may override the automated EOB by selecting ‘No, Send Manually’ if:
  • The policyholder has outstanding questions or concerns
  • The claim decision is complex and needs extra explanation
  • Multiple claims are being settled together and one needs a manual email
    • If all claims qualify for automated EOB, no manual email is needed.
  • If you opt out of the auto EOB include a brief reason for tracking and support purposes.

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