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LLM spend: $0.2185 of $1.00 budget
Entities and relationships extracted from your documents.
Process (19)
- Appraisal reviewException process allowing policyholders to dispute total loss valuation.1 relations · 1 doc
- Cancellation and Refund ProcessThe process of handling policyholder cancellation requests and issuing refunds.2 relations · 1 doc
- Catastrophe Response ProtocolExecutive notification process for large losses connected to declared catastrophe events.9 relations · 2 docs
- Claims Subrogation RecoveryThe process of recovering funds from at-fault parties' insurers after a claim is paid.5 relations · 1 doc
- Claims intake and triageReceiving and initial assessment of insurance claims3 relations · 1 doc
- Commission calculationProcess of determining agent commissions based on policies issued and renewed.3 relations · 1 doc
- Customer Complaint EscalationHandling and escalation of formal policyholder complaints through compliance and regulatory channels.3 relations · 1 doc
- Customer Data Privacy Request HandlingProcess for managing customer data access and deletion requests from policyholders.3 relations · 1 doc
- Damage AssessmentProcess for reviewing auto claim damage and generating repair estimates2 relations · 1 doc
- Fraud detectionIdentifying and flagging potentially fraudulent claims for investigation3 relations · 1 doc
- Fraud investigationIn-depth review and determination of whether a claim involves fraud5 relations · 1 doc
- Large-loss claim notificationExecutive notification process triggered when a claim's estimated loss exceeds $250,000.6 relations · 1 doc
- New Agent Onboarding and Licensing VerificationThe workflow for onboarding new agents and verifying their licenses before granting system access2 relations · 1 doc
- 3 relations · 1 doc
- Refund handlingThe process of responding to and issuing customer refunds for orders6 relations · 2 docs
- Total Loss ValuationProcess for determining total loss claims1 relations · 1 doc
- Total loss declarationProcess of determining and settling a claim when repair costs exceed vehicle actual cash value.5 relations · 1 doc
- Underwriting Exception ApprovalProcess for handling applications that fall outside standard Underwriting Guidelines.5 relations · 2 docs
- Vendor Network ApprovalProcess of vetting and onboarding repair shops to the Vendor Network4 relations · 1 doc
Step (81)
- Acknowledge complaint to policyholderSend formal acknowledgment of the complaint to the policyholder.3 relations · 1 doc
- Add shop to Vendor Network PortalRegister the shop in the portal for assignment availability2 relations · 1 doc
- Approve paymentAuto Adjuster approves payment when policyholder agrees with estimate1 relations · 1 doc
- 3 relations · 1 doc
- Assign repairs to vendorFormally assign repairs to approved shop in Vendor Network Portal3 relations · 1 doc
- Assign severity tierClassify claim based on estimated loss amount2 relations · 1 doc
- Calculate commissionFinance Team calculates commission amounts based on the Commission Schedule.4 relations · 1 doc
- Calculate prorated refundFinance Team issues a full prorated refund when canceling mid-term with no claims.5 relations · 1 doc
- 5 relations · 1 doc
- Check eligibilitySupport team checks if refund meets policy requirements7 relations · 2 docs
- Check for open claimsDetermine if the policyholder has any open claims.3 relations · 1 doc
- Check shop availabilityCall a shop directly to verify availability before formal assignment2 relations · 1 doc
- Close ticketSupport team closes the refund request ticket.2 relations · 1 doc
- Complete required trainingAgent completes mandatory training before being allowed to sell policies1 relations · 1 doc
- Confirm license is activeCompliance Officer verifies that the agent's license is active in their state4 relations · 1 doc
- Confirm purchase dateSupport team confirms the purchase date against the orders database.0 relations · 0 docs
- Consult with Underwriting ManagerSenior Underwriter consults with Underwriting Manager on borderline cases before finalizing decision.4 relations · 1 doc
- Decide on approval statusDetermine whether to approve with rate adjustment, approve with conditions, or deny.3 relations · 1 doc
- Decide whether to refer to Compliance OfficerDetermine if the case meets threshold or warrants escalation3 relations · 1 doc
- Determine regulatory issueCompliance Officer assesses whether the complaint involves a potential regulatory issue.3 relations · 1 doc
- Document exception approvalRecord the decision with written justification in the Policy Administration System.5 relations · 1 doc
- Escalate to CFORoute discrimination complaints directly to the CFO, bypassing standard Compliance Officer review.4 relations · 1 doc
- Escalate to Senior AdjusterRoute high-loss claims to senior-level adjuster instead of standard adjuster4 relations · 2 docs
- Finalize paymentProcessing payment once policyholder accepts the settlement offer.3 relations · 1 doc
- Flag claim in Claims Management SystemRecord new claim in the system6 relations · 2 docs
- Forward to Compliance OfficerRoute the logged complaint from Claims Team or Agent to the Compliance Officer.4 relations · 1 doc
- Generate repair estimateAuto Adjuster creates a repair estimate using Vendor Network Portal4 relations · 1 doc
- Get manager approvalSend refund request to support manager for approval0 relations · 0 docs
- Hold refund until claim resolvedFinance Team holds the refund until the open claim is resolved.3 relations · 1 doc
- Identify at-fault party's insurerDetermine which insurer represents the at-fault party.2 relations · 1 doc
- Initial contact from adjusterAn adjuster makes first contact with a claimant.3 relations · 1 doc
- Interview policyholderQuestion the claimant to verify claim details2 relations · 1 doc
- Issue refundProcess the refund in Stripe0 relations · 0 docs
- Issue refund in StripeSupport team issues the refund directly through Stripe9 relations · 2 docs
- Log complaint in CRMRecord the data request in the Customer Relationship Management system.9 relations · 2 docs
- Manager decisionSupport manager approves or denies the refund request.4 relations · 1 doc
- Notify CFOSenior Adjuster or Claims Director notifies the CFO of the large loss.2 relations · 1 doc
- Notify customer by emailSupport team notifies customer by email and closes the ticket4 relations · 2 docs
- Notify customer of denialNotify the customer that their refund request was denied.1 relations · 1 doc
- Obtain independent valuationSecuring an independent third-party valuation of the vehicle.4 relations · 1 doc
- Prepare CFO briefClaims Director prepares a brief for the CFO.4 relations · 1 doc
- Present settlement offerShowing the valuation-based settlement offer to the policyholder.3 relations · 1 doc
- Prioritize claims by severityClaims are ranked and handled based on severity rather than order received.2 relations · 1 doc
- Process payment to agentsFinance Team processes approved commission payments to agents.2 relations · 1 doc
- Process refundComplete refund processing and payment to the policyholder.3 relations · 1 doc
- Provision system accessIT Security grants the agent access to Policy Administration System and CRM5 relations · 1 doc
- 3 relations · 1 doc
- Pull or delete data from systemsRetrieve or remove the requested data from Policy Administration System and Claims Management System.5 relations · 1 doc
- Pull policy reportFinance Team extracts a report of policies issued and renewed by agents from the system.3 relations · 1 doc
- Reassign Adjusters from other regionsAdditional Adjusters are temporarily moved from other regions to handle increased claim volume.3 relations · 1 doc
- Report to Reinsurance teamCatastrophe-related claims are reported to the Reinsurance team.3 relations · 1 doc
- Request appraisal reviewPolicyholder action to dispute the total loss valuation.1 relations · 1 doc
- Request manager approvalSend refund request to support manager for approval6 relations · 2 docs
- Request photosRequest photos through the Claims Management System3 relations · 1 doc
- Request second reviewApplicant denied under exception review can request further review.3 relations · 1 doc
- Review application and historySenior Underwriter reviews the full application, driving history, and claims history.3 relations · 1 doc
- Review claim history in Policy Administration SystemCompliance Officer examines relevant claim and policy records related to the complaint.6 relations · 2 docs
- Review claim summaryClaims Director reviews the claim summary.3 relations · 1 doc
- Review complaint historyReview past complaint history if the shop has worked with the company before3 relations · 1 doc
- Review photosAuto Adjuster reviews submitted photos2 relations · 1 doc
- 3 relations · 1 doc
- Route claim to adjuster typeSend claim to appropriate adjuster based on claim type or fraud flag5 relations · 1 doc
- Route to Fraud Investigation UnitAutomatically direct the flagged claim to specialized investigators2 relations · 1 doc
- Route to Total Loss ValuationClaim is routed to Total Loss Valuation process when repair cost exceeds vehicle value1 relations · 1 doc
- 3 relations · 1 doc
- 3 relations · 1 doc
- Schedule review callSchedule a review call if potential reinsurance implications are present.2 relations · 1 doc
- Schedule vehicle inspectionAuto Adjuster schedules an inspection of the vehicle3 relations · 1 doc
- Share comparable vehicle listingsInformally sharing comparable vehicle listings with policyholder to explain valuation.2 relations · 1 doc
- Submit cancellation requestAgent submits the cancellation request through the Policy Administration System.4 relations · 1 doc
- Submit licensing verification requestHR submits a request to verify the new agent's license3 relations · 1 doc
- Submit payouts for approvalFinance Team submits calculated commission payouts for approval.2 relations · 1 doc
- Submit refund requestA customer submits a refund request through the help center6 relations · 2 docs
- Submit subrogation demandSend a demand for reimbursement to the at-fault party's insurer.4 relations · 1 doc
- Suspend inspection-scheduling timelinesStandard inspection-scheduling timelines are halted.2 relations · 1 doc
- Track recoveryMonitor recovery progress in the Claims Management System.2 relations · 1 doc
- Verify certificationsCheck the repair shop's certifications3 relations · 1 doc
- Verify orderSupport team verifies the order in Stripe and confirms purchase date9 relations · 2 docs
- Verify order in StripeSupport team verifies the order details in the Stripe dashboard.0 relations · 0 docs
- Verify policy is activeCheck that the policy in the Policy Administration System is active3 relations · 1 doc
- Verify requester identityConfirm the identity of the person submitting the data request.3 relations · 1 doc
Actor (24)
- AdjustersPerson who assigns repairs to vendors3 relations · 3 docs
- AgentAgent who submits cancellation requests on behalf of policyholders.3 relations · 2 docs
- Auto AdjusterRole responsible for declaring total loss and obtaining valuation.9 relations · 3 docs
- CFOExecutive who receives escalations of discrimination complaints.1 relations · 2 docs
- 2 relations · 1 doc
- Claims TeamTeam responsible for receiving and initially logging customer complaints.7 relations · 5 docs
- Compliance OfficerRole responsible for confirming agent license verification9 relations · 4 docs
- Finance TeamFinance Team responsible for calculating and issuing refunds.4 relations · 2 docs
- Fraud Investigation UnitTeam that handles claims flagged for possible fraud4 relations · 2 docs
- HRHuman Resources team responsible for initiating the onboarding process1 relations · 1 doc
- IT SecurityTeam responsible for provisioning system access2 relations · 2 docs
- Outside legal counselExternal lawyers handling confirmed fraud cases1 relations · 1 doc
- PolicyholderVehicle owner who receives settlement offer and can accept or dispute.2 relations · 1 doc
- PriyaFinance team member who handles large refunds with tax implications1 relations · 2 docs
- Property AdjusterAdjuster who handles property claims1 relations · 1 doc
- Reinsurance teamTeam responsible for managing reinsurance reporting and claims.1 relations · 1 doc
- Repair shopVendor applying to join the Vendor Network2 relations · 1 doc
- Senior AdjusterAdjuster who handles claims exceeding loss thresholds2 relations · 3 docs
- 4 relations · 1 doc
- Subrogation UnitTeam responsible for pursuing recovery from at-fault parties' insurers.2 relations · 1 doc
- Support managerManager who approves high-value refunds2 relations · 2 docs
- Support teamThe team responsible for handling refund requests6 relations · 2 docs
- 9 relations · 2 docs
- Vendor Management TeamTeam responsible for verifying shops and managing vendor approvals4 relations · 1 doc
Resource (9)
- CRMCustomer Relationship Management system that agents need access to3 relations · 3 docs
- Claims Management SystemSystem containing claims data.5 relations · 5 docs
- Commission ScheduleReference document defining commission rates for policies.1 relations · 1 doc
- Help centerCustomer-facing system where refund requests are submitted2 relations · 2 docs
- Independent third-party valuation sourceExternal valuation service required for total loss valuations.1 relations · 1 doc
- Orders databaseSystem containing order records and purchase dates2 relations · 2 docs
- Policy Administration SystemSystem where exception approvals are documented.8 relations · 8 docs
- Stripe dashboardSystem used to verify orders and issue refunds4 relations · 2 docs
- Vendor Network PortalSystem where approved vendors are listed for Adjusters to assign repairs3 relations · 2 docs
Policy (30)
- Catastrophe claims requirementPolicy requiring catastrophe claims to receive initial adjuster contact within 48 hours.1 relations · 1 doc
- Claim assignment deadline policyClaims must be assigned to an adjuster within 24 hours of intake1 relations · 1 doc
- Commission payout deadline policyFormal requirement that commission payouts be issued within 15 days of month-end.3 relations · 1 doc
- Data Request Timeline PolicyRequires data requests to be fulfilled within 30 days per state privacy regulations.2 relations · 1 doc
- Data tied to open claim or active fraud investigationException rule: data cannot be deleted until the case closes.1 relations · 1 doc
- Discrimination Complaint PolicyOfficial policy requiring suspected discrimination complaints to be escalated directly to the CFO.1 relations · 1 doc
- Exception Policy Commission AdjustmentPolicy governing reduced commission rates for high-risk applicants under Underwriting Exception Approval.2 relations · 1 doc
- Exception documentation requirementPolicy requires all exception approvals to be documented with written justification.1 relations · 1 doc
- Fraud Exception to the Prompt Payment PolicyOverride that exempts confirmed fraud cases from standard payment timelines2 relations · 1 doc
- Fraud threshold policyRule requiring automatic escalation of high-value claims with multiple fraud indicators1 relations · 1 doc
- Large Loss PolicyCFO must be notified within 24 hours of a claim crossing the $250,000 threshold.2 relations · 2 docs
- Large refund escalationRequirement to escalate refunds over $2,000 to Priya for tax review2 relations · 1 doc
- License verification before accessFormal requirement that license verification must be completed before any system access is granted1 relations · 1 doc
- Minimum Recovery Threshold PolicyPolicy that excludes claims under $1,000 from subrogation pursuit.1 relations · 1 doc
- Minimum liability insurance requirementAll vendors must carry minimum liability insurance before approval1 relations · 1 doc
- Multi-State Licensing PolicyPolicy requiring separate verification for each state license for agents licensed in multiple states1 relations · 1 doc
- Non-payment cancellation exceptionPolicies canceled due to non-payment are not eligible for a refund.1 relations · 1 doc
- Policy issuance requirementAll approved policies must be issued within 3 business days of a complete application1 relations · 1 doc
- Prompt Payment PolicyStandard timeline requirements for claim payments1 relations · 1 doc
- Refund timing policyRefunds must be issued within 15 business days of a processed cancellation.2 relations · 1 doc
- Repeat customer exceptionInformal practice of skipping manager approval for trusted repeat customers2 relations · 2 docs
- Standard reinsurance reporting thresholdsFormal threshold policy that determines which claims are reported to the Reinsurance team based on claim size.1 relations · 1 doc
- State Insurance RegulationsRegulatory requirement that formal complaints be acknowledged within 5 business days.1 relations · 1 doc
- Statute of Limitations PolicyPolicy requiring subrogation demands to be submitted within 60 days of claim payment.2 relations · 1 doc
- Total loss valuation policyRule requiring independent third-party valuation for total loss claims.1 relations · 1 doc
- US refund policyThe official policy governing refunds for US orders5 relations · 2 docs
- Underwriting GuidelinesStandard rules that determine underwriting decisions.2 relations · 2 docs
- Vendor Approval PolicyPolicy requiring repairs be assigned only to approved vendors1 relations · 1 doc
- Vendor Quality PolicyVendors with two or more substantiated customer complaints in 12 months are automatically suspended1 relations · 1 doc
- 1 relations · 1 doc
Concept (4)
- Catastrophe eventA declared catastrophe event that triggers special notification procedures.2 relations · 1 doc
- High-risk applicantsApplicants classified as high-risk under underwriting rules.0 relations · 1 doc
- Regional catastropheEvents such as hurricanes, wildfires, or major floods declared in a region.1 relations · 1 doc
- Underwriting Exception ApprovalException process for high-risk applicants that triggers reduced commission rates.0 relations · 1 doc