Comprehensive Insurance Claim Management in Odoo ERP |
Odoo ERP: A Complete Solution for Insurance Claim Management

Odoo Based Generic Insurance Management System

Odoo ERP: The Ultimate Insurance Management Suite

Insurance, Policy and Claims Management with Seamless Integration | Complete Insurance Lifecycle Management and Integration System

This module offers a complete solution for managing insurance, policies, and claims. Designed for any insurance company, it allows seamless creation and management of various insurance types, including health, vehicle, pet, property, business, travel, marine, life, disability, cyber, liability, renters, homeowners, fire, crop, cargo, aviation, and more. The system helps insurance providers streamline operations, automate workflows, and efficiently handle claims, ensuring a smooth and organized insurance management process.

Key Features of the Insurance Management Module

1. Create Generic Insurance

• Staff Assisted Insurance Creation : Insurance agents or staff members can create and manage insurance policies on behalf of customers based on CRM requests.
• Customer Request Handling : Staff can receive customer requests from the CRM module and initiate the insurance creation process.
• Customizable Insurance Types : Allows defining various insurance types, including health, vehicle, pet, property, business, travel, marine, life, cyber, and more.
• Terms and Conditions Management : Staff can define policy specific terms and conditions, ensuring transparency for both customers and insurers.
• Document Upload and Storage : Staff can attach necessary documents, such as identity proof, medical records, or vehicle details, during policy creation.

2. Insurance Policy Management

• CRM Integrated Policy Creation : Direct integration with CRM allows seamless policy registration based on customer interactions and requirements.
• Policy Categorization and Structuring : Insurance policies can be categorized based on type, duration, premium structure, and risk factors.
• Premium and Payment Management : Enables staff to configure premium amounts, payment cycles (monthly, quarterly, annually), and discounts.
• Beneficiary and Coverage Details : Captures all relevant information about beneficiaries, insured assets, and coverage limits.

3. Insurance Claims Management

• Staff Assisted Claim Requests : Staff members can initiate claim requests for customers, ensuring all required documents and information are submitted accurately.
• Claim Verification Workflow : Multi level approval process for reviewing claim requests, verifying documents, and assessing eligibility.
• Claim Status Updates and Tracking : Real time tracking of claim processing, including submitted, under review, approved, rejected, or settled status.
• Fraud Detection and Compliance Checks : Automated validation of claim requests to prevent fraudulent activities and ensure compliance with policy terms.
• Claim Settlement and Payout Processing : Automates claim settlements based on predefined policy coverage and conditions.

4. Automation and Renewal Features

• Automated Expiry Notifications : System generated reminders for expiring policies sent to both staff and customers via email or CRM notifications.
• Automated Insurance Renewals : Cron jobs automatically process eligible policy renewals, reducing manual workload.
• Manual Renewal and Policy Updates : Staff can manually renew policies, adjust coverage details, or modify premium structures if required.
• Grace Period Handling : Allows defining a grace period for policy renewals, preventing policy lapses.

Index of Features:

• 1. Comprehensive Insurance Lifecycle Management:
  • Streamlines the entire insurance process, from policy creation to claims and payments.
  • Fully integrated with Odoo CRM, Sales, and Accounting for seamless operations.
• 2. Generic Insurance Creation:
  • Staff Assisted Policy Creation : Insurance staff create policies on behalf of customers based on CRM requests.
  • Flexible Policy Management : Supports multiple insurance types (health, vehicle, property, business, travel, etc.).
  • Customizable Terms and Conditions : Define policy specific rules and conditions.
  • Complete Insurance Information : Captures policyholder details, beneficiaries, coverage limits, and more.
• 3. Insurance and Claims Checklist:
  • Insurance Checklist:
    • Ensures all required details (customer info, policy documents, coverage details) are verified before finalizing the policy.
  • Claims Checklist:
    • Tracks required documents and validations before claim approval.
    • Helps prevent missing critical information and ensures compliance.
• 4. Cost Breakdown for Insurance:
  • Displays a detailed cost breakdown based on the insurance amount.
  • Clearly outlines premium, additional charges, deductions, and total payable amount.
  • Provides transparency for customers and internal teams.
• 5. Insurance and Claims Agent Management:
  • Agent Assignment:
    • Introduced an "Agent" field in both Insurance and Claim forms.
    • Agents can be assigned at the time of policy or claim creation.
  • Agent Tracking:
    • Helps monitor agent based sales and claim processing.
    • Enhances commission and performance tracking for agents.
• 6. Insurance Claims Management:
  • Effortless Claim Processing:
    • Staff can create claims on behalf of customers.
    • Tracks the entire claim lifecycle from submission to settlement.
  • Automated Claim Status Updates:
    • Notifies users about claim approval, rejection, or pending status.
• 7. Integrated Payment Workflow:
  • 7.1 Insurance Payment Flow:
    • Integration with Odoo Sales Orders:
      • Insurance and agent details are automatically added when creating a Sales Order.
      • On Sales Order confirmation, details are transferred to the Invoice form.
      • Invoice follows Odoo standard payment workflow, ensuring accurate financial records.
  • 7.2 Claim Payment Flow:
    • Claim Settlement through Vendor Bills:
      • A "Create Bill" button is available on the claim form.
      • Clicking it generates a bill with pre filled insurance, agent, and claim details.
      • Bill follows Odoo standard payment workflow, ensuring correct financial processing.
• 8. CRM Integration:
  • Automatic CRM Reference on Insurance:
    • Insurance policies can be generated directly from the CRM pipeline.
    • CRM reference is automatically set on the insurance form.
  • Claim Generation from CRM:
    • Claims can be created from CRM, linking the CRM opportunity reference to the claim form.
  • Enhances Customer Relationship Management by linking insurance and claims to customer interactions.
• 9. Smart Buttons for Quick Access
• 9.1 On the Insurance Form:
• Provides one click access to:
• Claims (related claims for this insurance)
• Sales Orders (insurance related orders)
• Invoices (billing details)
• Payments (completed and pending transactions)
• 9.2 On the Claim Form:
• Quick navigation to:
• Related Insurance (linked insurance policy)
• Bills (claim related bills)
• Payments (settlement and pending claim payments)
• 10. PDF Report Generation
• Printable Reports for Documentation:
• Customers and staff can generate PDF reports for both insurance policies and claims.
• Ensures proper documentation and record keeping for audits and compliance.
• For further details, please refer to the screenshots provided below and watch the video for additional information.

Module Navigation Menus:

• Insurance
  • All Insurance
  • Insurance Expiry Soon
  • Insurance Expired
• Claims
• Reporting
  • Insurance
  • Claim
• Configuration
  • Insurance
    • Policy Types
    • Insurance Policies
    • Stages
    • Tags
    • Insurance Checklists
  • Claim
    • Claim Types
    • Stages
    • Tags
    • Claim Checklists