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User Segregation of Duties--Claims
Cycles:
Claims Administration, Reserves, Investigation
Claims Expenses, Payments, and Writeoffs
Claims Quality Assurance

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E
Sub-process Risks Transaction

Claim receipt and entry of new claim or edits into system X

Claims
Administration
High Review/approve claim entries, adjustments, deletions X

Establish, change, or remove claim reserves X X

Claims Reserves
Assign claim to adjuster; Review/approve reserve amounts,
High X X
changes, and removals

Create new service provider or vendor payee X

High Approve new service provider or vendor payee

Request claim/expense payments and settlements; process

X X
payment changes
Claims Payments
Approve claim/expense payments and settlements and
High X
payment changes

High Print, handle, and distribute checks X X

Approve claims writeoffs X

Claims Quality
Quality Assurance (independent of claim under review); Review,
Assurance, High X X
approval of management monitoring reports
Monitoring

X Indicates potential incompatible user duties

Note: Claims cannot be deleted from PowerComp
 E
re sta

X
X
X
X
X
X
X
X
s e bl
r v ish
es , c
h an
ge
,o
rr
em

X
X
X
X
X
As ov
R si e
e
ch vi n g cl
an ew cla ai
g e /a i m m
p
s , p to
an r ov a
d e dju
C re re s
m se te

X
X
X
X
X
X
X
ve rea ov rv r;
nd t e al e
o r ne s am
pa w
ye e s ou
e rvi nt
ce s,
pr
A ov
id

X
X
X
ve ppr
n d ov er
or e n or
pa ew
ye s
e er
vi
ce
pr
R ov

X
X
X
X
X
X
X
X
X
an e qu id
er
ch d es
s
an e t c or
ge ttle la
s m im
en / e
ts xp
; p en
A r o se

X
X
X
X
X
X

an ppr ce p
ch d ov s s ay
an s e e c p a me
t
g e tl e l a ym n t
s m im en s
en / e t
Pr ts xp
in an en
t, d se

X
X
X
X
X
X
X
X
X

ha pa p
nd ym ay
le en m e
,a
nd t n ts
di
st
Ap r ib
pr ut
e

X
X
X
X
X
X

ov
e ch
ec
cl
ai ks
m
s
w
rit
eo
ffs

X
X
X
X
X
X
X
X

Q
c ua
ap l a i m l i t y
re pr u As
p o ov nd s u
rts al er ra
of re nc
m vie e
an w (in
ag ); de
em R e p e
en v i e nd
t m w, en
to
on
i to f
ri
 Incompatible Compensating,
Incompatible Roles or User Mitigation
Systems IDs Controls in Place

A,B,C

A,B,C

A, C

A, C

A, C

A, B

N/A

Systems:
A PowerComp
B MAS200
C Paybase