ClaimCenter-Business-Analysts Leak Questions

To determine if a transaction requires approval, we must compare the proposed transaction against the Adjuster's Authority Limits and the current financial state of the claim.

Current State:Total Reserves = $3,000 ($2,500 Indemnity + $500 Expense). Total Paid = $0.

Adjuster Limits:

Claim Total Reserves Limit: $5,000

Payments Exceed Reserves Limit: $500

Evaluation of Options:

Option B (No Approval Required):Making a $2,000 payment against the "Claim Cost - Auto body" reserve.

The available reserve is $2,500. Since $2,000 < $2,500, the payment does not exceed the reserve.

The total payments on the claim would be $2,000, which is well below the "Claim payments to date" limit of $5,000.

Option D (No Approval Required):Increasing the Expense reserve to $550.

This increases the total claim reserves from $3,000 to $3,050 ($2,500 + $550).

Since $3,050 is below the Adjuster's "Claim total reserves" limit of $5,000, no approval is triggered.

Why other options require approval:

Option A:A payment of $1,100 against a $500 reserve means the payment exceeds the reserve by$600. The Adjuster's limit for "Payments exceed reserves" is only$500. Since $600 > $500, approval is required.

Option C:Increasing the Auto body reserve to $6,000 would raise the total claim reserves to$6,500($6,000 + $500). This exceeds the Adjuster's "Claim total reserves" limit of $5,000, triggering an approval.

In the Guidewire ClaimCenter object model, a Liability Exposure represents a specific potential financial obligation to a third party. To successfully instantiate (create) a new exposure record, the system requires three fundamental data associations to define "Who, What, and How":

Claimant:The specific person or entity seeking compensation (the "Who"). Every exposure must be linked to a contact designated as the claimant.

Coverage (Type and Subtype):The specific contractual provision from the policy that applies to the loss (the "How"). The exposure must link back to a valid coverage on the verified policy to confirm the insurer is liable.

Incident:The specific details of the event or damage (the "What"). In ClaimCenter, anIncidentis a distinct object (e.g., Vehicle Incident, Injury Incident) that captures the facts of the loss. Multiple exposures can link to the same incident (e.g., Bodily Injury and Property Damage exposures both linking to the same Vehicle Incident), but every exposure requires one underlying incident to define the scope of the damage.

Why other options are incorrect:

Reserve Line (A, C, D):A Reserve Line is a financial accounting object createdafterthe exposure exists to set aside funds. It is a child object of the exposure, not a prerequisite for creating the exposure itself.

In Guidewire implementation projects (often following the SurePath methodology), specific Guiding Principles are established to manage scope and ensure project success.

"We are not building a system from scratch" (Option A):This is the foundational principle of package software implementation. The scenario explicitly states that Succeed is implementing a "slightly modified version of ClaimCenter" (using the base product) rather than building a custom solution. The project team accepts that they are starting with a robust, pre-built application and will only modify it where necessary (e.g., the two specific fields).

"We will challenge current processes" (Option B):The scenario notes that "Currently language is not considered in assignment." To successfully implement the new requirement (bilingual assignment), the project team must challenge and change the legacy business process. Instead of automating the old way of working (which ignored language), they are defining a new, more efficient process that leverages the tool's capabilities.

Why other options are incorrect:

Option C:Adding scope (new fields) generallyincreasesrisk and time rather than accelerating it, unless the scope is strictly MVP. The primary focus here is efficiency, not just speed of deployment.

Option D:While "not revisiting decisions" is a good governance rule, it is not the primary principle illustrated by the decision to modify the UI for specific business value.

Guidewire ClaimCenter is designed to handle First Notice of Loss (FNOL) scenarios where the policy system is unavailable or the specific policy cannot be immediately located. The correct standard procedure is to create an Unverified Policy claim.

Unverified Policy Workflow:The New Claim Wizard allows the user to select "Unverified Policy" if a search returns no results. This allows the CSR to proceed with capturing critical accident details (Loss Details, Vehicles, Injuries) and providing service to the customer immediately.

Reconciliation:Later, once the correct policy number is found or the policy system comes back online, the claim can be updated. The "Unverified Policy" feature specifically supports the "Select Policy" step of the wizard to ensure claims are not blocked by administrative data issues.

Customer Experience:Option A (asking the customer to call back) is poor service and contrary to ClaimCenter's design philosophy. Option D is incorrect because a verified policy isnota hard blocking requirement for creating a draft claim in this specific workflow.