1.

FNOL (First Notification of Loss)

What it is:
The initial report of a loss or damage by the client.
Real-life Example:
 A driver in Kampala gets into an accident.
 He visits your online portal or uses WhatsApp to report it.
 He fills in a form: policy number, date, time, location.
 He uploads photos of the damage.
How you can implement:
 Simple mobile/web form with photo/video upload.
 Integration with Google Maps for accident location.
 WhatsApp chatbot or USSD option for lower-end users.

⚙️2. Workflow Engine

What it is:
A logic controller that moves a claim from one step to another automatically.
Real-life Example:
 FNOL is received → The system assigns it to an available assessor.
 If 3 days pass without an update → Send reminder to assessor.
 If a document is missing → Notify claimant.
How to implement:
 Build your claim process as a flowchart.
 Use a workflow library (e.g. Node-RED, Camunda) or your own logic tables.
 Add rules: “When A happens, then do B.”

🤝 3. Customer Self-Service Portal

What it is:
A space for clients to track their claim, upload documents, and communicate.
Real-life Example:
 A client logs in and sees: “Claim Assigned to Mr. John, Under Review”
 Uploads a police report to complete documents.
 Sends a message: “Can I get an update on my claim?”
How to implement:
 Simple web/mobile dashboard for each claimant.
 Status display (e.g. Pending, In Review, Assessed, Paid).
 File upload section + messaging interface.

📱 4. Adjuster Toolkit (Mobile App or Portal)

What it is:
Tools for field assessors to work digitally instead of on paper.
Real-life Example:
 Jane, a loss assessor, goes to inspect a damaged building in Jinja.
 She uses the app to:
 o Fill in the inspection form
o Take photos
o Record audio notes
o Get client’s digital signature
 It uploads when she gets back online.
How to implement:
 Mobile-friendly forms with offline mode.
 Camera, voice, GPS integration.
 Cloud sync once internet is available.

🧠 5. Basic Automation Rules

What it is:
Simple rules that reduce manual steps.
Real-life Example:
 If no documents uploaded within 7 days → auto-email reminder.
 If a claim has more than UGX 10 million → escalate to senior adjuster.
How to implement:
 In your backend, define triggers:
o “If condition met → perform action”
 Example: In code, trigger emails or route changes when timers expire or data conditions
are met.

🔗 6. Integrations Hub (APIs)

What it is:
A way for your system to connect with others (e.g., insurer, broker, payments).
Real-life Example:
 Broker uses their own CRM. Your system sends claim updates via API.
 After claim approval, your system pushes payout info to MTN Mobile Money API.
How to implement:
 Build REST APIs to expose or receive claim data.
 Example: POST /api/claim-status
 Set up webhooks for real-time updates.

📊 7. Dashboards & Analytics

What it is:
Visual reports for managers and clients to see trends and performance.
Real-life Example:
 Insurance company sees that 80% of claims from Western Uganda are motor-related.
 Your team sees 60% of delays are due to missing police reports.
How to implement:
 Use tools like Metabase, Superset, or embed dashboards in your platform.
 Track data: claim type, turnaround time, delay reason, location.
🔐 8. Security & Audit Trail
What it is:
Tracking and protecting system use.
Real-life Example:
 Every change to a claim is logged: who did it, what they changed, when.
 Adjusters can’t see data for clients they aren’t assigned to.
How to implement:
 Role-based access control (admin, adjuster, client, insurer).
 Audit log table in your database.
 User authentication and activity tracking.
📌 Add-on Module: Report Builder with Dynamic Tables (System-Integrated)
🧩 Key Feature: Smart Report Templates (System-Based, No Word Needed)
 Each type of report (e.g., Motor Vehicle Damage, Burglary, Fire, etc.) has a pre-loaded,
customizable template
 Assessors fill reports directly in the system — no external Word docs needed for most
cases
 Reports can include:
o Structured fields (claim number, dates, insured, etc.)
o Free-text boxes for assessor comments
o Dynamic table blocks for itemized data
📋 Dynamic Tables: The Core Table Component
 Assessors can add rows/columns dynamically
 Fields can be preset (e.g., Item, Qty, Unit Cost, Depreciation, Total Adjusted)
 Support auto-calculation
 Look professional when exported as PDF
 Fully editable within browser interface
Example Table in Fire Loss Report:
Item Description Qty Unit Cost Depreciation Adjusted Value
Office Chairs 5 $50 10% $225
Wooden Desks 3 $150 20% $360

✨ Other Features of the Report Builder Module

Feature Explanation
🔧 Template Editor for Back office can create or customize templates for different report
Admins types — add/remove fields, change instructions, etc.
System tracks each time a report is edited/submitted — version
🔄 Report Versioning
history for audit and review
🔗 Report Sharing with Reports can be shared securely within the platform to internal
Reviewers reviewers, insurers, brokers
Feature Explanation
📝 Lodging Reports from Assessors can begin drafting reports right from claim intake
Claim Intake dashboard
Final report export as PDF (with branding) — optional Word export
📤 Export Options
for exceptional cases
📚 Report Archive in All reports auto-archived and accessible under each claim’s
Claim File documents tab
Once approved, report is locked to prevent edits (regulatory
🔒 Lock Final Reports
compliance)
✅ Result:
 Faster report writing
 No switching between Word and system
 Clean, professional output for clients and insurers
 Easy review and feedback cycle
 Saves storage and ensures standardization
 Assessor company
 Insurer company
 Insured/Broker
 System-wide intelligence

🔍 A. Assessor Company Analytics

1. Claims Lifecycle Dashboard
 What it shows: Visuals of all claims by stage (intake, field visit, review, submission,
closed).
 How it works:
o System logs every workflow status change per claim.
o UI uses bar/step charts and counters (e.g., "12 Claims at Field Visit").
 Visual Look: Horizontal progress bar with claim counts at each stage.
 Example: Assessors see they have 5 claims overdue for submission.
2. Team Productivity Analytics
 What it shows: Cases handled per assessor, turnaround time, delay patterns.
 How it works:
o Each task is timestamped.
o Dashboards use Power BI or internal charts to rank assessors.
 Visual Look: Heatmaps + leaderboards.
 Example: Gift Joy sees Assessor A takes 3 days avg., Assessor B takes 7 days.
3. Report Quality Audit Tracker
 What it shows: Reviewer comments frequency per assessor, common issues.
  How it works:
o Each reviewer comment is tagged to a report section.
o System counts and analyzes issues by category (e.g., "valuation errors").
 Visual Look: Pie charts + tag clouds.
 Example: 40% of flagged reports lacked photographic evidence.

🏢 B. Insurer Company Analytics

1. Turnaround Time by Assessor
 What it shows: Avg time from claim assignment to final report per assessor company.
 How it works:
o Timestamps + claim IDs grouped by partner company.
 Visual Look: Line graph or rank chart.
 Example: Premier Assessors avg. 4.3 days, National Assessors avg. 7.8 days.
2. Claims Cost Forecasting
 What it shows: Projected payout amounts by claim type, region, period.
 How it works:
o ML model analyzes historical claims + cost components.
 Visual Look: Area chart or forecast trend line.
 Example: Expected motor claims payout in Q3 = UGX 2.4B.
3. Fraud Risk Heatmap
 What it shows: High-risk claims flagged by system.
 How it works:
o NLP + pattern detection on inconsistencies.
 Visual Look: Red-yellow-green heat indicators.
 Example: 3 out of 12 claims from District X show red flags (same incident photo used).

🧑‍💼 C. Insured / Broker Analytics

1. Claim Status Tracker
 What it shows: Real-time view of where a claim is in the process.
 How it works:
o Status updates synced to broker/insured portal.
 Visual Look: Timeline flow (like package tracking).
 Example: Status = “Awaiting Insurer Decision” with last update 3 hours ago.
2. Claims Outcome History
 What it shows: Archive of all closed claims with payout, resolution time.
 How it works:
o Claims auto-archived per user.
 Visual Look: Table + graphs (sortable).
  Example: Broker sees avg payout on fire damage is UGX 8.7M.
3. Customer Experience Score
 What it shows: Feedback from post-claim surveys.
 How it works:
o System sends survey after closure.
o Ratings are averaged per insurer/assessor.
 Visual Look: Star rating + trend line.
 Example: 4.2/5 satisfaction for Premier Adjusters on motor claims.

🌐 D. System-Wide Intelligence
1. Claims Volume Trends
 What it shows: Claims over time by region, type, insurer.
 How it works:
o Aggregated metadata + filters.
 Visual Look: Interactive dashboards.
 Example: Spike in burglary claims in Kampala in April.
2. Compliance Monitoring (IRAU)
 What it shows: SLA adherence, overdue cases, regulatory flags.
 How it works:
o System compares timestamps to SLA limits.
 Visual Look: Compliance bar + red-alert counters.
 Example: 12 claims exceeded the 90-day limit.
3. AI-Based Anomaly Detection
 What it shows: Claims that behave differently from norms.
 How it works:
o AI models detect outliers in costs, frequency, or assessor behavior.
 Visual Look: Alert feed + explanation panel.
 Example: Claim ID #545 has payout twice above normal range.
🔶 Assessor Finance Module: Features, Automation & Analytics

🧾 1. Proforma Invoice Management

How it works:
 Automatically generated upon final report submission.
 Includes job reference, client, amount due, date, and breakdown of charges.
 Linked directly to the claim file for traceability.
System Features:
 Auto-generate PDF-format proforma.
 Editable before finalization.
  Mark status: Generated, Sent, Approved, Pending EFRIS, Paid.
 Auto-send via email to insurer with template (e.g. “Dear [Insurer], please find
attached...”).

📧 2. EFRIS Invoice Handling

How it works:
 Once insurer confirms payment, assessor creates a URA EFRIS invoice.
 EFRIS invoice PDF is uploaded to the claim.
System Features:
 Dedicated upload area for EFRIS.
 Reminder to finance staff when EFRIS is due (based on proforma status).
 Option to email the EFRIS to insurer directly from system.

💵 3. Payment & Proof Tracking (POP)

How it works:
 After payment by insurer, POP is sent and uploaded to claim.
 Finance team confirms and updates payment status.
System Features:
 Upload POP (screenshot, bank slip, etc.)
 Payment status tracker: Pending, Paid, Partially Paid.
 Auto-email triggers when POP is not received in X days.
 Dashboard: “Outstanding Payments”, “Paid in Last 30 Days”, etc.

🔔 4. Auto-Reminders for Unpaid Invoices

System Automation:
 If no payment is recorded within 14 days after EFRIS invoice:
o Auto-email reminder is triggered.
o Task is created in the finance dashboard: "Follow up unpaid invoice – [Claim
Ref]".
Analytics:
 List of overdue invoices.
 Average days to payment by insurer.
 Payments by insurer performance (who delays, who pays quickly).

📊 5. Finance Analytics Dashboard

Metrics Tracked:
 Total invoiced vs. received (monthly, quarterly).
 Unpaid proformas by insurer/client.
  Aging report (30, 60, 90+ days).
 Field expense vs. recovered revenue.
Views:
 Bar/line graphs for trends.
 Pie chart by client/insurer.
 Filters by assessor, branch, region.

💼 6. Internal Expense Tracker

Use Case:
 Assessors incur costs for:
o Transport
o Field Allowances
o Lodging
o Equipment
System Features:
 Expense input form per claim/job:
o Type, amount, date, receipt upload (optional), who submitted
 Categories: Transport, Allowance, Fuel, Others
 Weekly summaries
 Expense vs. revenue per job
Workflow:
 Assessor logs expenses → sent to finance reviewer → approved → added to job
financials.

7. Finance Section in Case File

Each job file contains:
 Proforma Invoice(s)
 EFRIS invoice
 Proof of Payment
 Internal expenses
 Payment status log
✅ Feature: Live Claim Tracker Dashboard for Insurers & Assessors

🔹 What This Is
A dedicated module where insurers (and your own internal managers) can log in and view the
real-time status of every claim you are handling for them.

Dashboard View:
  Simple, clean table format with filters and sorting.
 Each insurer only sees claims you are handling for them.
 Your assessors/managers can view across all clients.
📊 Example Table:
Date
Ref No Claimant Adjuster Status Report Invoice Notes
Assigned
Sarah Report Awaiting
C/01234 5-May-2025 Isaac Yes No
Mbabazi Submitted approval
Review in
C/01245 K. Namanya 8-May-2025 Gift Joy Site Visited No No
progress

🔧 Key Features:
1. Real-Time Data
o Status updates as your team progresses each case.
o No manual work needed to compile weekly updates.
2. Filters/Sorting
o By adjuster, date assigned, status, etc.
o Helps insurers quickly find what they need.
3. Report Download Option
o Optional “Export to Excel/PDF” for insurers who still want to download.
o Or just print the current view.
4. Permissions Control
o Each insurer sees only their claims.
o Internal assessors can see all.

🚦 Status Tags (Color-coded for quick view):

 ⏳ Assigned
 📍 Site Visited
 📝 Drafting Report
 📤 Report Submitted
 ✅ Finalized
 💰 Invoice Sent
 ✔️Paid

🔐 Optional Add-ons Later:

 Email notifications when a new claim is assigned or a report is submitted.
 Chat/comments per claim (limited feedback loop between insurer and assessor).
🌱 Example Use Case:
Friday 9 AM — Instead of asking you to send a list, the insurer logs into their dashboard and
immediately sees all claims and statuses. They can filter by those still pending reports, or
download the list if they want to file internally.