9.4 Mandatory Claims Process
This document outlines the mandatory standardized procedure for identifying, processing, validating, and closing all client, vendor, insurance, and internal claims. Adherence to this process is required to ensure regulatory compliance, mitigate financial risk, and maintain operational transparency across all departments at That Is A Q.
1 Overview & Purpose
The Claims Process establishes a uniform framework for handling any formal claim filed against, by, or involving That Is A Q. The primary objectives are:
- Ensure consistent, legally defensible handling of all claims
- Maintain accurate audit trails for internal and external review
- Minimize exposure to financial, reputational, and operational risk
- Guarantee timely communication with all stakeholders
Failure to follow this mandatory process may result in procedural violations, financial liability shifts, and disciplinary action per internal compliance guidelines.
2 Scope & Applicability
This policy applies to:
- All full-time employees, contractors, and subcontractors
- Client-facing projects, vendor partnerships, and internal operations
- Financial, liability, service-level, and intellectual property claims
- Cross-departmental workflows (Legal, Finance, Operations, Project Management)
Exceptions require written approval from the Chief Operating Officer or General Counsel.
3 Mandatory Process Steps
All claims must proceed through the following sequential stages. Skipping or bypassing any step requires documented executive authorization.
Identification & Intake
Claim is formally logged in the QMS Portal within 24 hours of receipt. Initial metadata includes claim type, origin, value estimate, and originating department.
Triage & Documentation
Claims Coordinator assigns a unique ID, categorizes severity, and requests supporting documentation from relevant parties. All communications are archived.
Assessment & Validation
Legal and Finance review contractual obligations, coverage limits, and liability exposure. A validation report is generated and signed off.
Resolution & Execution
Approved settlement, mitigation, or rejection is executed. Adjustments, refunds, or third-party notifications are processed with dual authorization.
Closure & Audit
Claim status is marked "Closed" in QMS. A post-resolution review is conducted within 14 days to identify process improvements or systemic risks.
4 Roles & Responsibilities
| Role | Primary Responsibility | Authority Level |
|---|---|---|
| Claims Coordinator | Intake, tracking, documentation, stakeholder communication | Level 1 |
| Department Head | Provide operational context, approve departmental adjustments | Level 2 |
| Legal & Compliance | Contract review, liability assessment, regulatory alignment | Level 3 |
| Finance Controller | Fund allocation, settlement processing, audit reporting | Level 2 |
| Executive Sponsor | Exception approval, high-value claim sign-off, escalation resolution | Level 4 |
5 Documentation & Compliance
- All claims must be recorded in the centralized QMS Portal within 24 hours of awareness
- Supporting documents must be stored in encrypted, access-controlled folders
- Records must be retained for a minimum of 7 years per jurisdictional requirements
- Quarterly compliance audits will verify process adherence and documentation integrity
- Unauthorized external communications regarding active claims are strictly prohibited
Failure to log, document, or retain claim records as specified may result in policy violation tickets and mandatory retraining.
6 SLAs & Timelines
Strict adherence to service level agreements ensures predictability and accountability.
7 Escalation Protocol
If a claim cannot be resolved within standard SLAs or exceeds defined thresholds, follow this escalation path:
- Level 1 → Level 2: Coordinator notifies Department Head if missing documentation or stakeholder unresponsiveness delays process
- Level 2 → Level 3: Department Head escalates to Legal/Compliance for liability disputes or contractual ambiguities
- Level 3 → Level 4: Legal/Finance jointly escalate to Executive Sponsor for claims exceeding $50,000 or involving reputational risk
All escalations must include a written summary, current status, and recommended action.
8 Support & Contacts
For questions, process exceptions, or technical assistance with the QMS Portal:
- Claims Operations: claims-ops@thatisaq.com
- Legal & Compliance: legal@thatisaq.com
- QMS Portal Support: helpdesk@thatisaq.com
- Emergency/Liability Hotline: +1 (800) 555-0194
This document is subject to periodic review. The latest version will always be available on the internal policy portal.