Managing Reward Claims

Reward managers can view, accept and reject reward program claims. Claims can be marked for reimbursement and files such as receipts can be attached to claims. Program managers and administrators have comprehensive tools to review claim submissions, validate documentation, adjust reward values, and manage the complete claim lifecycle from submission through approval or rejection.

Requirements

To review reward claims, users must have one of the following permissions:

• Administrator System Role
• Security Role with Additional Settings: Access Rewards Enabled
• Program Manager (assigned as the Program Manager for specific reward programs)

Before You Begin

Before reviewing reward claims, ensure the following:

• Email templates are configured for claim notifications (Claim Submitted, Claim Approved, Claim Rejected, Claim Reimbursed)
• Clear approval criteria are established for different activity types
• Review workflows and service level agreements are defined for timely claim processing
• Program managers understand documentation requirements for each claimable activity
• Escalation procedures are established for flagged or questionable claims

Understanding Claim Statuses

Claims progress through various statuses during their lifecycle:

Pending Rewards

• Newly submitted claims awaiting initial review
• Default status for all claim submissions
• Requires administrator or program manager action

Submitted

• Claims that have been submitted and are in the review queue
• Functionally similar to Pending Rewards

Approved Points Rewards

• Claims that have been approved for points distribution
• Points are automatically added to user balances upon approval
• Users can redeem approved points through the redemption system

Approved Cash Rewards

• Claims that have been approved for cash distribution
• Cash amounts are added to user balances upon approval

Reimbursed

• Points rewards where users have redeemed their points for gift cards or other rewards
• Indicates the reward cycle is complete
• Claims with this status cannot be reversed

Payout and Reimbursed Rewards

• Cash rewards that have been paid out to users
• Indicates the payment process is complete

Rejected Rewards

• Claims that did not meet approval criteria
• Includes rejection reason for user reference
• Users can submit new claims if they address rejection reasons

Flagged Cash Rewards

• Claims marked by administrators or program managers for additional scrutiny
• Indicates potential fraud, unusual activity, or need for further investigation
• Requires manual review before approval or rejection

Expired Rewards

• Claims that exceeded claim deadlines if claim deadlines are set
• Claims manually marked as expired by administrators
• Points are forfeited and no longer available to users

Accessing the Claim Review Interface

To access pending claims:

1. In the Setup Home page, click Create > Rewards.

2. Click Review Claims.

This navigates to the Rewards List page with pending rewards displayed by default.

Alternative access from Reward Settings page:

1. In the Setup Home page, click Create > Rewards.

2. From the Reward Programs Home page, click More Actions > Review Claims.

This also navigates to the Rewards List - Pending Rewards page.

Filtering and Searching Claims

Status Filter Dropdown:

At the top of the page, use the dropdown to filter claims by status:

• Pending Rewards: View newly submitted claims awaiting review (default view)
• Approved Cash Rewards: View cash rewards that have been approved
• Approved Points Rewards: View points rewards that have been approved
• Expired Rewards: View rewards that have exceeded deadlines or been marked as expired
• Rejected Rewards: View claims that have been rejected
• Flagged Cash Rewards: View claims marked for additional scrutiny
• Payout and Reimbursed Rewards: View cash rewards that have been paid out

Search Functionality:

Use the search bar to quickly locate specific claims by:

• User name
• Claim number
• Activity name
• Program name

Add Filters:

Click Add Filters to create advanced filter criteria:

• User: Filter by specific users or user groups
• Program: Filter by reward program
• Date Range: Filter by creation date, submission date, or approval date
• Status: Filter by claim status
• Reward Activity: Filter by specific activity types
• Value: Filter by reward amount ranges
• Combine multiple filters using AND/OR logic for precise claim lists

Filter Best Practices:

• Save commonly used filter combinations for quick access
• Use date range filters to focus on claims within review SLA timeframes
• Filter by program manager to view claims requiring your specific review
• Combine user and program filters to analyze individual participant patterns

Reviewing Individual Claims

To review a single claim:

1. From the Rewards List page, click on the claim number or click the dropdown arrow next to the claim.

2. Review the claim details:

   • Number: Unique claim identifier
   • Owner: The user who submitted the claim
   • Reward Type: Points Reward or Cash Reward
   • Value: Amount of points or cash requested
   • Status: Current claim status
   • Program: Associated reward program
   • Reward Activity: The activity type for which the claim was submitted
   • Created On: Submission date and time
   • Claim Form Responses: User-submitted information from custom claim form fields

3. Review claim form responses carefully:

   • Verify that all required documentation is described or referenced
   • Check that submitted information meets activity criteria
   • Validate that descriptions are detailed and credible
   • Look for inconsistencies or incomplete information

4. Make a decision:

   To approve the claim:

   • Click Edit
   • In the Status field, select Approved
   • In the Value field, adjust the reward amount if needed (e.g., partial approval)
   • Optionally add notes in the Reason field explaining any value adjustments
   • For cash rewards, enter the Reimbursement Date if applicable
   • Click Save
   • The system automatically adds points or cash to the user's balance
   • User receives the Claim Approved email notification

   To reject the claim:

   • Click Edit
   • In the Status field, select Rejected
   • In the Reason field, enter a clear, specific explanation for rejection
     • Explain what documentation was missing
     • Clarify what criteria were not met
     • Provide guidance for successful future submissions
   • Click Save
   • User receives the Claim Rejected email notification with the reason

   To flag the claim for review:

   • Click Edit
   • In the Status field, select Flagged
   • In the Reason field, document why the claim requires additional scrutiny
     • Note potential fraud indicators
     • Describe unusual patterns or concerns
     • Reference need for additional verification
   • Click Save
   • The claim status changes to Flagged Cash Rewards
   • Investigate thoroughly before final approval or rejection

5. To delete a claim:

   • From the claim dropdown, select Delete
   • Confirm the deletion
   • Any awarded points or cash are automatically removed
   • Use caution: deletion is permanent and cannot be undone
   • Consider rejection instead of deletion to preserve audit trails

Bulk Claim Actions

For efficient processing of multiple claims, use bulk actions:

To approve multiple claims:

1. From the Rewards List page, use the checkboxes to select multiple claims.

2. Click Approve Claims (or More Actions > Approve Claims).

3. Confirm the bulk approval.

4. The system:

   • Changes all selected claims to Approved status
   • Automatically adds points or cash to user balances
   • Sends Claim Approved email notifications to all affected users

Bulk approval best practices:

• Review claim details individually before bulk approval
• Use bulk approval for straightforward claims with complete documentation
• Avoid bulk approving high-value claims without individual review
• Verify that all selected claims meet approval criteria

To reject multiple claims:

1. From the Rewards List page, use the checkboxes to select multiple claims.

2. Click Reject Claims (or More Actions > Reject Claims).

3. Enter a rejection reason that applies to all selected claims.

4. Confirm the bulk rejection.

5. The system:

   • Changes all selected claims to Rejected status
   • Sends Claim Rejected email notifications with the reason to all affected users

Bulk rejection considerations:

• Use bulk rejection only when the same reason applies to all selected claims
• Provide clear, actionable rejection reasons
• Consider individual rejection for claims with unique issues requiring specific feedback

To flag multiple claims:

1. From the Rewards List page, use the checkboxes to select multiple claims.

2. Click Mark to Review (or More Actions > Mark to Review).

3. The system:

   • Changes all selected claims to Flagged Cash Rewards status
   • Enables detailed review and investigation before final decision

4. Add investigation notes:

   • Open each flagged claim individually
   • Click Edit
   • In the Reason field, document investigation findings and concerns
   • Click Save

Flagging best practices:

• Flag claims with unusual patterns or amounts
• Flag claims from users with previous rejections or fraud indicators
• Flag claims lacking sufficient documentation
• Document flagging reasons thoroughly for audit trails
• Review flagged claims promptly to avoid user frustration

Reversing Approved Rewards

Approved rewards can be reversed if errors are discovered or if fraud is confirmed:

To reverse an approved reward:

1. Navigate to the approved claim that needs to be reversed.

2. Click Edit.

3. In the Status field, change from Approved to another status (typically Rejected or Flagged).

4. In the Reason field, explain why the reward is being reversed.

5. Click Save.

6. The system automatically deducts the points or cash from the user's balance.

Important reversal considerations:

• Rewards with status Reimbursed cannot be reversed because users have already redeemed the points
• Claims with payout status of PayoutPaid, PayoutFailed, or PayoutProcessing cannot have status updated
• If a user has insufficient balance due to redemption, reversals may create negative balances
• Communicate reversal reasons clearly to affected users to maintain trust
• Document reversal justification thoroughly for audit purposes

Managing Reimbursements

For cash-based reward programs, administrators track when cash rewards are paid out:

To mark cash rewards as reimbursed:

1. From the Rewards List page, filter by Approved Cash Rewards.

2. Select the claims that have been paid out using the checkboxes.

3. Click More Actions > Reimburse Claims.

4. Confirm the reimbursement.

5. The system:

   • Changes claim status to Payout and Reimbursed Rewards
   • Optionally sends Claim Reimbursed email notifications
   • Records reimbursement date for financial tracking

Reimbursement tracking best practices:

• Update reimbursement status promptly after payment processing
• Use consistent reimbursement schedules (weekly, bi-weekly, monthly)
• Document payment methods and reference numbers in claim notes
• Reconcile reimbursement records with financial systems regularly
• Generate reports of reimbursed amounts for budget tracking

Viewing Claims from Reward Programs

Claims can also be accessed directly from reward program pages:

1. In the Setup Home page, click Create > Rewards.

2. Select the reward program you want to review.

3. Click the Rewards tab.

4. The system displays all rewards (claims) associated with this specific program.

5. Use the Actions dropdown on individual claims to:

   • Edit: Modify claim status, value, or reason
   • Delete: Remove the claim permanently

Program-specific claim review benefits:

• Focus review efforts on specific programs
• Analyze claim patterns within individual programs
• Identify high-performing or problematic activities
• Track program-specific approval and rejection rates

Claim Review Best Practices

Establish Consistent Review Cadence:

• Review pending claims daily, weekly, or bi-weekly based on submission volumes
• Set and communicate expected review timeframes to users (e.g., "Claims reviewed within 3 business days")
• Maintain consistent schedules to build user trust and confidence

Document Clear Approval Criteria:

• Create written guidelines for what constitutes acceptable documentation
• Define quality standards for different activity types
• Share approval criteria with users through program descriptions and FAQs
• Train program managers on consistent application of criteria

Provide Specific Rejection Reasons:

• Avoid generic rejections like "Insufficient documentation"
• Explain exactly what was missing or incorrect
• Provide examples of acceptable submissions
• Include contact information for questions
• Maintain professional, helpful tone to encourage future participation

Investigate Flagged Claims Thoroughly:

• Review user's complete claim history for patterns
• Verify information against source systems when possible
• Contact users directly if clarification is needed
• Document investigation findings comprehensively
• Escalate serious fraud concerns to appropriate leadership

Monitor Claim Metrics:

• Track approval rates by program, activity, and reviewer
• Identify programs with high rejection rates requiring better user guidance
• Analyze average review time to ensure SLA compliance
• Monitor flagging rates to identify potential fraud patterns

Communicate Transparently:

• Send timely notifications at each stage of claim lifecycle
• Provide clear next steps in all communications
• Offer assistance for questions or concerns
• Acknowledge delays if reviews take longer than expected

Maintain Audit Trails:

• Use the Reason field consistently to document decisions
• Preserve deleted claim information through notes before deletion
• Review audit logs regularly to track all claim modifications
• Document escalations and unusual situations

Troubleshooting Tips

Issue: Claims are not appearing in the Review Claims interface
Solution: Verify that claims have been submitted by users. Check that you have appropriate permissions (Administrator, Access Rewards Enabled, or Program Manager role). Confirm that the status filter is set correctly (default is Pending Rewards). Use the search or Add Filters functionality to locate claims that may be in different statuses.

Issue: Cannot approve or reject certain claims
Solution: Verify you are assigned as the Program Manager for the associated reward program or have Administrator permissions. Check if claims are in a status that prevents modification (Reimbursed claims cannot be changed). Ensure the reward program is not deactivated or ended.

Issue: User did not receive claim notification email
Solution: Verify that email templates are selected in Reward Program General Settings. Check that the selected email templates are published and active. Confirm user email address is valid and deliverable. Review email delivery logs for bounce or spam filter issues. Test email sending by submitting a test claim.

Issue: Cannot reverse an approved reward
Solution: Check the claim status. If status is Reimbursed, reversal is not possible because the user has already redeemed points. For cash rewards, verify payout status is not PayoutPaid, PayoutFailed, or PayoutProcessing. If the user has redeemed points creating insufficient balance, the system will create a negative balance upon reversal.

Issue: Bulk actions are not working as expected
Solution: Verify that all selected claims are in the appropriate status for the bulk action. Ensure you have permissions to modify all selected claims. Check that you are not mixing claims from different programs with different approval requirements. Try processing claims in smaller batches if large selections are causing issues.

Issue: Flagged claims are not showing investigation notes
Solution: Open each flagged claim individually and click Edit. The Reason field contains flagging justification and investigation notes. Ensure notes are being saved after entry. Check that all reviewers understand where to document flagging reasons.

Issue: Claim form responses are incomplete or unclear
Solution: Review the claim form field configuration for the associated reward activity. Consider adding field descriptions or help text to guide users. Mark essential fields as mandatory. Simplify claim forms to request only critical information. Provide claim form examples in program descriptions or FAQs.

Issue: Too many claims are being rejected
Solution: Analyze common rejection reasons to identify patterns. Consider whether approval criteria are too strict or poorly communicated. Review program descriptions and claim notes for clarity. Provide examples of successful claims. Update claim forms to collect information needed for approval. Consider program manager training on consistent criteria application.

Issue: Unable to find specific claims using search
Solution: Use the Add Filters functionality for more precise searches. Filter by date range, program, user, or activity. Verify spelling of user names or activity names in search. Check different status views as claims may have been approved or rejected. Use claim numbers if available for exact matching.

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