What are digital claims?

Today, insurance claims automation and smarter claims technology are completely rewriting the playbook. Digital claims, which are fast, data-driven, and customer-friendly, are taking insurers over the line from customer dissatisfaction to customer loyalty. 

This article unpacks the concept of digital claims, how they work, and why the technology behind them matters so much.

Digital-only insurance, sometimes called digital-first insurance, is an operating model where the entire customer journey can happen through digital channels. This  includes getting a quote, comparing coverage, applying for a policy, making payments, updating information, filing a claim, uploading documents, receiving status updates, and getting paid — all without requiring a physical branch visit, paper form, mailed document, or manual handoff.

This doesn’t mean humans disappear from insurance — it just means customers and employees aren’t forced into physical, manual processes when digital ones can do the job faster, cleaner, and with fewer headaches. Human expertise still matters for complex underwriting, sensitive claims, escalations, fraud investigations, and customer support, but routine interactions are easy to complete through self-service channels.

Digital claims processing is foundational to making digital-only insurance work. A digital-only insurer can’t deliver a modern buying experience and then send customers into a paperwork maze when they need to file a claim. Claims are the moment customers find out whether their insurer is actually built for them. Digital FNOL and intake, automated data capture, AI-powered processing, real-time claim status updates, and digital payments all help turn the claims experience from a black box into a guided, transparent process.

Insurers need self-service portals to provide customers, agents, brokers, employers, and partners with the right access at the right time. Automated FNOL is essential for capturing structured data from the start. Utilizing AI and machine learning can support triage, fraud scoring, document review, and decisioning. To close the loop quickly, digital payments are a necessity. Finally, connected systems underneath it all ensure policy, billing, customer, claims, and payment data move together instead of living in separate corners of the business.

EIS enables insurers to offer digital-only products through EIS OneSuite™, a customer-centric, event-driven platform designed to connect core insurance operations with digital experiences. With ClaimCore®, ClaimSmart™, PolicyCore®, BillingCore®, CustomerCore™, and EIS Portals working from a shared platform foundation, insurers can create digital insurance journeys that feel consistent from quote to claim. That is the real promise of digital-only insurance: less friction, faster service, and a customer experience that does not suddenly go analog when it matters most.

So let’s get specific. What is a digital claim? And what are digital claims in insurance?

A digital claim is any insurance claim that’s filed, processed, and resolved using electronic systems‌ — ‌usually via web portals, mobile apps, or integrated third-party platforms. It eliminates the friction of paperwork, manual reviews, and human bottlenecks. This isn’t just digitizing a form, it’s rethinking the entire claims experience around speed, accuracy, and user control.

So how do paper claims vs electronic claims compare?

In the context of modern insurance operations, digital claims aren’t just more efficient, they’re now expected by most policyholders. Customers want transparency, insurers want accuracy, and everyone wants less busywork. Digital claims deliver on all three.

To start, let’s focus on what is the purpose of a claim form‌ — ‌whether digital or physical? 

At its core, a claim form collects  the essential information required to determine coverage, assess damage or loss, and calculate payouts. Digital versions just do it faster, and with fewer headaches for everyone involved.

A digital claim form is exactly what it sounds like: the digital version of a traditional insurance claim form. It’s how policyholders provide the required information to begin a claim‌ — ‌but instead of printing, scanning, or faxing anything, they enter data directly into an online system, via an app or a web browser.

So, what is the electronic claim submission definition? Simply put: it’s the process of submitting claim information electronically through a structured digital interface‌ — ‌no paper involved. That data then moves directly into the insurer’s core systems, automatically triggering workflows for validation, review, and resolution.

With electronic claims submission, insurers can reduce error rates, eliminate duplicate data entry, and speed up cycle times. It also allows for better tracking, faster customer updates, and more reliable analytics.

Some people ask, “What is the standard format used for submission of electronic claims?” This depends on the line of business: in healthcare, it’s often EDI 837. In P&C and life insurance, standards vary but tend to follow structured formats designed to support data integration across systems.

Want to see what this looks like in real life, and why they’re so effective for improving customer loyalty and reducing churn? 

What are digital claim examples we can learn from? Here are a few:

• A policyholder gets rear-ended and opens their insurance app at the scene. They snap a photo of the damage, fill out a few fields, and hit submit. The claim is already 80% processed by the time they get home.

• After a big storm, hundreds of homeowners had to file property claims. Thanks to automation and pre-integrated vendor systems, adjusters are auto-assigned, and payout estimates are generated in hours, not days.

• A worker files for disability leave via a digital HR portal. The data syncs with the insurer’s system in real time, verifying eligibility and starting the claims process without anyone having to re-enter the same information twice.

Being able to serve your customers in this way isn’t just a convenience, it’s a way to strongly differentiate yourself against the competition.

A digital insurance platform is the technology foundation insurers use to connect the entire insurance lifecycle: quote, bind, policy administration, billing, claims, customer engagement, analytics, and partner ecosystems. It isn’t just a digital front end or a prettier portal — a true digital insurance platform connects the systems, data, workflows, and experiences that make modern insurance possible.

Legacy systems, on the other hand, were often built around products, policies, and internal processing needs, and relied on batch updates, rigid workflows, closed integrations, and manual workarounds. They may still run, but they do not make change easy. And in insurance, change is no longer optional: customers expect real-time updates, teams need better data faster, and partners need clean integrations. 

A digital insurance platform is built differently: cloud-native architecture (like in EIS OneSuite) gives insurers the scalability and flexibility to support changing volumes, new products, and evolving business models. API-first design makes it easier to connect with internal systems, third-party data providers, distribution partners, payment tools, fraud solutions, and service networks. Real-time data processing allows claims, billing, policy, and customer information to stay current across the business instead of being trapped in yesterday’s batch cycle.

Omnichannel customer experience is another defining characteristic of a digital insurance platform. 

Policyholders, agents, brokers, employers, members, and adjusters should be able to interact through the channels that make sense for them — mobile, web, portal, call center, partner platform, or embedded experience — without losing context along the way. Embedded analytics help insurers monitor performance, identify patterns, spot risk, and make better decisions. Ecosystem connectivity allows insurers to work more smoothly with vendors, data sources, partners, and insurtech tools.

Digital claims are one of the clearest examples of why this platform strategy matters. A digital claim is not just a claim form submitted online. It depends on coverage validation, customer data, document intake, fraud scoring, workflow automation, payment processing, communications, reporting, and sometimes vendor or third-party coordination. If those capabilities are disconnected, the experience still feels slow and fragmented. If they are connected, the claim can move with less friction and more intelligence.

EIS delivers this broader digital insurance platform approach through EIS OneSuite. Its cloud-native, API-first, event-driven architecture connects claims with policy, billing, customer, analytics, portals, automation, and ecosystem services. With ClaimCore®, CustomerCore™, BillingCore®, and PolicyCore® working from a shared platform foundation, insurers can build digital claims experiences that are faster, more transparent, and easier to adapt as customer expectations keep moving.

Digital claims aren’t just a trend, they’re crucial insurance infrastructure. They redefine what insurers can deliver during a policyholder’s most loyalty-defining  moment: the claim. If you’re still relying on legacy processes, you’re not just lagging, you’re leaking time, money, and trust.

See how one EIS customer upgraded their digital claims process, and in return improved their customer experience and slashed their loss adjustment expenses. 

A better claims experience for everyone involved — learn more about claims automation and management with EIS.