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Claims Management
A better claims experience for everyone involved
(and we do mean everyone)
Our claims management solutions take you seamlessly from loss notification all the way through assignment, investigation, payment, subrogation, and closure. Customers and employees are much happier, and claims are processed quicker, and with higher accuracy.
Why ClaimCore?
ClaimCore® boosts operational efficiency and reduces manual burden with pre-built and customizable processes. Ultimately, ClaimCore’s automated workflows benefit everyone involved in the claims process: claims personnel, insureds, brokers, and agents, among others.
Claim Intake / First Notice of Loss (FNOL)
Capture claims quickly and accurately whether they’re submitted via mobile app, email, phone, or online form. Automated processes established during rule configuration then routes the claim based on data available.
Lifecycle Management: Assignment, Adjudication, Payment, Subrogation, & Resolution
Truly complex (or suspicious) claims demand scrutiny, but what about the many straightforward claims filed daily? With ClaimCore, insurers can tailor rules or workflows so simple, non-fraudulent claims skip inessential processing stages and get resolved faster, with little to no manual interaction.
Financial Management and Reporting
Carriers can rely on ClaimCore to deliver accurate payments across all insurance lines of business. Payments are calculated based on policy details and in compliance with applicable regulations. Further, payment amounts are tracked against coverage limits for helpful benchmark reporting.
Data and Analytics
ClaimCore becomes a source of critical business insights with data management and analytics capabilities. Insurers can spot the rise and fall of certain claim types, extrapolate risk potential, change underwriting strategies as needed, and support more informed decision-making overall.
ClaimSmart
Our AI & machine-learning-enabled ClaimSmart ensures the claims process is as fraud-free, accessible, transparent, and personalized as possible. Though its technology is state-of-the-art, both business users and insureds will find it a user-friendly and streamlined solution for claims. Plus, it works easily alongside ClaimCore or any other insurance claims platform.
ClaimGuard
ClaimGuard™ equips insurers with ironclad fraud detection and risk assessment. The ML (machine learning) algorithms that drive it continually improve its ability to recognize even well-hidden problems in the ever-evolving world of fraud.
Using ML algorithms and advanced analytics, ClaimGuard examines countless potential scenarios related to each claim and assigns risk scores. Once a determination is made, the machine learning takes notes of the factors and the outcomes, and continually improves its fraud detection abilities.
Meanwhile, ClaimCore (or your chosen claims management system) works in the background to ensure accurate settlement and payout.
ClaimPulse
The AI- and ML-powered ClaimPulse™ redefines claims automation, bringing a new level of efficiency, technological sophistication, and reliability to the experience for insureds and claims managers alike.
Insureds file claims through the digital front end and can access an easy-to-use portal to track real-time claim status and communicate with the carrier as needed. Simultaneously, the automation layer has numerous pre-configured processes to eliminate manual tasks (like setting up a car rental after an accident), reducing examiners’ workloads and ensuring faster payouts.
Leave and Absence Management
Integrating seamlessly with ClaimCore and PolicyCore®, this solution gives group benefits carriers a huge advantage when working with and attracting new employer clients. By facilitating smooth, event-driven processes, insurers who use this solution stand out from their competition in a noticeable way. For example, an employee’s emergency room claim can trigger the initiation of a short-term disability claim — and track both against regionally-regulated leave types for HR departments, as well as policy data and coverage amounts for the insurer. It’s seamless for everyone involved: the HR department, the employee, and the carrier.
ClaimCore® & ClaimGuard™ Separately Recognized as 2024 Technology Standouts
“ClaimCore stands out for its technical architecture, including the modern code base, API integration, and ease of client-side configuration. But it’s no slouch functionally either, with fraud detection, litigation, and subrogation capabilities available out of the box alongside an intuitive user interface. This makes it a good choice for personal lines insurers of all sizes looking for a robust solution to claims management.”
- Nathan Golia, Senior Analyst, Celent
How do insurers use EIS claim solutions?
The ClaimCore + ClaimSmart combination makes it easy to improve the entire claims process — for you and your customers.
Through proprietary fraud detection, easily-configured customer experiences, and automated workflows, the combination of ClaimGuard and ClaimPulse is revolutionizing the claims journey.
Hospital Indemnity and Accident
ClaimCore makes even the most complex accident claims easier to process through state-of-the-art automation. When examiners create cases in the system, noting all the necessary treatments and their coverage types, the solution calculates accurate payouts based on eligibility, policy types, coverage thresholds, limit amounts, and other relevant factors.
Property and Casualty
P&C claim filing is simple with ClaimCore: Drawing from all relevant customer data within EIS OneSuite™, the solution enables fully or partially automated processing based on claim complexity. Even cases involving single events that generate multiple claims are no match for the data-driven workflows of ClaimCore.
Insurance’s moment of truth has never been more important.
Make claims your claim to fame.
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