That’s why ambitious insurers are shifting to insurance claims automation, cutting delays and errors while improving customer satisfaction. With automated claims processing, insurers can speed up every step, from the first report to the final payout.

To drive home the value of claims automation, we’ll take a trip along the claims lifecycle, addressing the improvements automation offers at each step of the journey.

The claims process begins with First Notice of Loss (FNOL), or claim intake‌ — ‌when a policyholder reports an incident. Any delay or error here can slow down the entire claim.

Traditionally, FNOL meant long hold times and paperwork. Now, automation speeds things up with AI-driven chatbots, mobile apps, and connected devices (like telematics for auto insurance, or in-home water level sensors). These tools instantly capture crucial details, verify coverage, and even flag potential fraud.

For policyholders, that means no more waiting in limbo‌ — ‌just fast, clear updates. For insurers, it means fewer errors, faster claims, and a smoother overall process.

What are the steps in processing a claim? 

Regardless of line of business, insurance claims tend follow a structured path from report to resolution. While specifics can vary by insurer and claim type, the core claims processing steps remain the same.

Here’s how they work when supported by automation:

5 Steps in a Claims Lifecycle

1. 1. First Notice of Loss (FNOL): The policyholder reports the claim, providing details about the incident. Modern automation tools enable instant FNOL via chatbots, mobile apps, and IoT-connected devices.
   2. Claim Triage and Assignment: The insurer reviews the claim to determine complexity. Low-risk, straightforward cases can be auto-processed, while complex claims are routed to adjusters.
   3. Investigation and Documentation: The insurer gathers evidence, assesses coverage, and verifies details. AI-driven fraud detection and automated data retrieval help streamline this process.
   4. Claim Decision and Settlement: Based on findings, the insurer either approves, denies, or negotiates the claim. Automated decisioning can handle simple claims instantly while flagging exceptions for human review.
   5. Payment and Closure: Once approved, payments are issued, and the claim is officially closed. Automated payment processing ensures quick, accurate payouts, improving customer satisfaction.

The claims handling process is only as efficient as the systems that support it. Outdated technology slows down resolutions with an excess of manual tasks, fragmented data, and human error. That’s why insurers using EIS ClaimCore® and ClaimSmart™ see a major transformation in their claims operations: one that reduces costs, speeds up settlements, and enhances customer satisfaction.

ClaimCore is a comprehensive claims management system that automates key steps from FNOL to final payment. It digitizes claim intake, verifies coverage in real time, and assigns claims based on complexity. 

Simple, low-risk claims can go through straight-through processing (STP) — in other words, no human intervention is necessary to complete approval and payout. Cases on the more complex side get routed to adjusters with all relevant data consolidated in a single interface. This cuts down on the time claims teams might ordinarily spend tracking down data piece by piece with old-fashioned claims management software.

ClaimSmart improves the claims workflow with advanced fraud detection and a careful streamlining of the overall process. Its ClaimGuard™ feature analyzes claims data with advanced machine learning, detecting fraud risk early through a unique scoring model. This helps insurers reduce claims leakage and unnecessary payouts. 

Meanwhile, with the dynamic intake and automated workflows of ClaimPulse™, claims teams can tailor the entire claims lifecycle so it best matches each case. The feature also uses a customer-facing portal to keep policyholders updated on their claims in real time — ‌eliminating the need for status calls and improving customer trust.

Whether used together or separately, ClaimCore and ClaimSmart help insurers deliver faster claim payouts, minimize errors, and reduce operational costs‌. And carriers get all of these benefits without sacrificing the human oversight that’s necessary for nuanced claims.

The steps in the claims process can be full of snags if using outdated systems and workflows. Slow turnaround times, manual errors, and leakage risks represent just a few of these problems, and they’re frustrating for insurers and customers.

Claims processing automation supported by EIS solutions changes all that. It streamlines each step, from initial claim intake to final payout. By reducing human intervention in routine tasks and gaining more time to focus on difficult claims, insurers can improve processing times, minimize fraud, and improve customer satisfaction. 

Get started on your journey to your ideal claims lifecycle. Learn more about claims management and processing claims with EIS OneSuite.