Claims Administration

Claims Processing sometimes involves collating and sharing large amounts of information among multiple parties involved in a claim-from body shops to adjusters to investigators to lawyers and doctors to claimants and regulators. And it involves the knowledge of experienced adjusters to determine the fair and appropriate outcome of a claim. In fact, losses and loss expenses absorb 80% of premium dollars collected by carriers.

Insurance Claims Administration - Key Solutions

To deliver optimum results, NeelInfo combines proven methodologies with best practice custom claims applications development, legacy and third party systems integration, claims search integration and leading Vendor technology (FileNet) and application products.

Claims solution components that NeelInfo delivers include:

HexSOACF

HexSOACF, a Claims Business Process Management (BPM) application framework, powered by IBM SOA Foundation tools, accelerates the development timeframe as well as reduces the cost of implementation of an Auto Claims BPM system from the initial stage of First Notification of Loss to Claims settlement. The business process workflow of HexSOACF has been modeled using IBM WebSphere Business Modeler (WBM).

HexSOACF, the NeelInfo Auto Claims Administration framework uses IBM SOA Foundation tools adding value to insurance claims settlement process as listed below:

  • Allows identification of pain areas in the auto claim business process and their resolution before process implementation in production (using simulation features of IBM SOA Foundation tools)
  • Brings in business agility by quickly adapting to the auto claim business process suiting to various Insurance industries where the auto claim changes significantly at the process level
  • Ensures close alignment of business and IT by virtue of the business model driving the IT development downstream
  • Allows definition and change of business rules with the help of rule component and increasing business agility in response to market changes

FileNet Acenza P&C Claims 4.0

Acenza P&C comes with pre-configured workflows that are built on industry best practices. Since the Acenza P&C workflow maps are part of the solution, in-depth process design and implementation activities are not required. Business processes that are included with Acenza P&C are:

  • Claims File Creation and Assignment
  • Coverage Verification and Claims Maintenance
  • Review for Salvage and Subrogation
  • Special Investigations Processing
  • Supporting Document Processing

Implementation of Document Management Tools

Document management tools are those that automatically generate, organize, and print correspondence to comply with service and regulatory requirements. NeelInfo provides services around FileNet Enterprise Content Management (ECM) platform to implement these tools and integrate with the Legacy and Web based Claims applications.

  • Distributor Administration
  • Licensing and Appointment
  • Selling Agreements
  • Debt Management
  • Net Pay

Fraud Management

Fraudulent Claims is a significant and costly area of concern for property and casualty insurance companies. NeelInfo has helped its clients in developing a multipurpose Insurance fraud alerts system to detect fraud and improve the Productivity of Claims officers. This system (Acenza ClaimsSearch Connect) works in the FileNet Acenza environment providing a comprehensive solution for Claims Automation.

Key benefits include:

  • Reduction of loss due to fraudulent claims by quickly verifying the claims against the historical claims data before payment is made. ACSC eliminates the batch mode interface and provides real-time interaction with ClaimsSearch databases. This results in elimination of manually intensive batch mode file transmission and collation of the search results
  • ACSC web interface provides intranet based tool for claims information query during processing
  • Faster claims processing and loss reduction will result in customer retention and improved customer satisfaction. The carrier can control the costs better leading to competitive rates
  • The solution implemented on industry standards is platform independent and scalable
  • NeelInfo technology (Legacy and new) and business expertise with offshore based development/customization resources will enable faster customization and implementation at reduced overall cost