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Improving Claims Process and Management


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Efficient and effective claims management systems are crucial for any business as insurance claims have a wide range in complexity - from straightforward ones that get settled within few days to complex liability claims that take years.

Companies are now looking to reduce cycle time with innovative ways to improve the claims process and enhance the customer’s experience. Claims handling can be looked at as a very intricate process. From receiving to paying there are several detailed workflow processes that should be paid attention to closely in order to have a smooth transition. With the proper insight and enhanced methods, adjusters can turn it into a process to improve operational performance and workflow productivity.

Let’s dive a little deeper into the process with a breakdown of the important moments in each claim.

First Notice of Loss (FNOL) is client driven, and provides the first step in enhancing your customer’s experience. Streamline this critical internal process with the option for the claim to be entered by the claimant, HR, lawyer, and/or broker with established system business rules that follow the reporting process. The end result is a dynamic first notice of loss workflow.

Acceptance, evaluation, and approval are the meat of the claims management process. For insurance carriers, the demand is to not only provide an optimal customer experience with fair settlements, but also micro manage the behind the scenes details. Implementing client driven business rules creates a stimulated workflow process.

Other challenges that present itself during the process are leveraging the data. Claim adjusters look to get integrated outcomes and specific or customized reports generated that an antiquated system may not be able to provide. The capability to generate basic reports is a normal function in a claims processing software. Take the next step to transform it by maximizing your reports and implementing sophisticated ad hoc reports. Enhanced reporting helps managers adjust to new market demands to retrieve information and output outcomes to provide better understanding for decision making.

Claims loss payouts allocations are the most important costs to insurance carriers and also have one of the biggest outcomes on underwriting bottom lines. Insurance company’s claim process needs to not only be effective but also efficient. Closely observing the end to end process helps to put together a high level workflow - from receiving to paying - that can be evaluated for improvements. The outcome is contained costs, high-quality customer service, operational efficiency, and streamlined internal processes.

JDi Data Corporation has provided insurance claims software since 1992. Our product suite includes workers compensation software and claims management systems for property and casualty, medical malpractice, and specialty lines to be administered by insurers, risk managers, and third party administrators. JDi Data has built a reputation in quality claims management software with special emphasis on complex litigation.


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