Comprehensive Claims Management Software Components

By James DeRosa | April 17, 2014

Is searching for a pre-designed claims system with components that fit your company’s requirements like finding a needle in a haystack? Let’s make finding the perfect claims system not so difficult. We’ve started a list of basic components found in a comprehensive claims management software, feel free to add your ideas onto the list.

  • Is the system “intuitive?” New users should be able to master the system quickly, without much help from busy coworkers.
  • A robust connection to policy source data with immediate coverage information, including endorsements and deductibles, is essential. To verify applicable coverage prior to loss acceptance, adjusters must be able to locate policy details as quickly as possible. Even short delays can impel claimants to retain counsel. Adjusters cannot handle a claim until they verify the appropriate coverages.
  • Computer stuck? Adjusters need a way to get “unstuck,” and fast. Multiple help screens enable users to quickly find appropriate answers when unsure about how to proceed.
  • Strong components to ensure easy access to claimant information, including name search, policy search and claim number search, must be a feature of a user-friendly system.
  • A strong diary system keeps adjusters on task. Adjusters rely heavily on diaries. Without a strong diary system, adjusters may miss critical deadlines.
  • An efficient system keeps adjusters out of the file room. Paper equals struggling performance in many modern organizations. Look for a claims management system that provides easily locatable, tagged PDF documents. Adjusters should not have to play telephone tag with elusive vendors simply because they can’t find a report or an estimate.
  • A system should be designed to align with the current line of business, not pieced together from another line of business and applied to your coverages. For example, some of the most inefficient claims management systems were designed for workers’ compensation claims and then altered to manage liability claims.
  • A modern claims system should offer an efficient document-management process that enables adjusters to easily add both incoming and outgoing emails to the file.
  • Do your forms auto-populate? Can you integrate standard letters that auto-populate? Adjusters simply don’t have time to reenter information. Many systems on the market designed to provide financial data are not intuitive and user friendly. An inadequately designed, slow claims system is not only time consuming, it’s very demotivating to employees.
  • The fields listed below are essential to an effective claims management system.
    • First notice of loss;
    • Date of loss, which can be changed when more facts emerge;
    • Insured information;
    • Policy information, including coverages;
    • Type of loss and event type for loss prevention and pricing integration;
    • Reserving history;
    • Bill payment history;
    • Recovery/subrogation;
    • Fraud fields;
    • Medical case management history;
    • Loss details with a loss summary;
    • Robust reporting availability.
  •  A strong desk-level claims system must also deliver top-notch management data. It is crucial that the claims system utilizes the accurately entered data from individual claim files to develop management reports such as lag time, legal spend, injury trends and pinpoint possible coverage modifications.

A solid claim management system should be a fully transaction-enabled record system used over the entire claim lifecycle, from first notice of loss through settlement or resolution and claim file closure. Finding the right claims management system is a major challenge. However, the right system will provide many unexpected benefits. These include improved morale when adjusters no longer have to wrestle with an antiquated claims system, as well as fewer missed deadlines and fewer bad faith lawsuits from decisions made with available but unconsidered information.

image of James DeRosa

About James DeRosa

James DeRosa the founder/CEO of JDi Data Corporation, has successfully developed innovative technology software solutions for company growth and client satisfaction in the insurance industry for carriers, risk managers, third party administrators and public entities. Learn more at www.jdidata.com. More from James DeRosa
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