Improve customer service with a comprehensive claims management system

While the Customer Portal allows the client to initiate claims, follow up on their processes, and provide additional information, the Back-Office guides the user through the entire process from an initial review to final settlement

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Healthcare

Medical malpractice claims
Medical billing
Insurance reimbursements
Workers' compensation claims
Patient injury claims

Insurance

Auto insurance claims
Property insurance claims
Life insurance claims
Liability insurance claims

Retail & Logistics

Production liability claims
Warranty claims
Accident claims
Consumer complaints
Return and refund claims

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Manage the full claim management lifecycle

Core capabilities

How does it work?

Customer Portal

Empower customers by providing a user-friendly platform to manage their claims effectively

After adding the necessary information, clients can submit their claims which means the request is sent to the back-office application via integration.

The settlement, which is the initial agreement with the claimant and parties involved, must be adjusted once each type of claim is evaluated: considering the case, insurance policy, and information relevant to the claim. Depending on the nature of the claim, the insurance type, and the industry, the settlement can vary and be tailored. In essence, the settlement establishes the type of compensation (reimbursement, reinstatement, replacement, repair) as well as the settlement agreement with the parties: the insurance provider, or the policyholder, details from vendors, etc.

The final resolution establishes the final agreement, adjudication, status of the claim (favorable or unfavorable to the client) and the details relevant to the case: evaluation, documents, dates, justification, contracts.

Explore Customer Portal

How does it work?

Back-Office

Optimize claim handling, streamline processes, and provide efficient tools for management

An analyst has an option to either send a claim to evaluation to the handling department or ask for some adjustments from the client. If the claim was sent to evaluation the handling analyst can add multiple evaluation items and a resolution. The customer will get the notification about the update with the summary.

On Back-Office side the business process is designed to cover multiple scenarios such as requesting missing information from clients, necessary approvals and internal corrections of evaluation. The customer gets a notification about what they need to adjust in their application.

The analytics and reporting section display common and custom statistics of claims, it's volume, claim trends, filter by claim statuses, resolution time and also allows decisions makers to customize reports with information of their interest.

The Back-Office employees are divided into two main departments: Notice department, which is responsible for the initial review of new requests and Handling department which evaluates the claims and defining the proper settlements for each case. The platform allows the administrator to assign specific access rights to different user groups or users. The setup is under Administration, access control.