Sirma Claims Management is delivering an enterprise-wide application that is supporting carriers in claims efficiency improvement, lowering claims adjusting costs and customer satisfaction increase. It accomplishes this by cutting claims resolution times, improving adjuster productivity, ensuring consistent claims adjusting and smoothing the hand-offs between claims constituents.
Benefits for All Stakeholders
The claims management ecosystem encompasses a variety of constituents, including customer service representatives, insurance claims adjusters and managers, insurance agents and brokers, claims partners (i.e. repair shops), insured parties, etc. Sirma Claims Management provides a solution for all constituents enabling fast and easy access to “single source of truth” claims information, claims activity plans and claim adjusting performance.
Claim Lifecycle Management
Sirma CLM supports the entire claim lifecycle from the initial claim report to the settlement and analysis. With this solution organizations can manage the activities of all claim involved constituents representing real-time information about stage, status and task responsibilities. This gives the insurers better visibility and high level of collaboration ensuring all activities are properly assigned and completed.
First-notice-of-loss (FNOL) information, such as descriptions, nature of claim, parties and properties involved, nature of damages, can be captured with Sirma Claims Management. The information can be delivered by different communication channels like contact centers, customer web based self-service, standard forms or electronically from other legacy systems. Full claim information is collected in one logical business area called “claim dossier”, accessible for all stakeholders with the respective permissions.
Sirma CLM provides flexible tools for allocation and planning of the tasks and activities during the claims processing. Claims can be divided into sub categories as sub-claims, by coverage, claimants, injury or property type, and so on. Each of these claims or subclaims can be assigned to the appropriate adjusters, based on their knowledge and experience, geographic location or capacity. It also provides an opportunity a claim to be sent to a group of adjusters, and one of them should take a voluntary assignment.
Improvement of data interconnections
When FNOL information is entered into the system, it automatically generates a “claim dossier” with unique identifiers and respective properties. All necessary data is collected in the dossier in order proper adjustment and settlement to be completed. With the specific semantic functionalities of the solution it automatically connects on a pre-defined rule-based contextual logic all necessary business objects connected with the claim – claimant, adjuster, property, etc. If the organization is using other legacy systems, the application integrates with it and requests the information needed. This way Sirma Claims Management becomes single source of truth.
Settlement and reimbursement
Sirma CLM supports the settlement and reimbursement processes. Tasks are being created and assigned within the application for the authorized employees. User actions and the respective deadlines are monitored. This process ensures all needed steps including settlement proposal, approval, settlement and reimbursement are covered and accomplished according to company policy and best practices. Achieved transparency and velocity is vital for improvement of the customer satisfaction.
The application provides management reporting capabilities for creation of standard and on-demand queries and analisys, based on existing information such as number of claims, claims by type, reimbursed amounts of money, time per claim service, performance of individual adjuster, etc. The information is presented in both graph or chart reports and is giving to the senior executives the ability to quickly evaluate the effectiveness of the claims organization.
The application is with flexible SOA based architecture that allows full integration with third party legacy systems.
Sirma CLM has an unique functionality for creation, management end expansion of the knowledge base of the insurance organization in “Wiki spaces”. It can be used as a claims resolution base, with references to complex claims cases and also as a foundation for development and introduction of new insurance products. This functionality can also support the on-boarding process for newly hired employees.
Why choose Sirma Claims Management ?
Sirma Claims Management is a unique combination of tools for management of business processes, documents and knowledge, which provides insurance companies with the necessary equipment for achieving high operational velocity and for correct decision making based on correct real-time information. The application provides the opportunity to build natural and contextual links between different business objects (underwriter, claim, property, policy, damage, etc.) and represent them in the same way as they exist in the Real World. Sirma Claims Management supports companies in increasing customer satisfaction and control of the operational claims management costs.