Learn More About Insurance Claims Management Software
What is Insurance Claims Management Software?
Insurance claims management software is used by insurance companies to manage the entire claims lifecycle, from claims creation to claims settlement.
These systems are designed to automate large portions of the claims process, reduce processing time and costs, and improve customer experience throughout the claims process.
Insurance claims management software acts as a single platform for insurance companies to manage, track, and process claims while ensuring compliance, customer satisfaction, and accuracy.
Some of the key features of an insurance claims management system are compliance management, automated claims processing, document management, settlement processing, reporting, and data analytics, which together facilitate insurance claims management and settlement to ensure equitable resolutions via streamlining of data, workflow and process automation and enhanced decision making support.
What Types of Insurance Claims Management Software Exist?
Insurance claims management tools are divided into types based on the following factors: solutions offered and the industry or business they serve.
It is important to note that because of competition and high market concentration, most insurance software tends to provide claims management, policy management, billing and invoicing, customer support, broker management, and other offerings.
The few popular types of software based on businesses they serve are:
General claims management software
This is a comprehensive solution for managing various claims where the entire lifecycle from intake to settlement is taken care of. This category covers health, life, homeowner, auto, and other popular insurances in general.
General insurance is any insurance contract that does not come under life insurance's ambit. Life insurance contracts are one in which an insurer promises to pay the insured upon the individual's death or after a set period in exchange for a premium.
Healthcare claims management software
This software is specifically designed for health insurance providers, where the software can handle medical claims, billing, investigation activity, and claim disbursements. This software integrates with medical billing systems and other healthcare operations software.
Auto claims management software
This insurance claim management software focuses on vehicular and auto insurers, where the product facilitates claims arising from vehicle accidents, damages, auto thefts, and other auto insurance policies.
Auto claims management software integrates with telematics or connected car software, vehicle valuation software, and repair estimation tools.
Worker’s compensation claims software
This software is designed explicitly for workplace insurance, i.e., to manage claims related to workplace injuries, employee compensation, and other related cases.
Worker's compensation claims software is used by factories, construction sites, and industries where workplace injuries are common.
There are various other insurance management software based on the business verticals they serve, such as shipping insurance, life and health insurance, property and casualty claims, etc.
The choice of software type depends on the specificity of the insurance, customer needs, organizational requirements, and the level of customization to improve efficiency in managing claims processes.
The insurance claims management software type also depends on the offerings, marketing automation (B2B or B2C), and business verticals. For example, cloud-based claims software, specialty insurance claims software, and integrated insurance suites.
What are the Common Features of Insurance Claims Management Software?
The following are some core features of insurance claims management software.
Claim intake wizard: The software must allow claimants to submit documents and information either through online portals or mobile apps to help build the claim.
Enhance customer service: Provides various features like omnichannel customer service, customer self-service portal, customized dashboards, and tailored insurance products based on customer interests and needs to increase customer experience (CX).
Process management and automation: The software provides task management to control the creation and distribution of tasks to claim processors within the agency.
Also, reducing employee involvement via automation in claims process management with pre-built workflows reduces manual errors.
Document management: Every insurance agency has guidelines on processes and document management, which are cumbersome and complex.
Therefore, for ease of use and efficient search, every insurance claims management software must provide a customized document management feature to search, track history, create reports, manage, organize, and secure documents to help create customer trends and behavior.
Predictive data analytics: Provide business insights from the market and customers to understand and predict user behavior, recognize the most profitable customers, identify risks resulting in increased sales and customer-insurer relationships, etc. This helps create reports and dashboards for internal business strategies to convince senior management and stakeholders.
Integration capabilities and API: The software can integrate seamlessly with other systems, such as customer relationship management (CRM), policy compliance, procurement solutions, contract lifecycle management (CLM), and financial software. This results in improved data-sharing, accuracy, real-time tracking, and efficiency, which are critical to insurance operations.
Policy and compliance management: The software allows agencies to automate end-to-end insurance handling, which helps underwriting, quoting, proposal generation, policy issuance, renewal, and cancellation, including claims processing and loss run report preparation.
What are the Benefits of Insurance Claims Management Software?
Having an open and flexible platform boosts the value of the insurance agency, which can be used to innovate and periodically customize to the customer needs to grow the business.
Scalability of the software is essential to increasing customer satisfaction and productivity, which in turn increases business profitability.
Increased efficiency and reduced human errors: Insurance and damage claims have been part of general legacy businesses for a long time. Hence, integrating technology into the manual system and automating the claims processing will increase operational efficiency in a company, saving costs and time and decreasing errors.
Technology can overdo human capabilities as the insurance business plays with bulky documents, extensive data or numbers, and repetitive processes.
Upgraded fraud detection and regulatory compliance: Technology has evolved to a point in detecting suspicious activity from patterns, claims history, and trends, which aids in safeguarding the insurance agency from financial losses and fraudulent claims.
The software also can aggregate and provide real-time access to laws and industry regulations, minimizing compliance risks and legal complications.
Enhanced customer experience: Customer acquisition and retention are core factors in the insurance business. Therefore, having a claims management solution that is tailor-made to the users and customized to a firm's internal system improves ease of use and customer experience.
Centralized storage system: Systematic documentation and storage of digital documents ensures quick access to accurate information and prevents loss of data and misplacement of documents.
Informed decision making: Insurance claims management software has predictive analytics, financial reporting, data visualization, and risk identification capabilities, which aids insurance agencies to have data-driven insights to make strategic decisions.
It is also important to note that having an insurance claims management system helps scale businesses, standardize the policy management and claims procedure, capture the first notice of loss, ensure data security, and integrate with external systems while decreasing overall cost and increasing efficiency.
Who Uses Insurance Claims Management Software?
Professionals and stakeholders across the insurance ecosystem use this software.
Insurance agencies: They are the primary users of the software in the B2B business. They may be independent or enterprise insurance agencies. These businesses leverage the capabilities of these systems to handle the entire claims process, streamlining workflows and improving the overall experience for both the end user and the claims department.
Third-party administrators (TPAs): Entities that manage insurance claims processing on behalf of insurance agencies are called TPAs. They use this software to process, track, and disburse claims for multiple insurance companies.
Insured parties: Also called policyholders or claimants, i.e., those with insurance policies use insurance claims management software extensively. Customers use this software to submit claims and follow the claim's progress, eventually collecting their payout if deemed appropriate.
Legal and compliance teams: Whether the policy and its claim adhere to regulations and laws is assessed by legal and compliance teams. They and the finance department check the standards and requirements of claims during the evaluation and disbursement process.
Insurance agents and brokers: Most agents and brokers who sell insurance policies also take the responsibility to submit claims on behalf of insurance parties. They facilitate insurance policy management and claims processing.
Insurance claims management software is also used by stakeholders in the ecosystem, such as underwriters, claim adjusters, risk managers, customer service teams, data analysts, and CXOs of a company, to gain insights, metrics, and performance of the policies to make strategic decisions in their roles and businesses.
Software Related to Insurance Claims Management Software
Insurance claims management software is majorly used by insurance companies and agencies. They can be used as standalone software or part of insurance suites software, i.e., a set of software that complements each other in insurance business workflow.
Insurance policy administration systems: This software is the record management system for all insurance policy-related information. It includes quotes, rating actions, issuances, and renewals.
Insurance policy administration systems manage the entire policy lifecycle, including housing and updating policy details, updating new billing information, tracking beneficiary changes, ending policies, and designing transaction workflows.
Insurance billing software: Helps insurers configure billing plans and invoice clients. Insurance billing products enable users to maintain non-standard payment arrangements and facilitate bill collection and accounts receivable reconciliation.
Underwriting and rating software: Manages and automates the underwriting process for insurance agencies. Underwriting and rating solutions allow users to write rules and policies executed automatically during the underwriting process.
These applications can then conduct pricing and rate analysis, calculate premiums, standardize quotes across channels, and vary rates according to risk and policy information.
Insurance agency management software: These systems provide CRM software and marketing automation software capabilities to help agents enhance relationships with customers, clients, and prospects.
In addition, these systems include back-office features such as automated workflows and commission processing to facilitate agent efforts.
Insurance compliance software: Enables insurance companies to meet compliance regulations efficiently and effectively. Insurance companies use these solutions to reduce noncompliance events, establish effective compliance processes, and maintain strict, auditable records for compliance officers.
It is important to note that the choice of complementary tools depends on the insurance claims management system's specific needs, processes, and goals.
Apart from the software mentioned above, some of the popular complementary software and tools are document management software, data analytics and business intelligence tools, payment gateway integration or digital payment platforms, image recognition tools, artificial intelligence systems (for analytics, chatbots, virtual assistants, etc.), e-signature software and remote inspection or investigation software.
Assessing the requirements and then integrating tools for seamless claim processing capabilities is essential.
Challenges with Insurance Claims Management Software
The insurance claims process is voluminous, data driven, and repetitive. Due to data overload, unstructured documentation, lack of technology adoption, and ever-changing regulations, it is tough for players in the insurance market to be efficient and manage customer expectations.
Therefore, insurance claims management software needs to address the following challenges to be competitive in the market:
Poor business modeling: Multiple touchpoints in the claims process ecosystem and repeated back and forth result in miscommunication, information loss, and human error.
Every company and agency follow different norms and procedures without having a clear customer understanding, resulting in a lack of standardization and transparency in the insurance claims process.
There is a requirement for a unified, standardized, and market-competitive platform.
Managing data: Bulky data, multiple documentation, and access to necessary relevant information are at the core of the insurance claims process. In addition to that, the data is sensitive and sometimes fraudulent. Therefore, analysis and interpretation of these become cumbersome, time consuming, and costly.
An outdated manual claims management process that still follows the legacy system with poor integration capabilities is not a practical solution.
Coping with evolving and complex compliances: Laws and regulations are similar to weather changes, constantly evolving and difficult to understand.
Keeping up with these complex and comprehensive compliance requirements is necessary but labor-intensive. Over and above this difficulty, these laws and regulations change geographically, making it extremely difficult for large-scale businesses to follow.
Tools that aggregate real-time information from across the globe of all the insurance rules and regulations are required for managing claims effectively.
In addition to these core challenges, there are always common cross-industry challenges such as workflow optimization, tech compatibility, intuitive customer satisfaction, data security, cost optimization, data migration, customization to user requirements, and scalability.
How to Buy Insurance Claims Management Software
Requirements Gathering (RFI/RFP) for Insurance Claims Management Software
It is important for the buyer to assess the needs of the business by identifying the requirements, policies offered (if they are industry-specific software), desired tools and functionalities, regulatory compliance, CX, and other features per the target market.
It is also important to gather information about the software's capabilities and performance by its historical performance in the market via reviews and rankings, along with the scalability of the software.
This helps to understand user experience (interface, design, ease of use of the insurance claims management software), security and compliance (GDPR, HIPAA, PIPEDA, HITECH, etc.), software performance, and vendor financial stability.
Compare Insurance Claims Management Software Products
Create a long list
To align the product with the customer's interests and needs, the customer must begin by learning about the top picks in the marketplace.
This involves researching various sources, collecting information, and verifying the data they find. Each vendor's offerings should be strictly categorized.
Create a short list
Once the long list has been compiled, the buyer gains insight into multiple offerings presented by various vendors.
It becomes crucial to synchronize the buyers' preferences with the features, offerings, and specialized industry needs, refining the selection process to yield a more concise roster of potential vendors.
It is advisable to curate a shortlist comprising a minimum of 8 to 10 vendors, selected based on their offerings, customer evaluations, and pricing (displayed on the website before any negotiation).
Technology review platforms such as g2.com provide unbiased reviews and different comparative perspectives on the software platform.
Conduct demos
In either white labeling an existing product or developing a platform tailored to a buyer's requirements, it is essential for a buyer to have the initial look and feel of the software.
This helps the buyer check employee experience, CX (can be provided to a sample set of customers), ease of use, and confirm if the product addresses the buyer's problem statement.
Since this acts as a testing phase, it helps identify potential issues. It gives an idea of the software product's implementation plan, milestones, and schedule during the development, testing, and live phase.
Selection of Insurance Claims Management Software
Choose a selection team
A selection team to funnel down and finalize insurance claims management software must consist of the following:
- A legal head or a specialist is a must, as insurance policies and claims involve regulatory and industry-specific compliance challenges.
- A product development head is required as the individual will play a vital role in providing product requirements, product design, and software customization to the company's needs and internal system.
- Like a chief financial officer, a finance specialist can provide vital details about purchase costs and implications. They are also responsible for integrating claim disbursements and other financial tools (such as financial data APIs, payment gateways, etc.) with the insurance claims management software.
- A project manager, if this is an R&D project for an insurance company, like a new product is being launched (for instance, a healthcare insurance agency is stepping into an auto insurance space, in such cases, a new product specifically for auto insurance needs to be launched).
- The procurement head plays a vital role during the selection process, where the dedicated personnel will engage with selected vendors to request demonstrations, gather detailed information, and negotiate contract terms.
Negotiation
Negotiation is an integral part of buying a software product. While purchasing an insurance claims management software, the negotiation must consist of three steps:
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Preparation: The buyer must draft the requirements for the top three vendors with software specifications. This helps vendors provide cost estimation for the overall product. This is also called the first offer.
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Bargaining: The buyer can request additional facilities from the vendor for the setup process and post-software product sale. These negotiation points can include additional software testing, free employee training, the onus of complete transition from test to live, increased licenses, support and maintenance fees post sale, continuous improvement cost, etc. The extent of bargaining power and extreme clauses will be based on the benefits and terms of the partnership (long or short term), which will be the deciding factor.
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Closing: After back and forth between vendor and buyer over various features, workflows, and best practices, the vendor provides the final offer. The buyer must choose between the top three vendors based on the benefits and pricing. Consider the vendor's reputation, size, and capabilities if looking for a long-term partnership.
Final decision
The insurance claims management software will be used as the key tool and fundamental in the buyer's day-to-day business operations. The board of directors, along with key stakeholders, will make the final decision by considering the opinions and suggestions of the selection team.
What Does Insurance Claims Management Software Cost?
Insurance claims management software cost is based on the type of insurance claims management software and the business model the buyer is using with the vendor.
If it is a partnership model, insurance claims management software vendors typically charge a monthly or annual subscription fee per user license, ranging between $50-$200 per user a month (depending on buyer size, vendor geography, type of solution, model, extent of personalization and other factors).
Suppose it is a complete sale (whitelabeling and selling the software with full ownership with no maintenance and support) with necessary integrations of a customer portal, accounting software, and other necessary APIs. In that case, it costs upward of $100,000.
The type of insurance claims management software depends on two things:
- The tier of the firm the software solution is implemented in, for example, a small, medium, and large/enterprise-level firm.
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The features and add-ons the software provides, which is either dependent on vendor pricing models or buyer-vendor negotiation.
Return on Investment (ROI)
Implementing insurance claims management software with automation increases productivity while decreasing the claim processing time and costs.
It is estimated to decrease claims processing costs by up to 25%-35% and almost double (200%) the business's profitability with necessary AI automation and system integrations.
Implementation of Insurance Claims Management Software
How is Insurance Claims Management Software Implemented?
Once the buyer decides on the vendor from the steps above, they tend to partner with the technology provider if they are looking for a long-term solution for the software platform's initial sale, maintenance, support, and continuous development.
If the buyer is looking for a one-time buy, then the software is bought by following these steps:
- Software selection
- Software customization and integration
- Data migration from the legacy system
- Preparation and user training for the internal team with plans for end-users
- Pilot testing
- User feedback refinement and configuration
- Full deployment and initial setup/monitoring.
If a performance evaluation is conducted based on the contract terms, the implementation process continues until the software's complete handover (ownership, storage, management, and support) to the buyer.
Who is Responsible for Insurance Claims Management Software Implementation?
Senior management and the IT department are responsible for project implementation and work with the project team to ensure that all relevant departments' proper installation, configuration, and requirements are met.
The research and quality assurance (QA) team plays a vital role in ensuring the software meets end-users' standards. Since this software is a fundamental base for the whole company, it will be a cross-functional team that plays crucial roles during every project stage.
Insurance Claims Management Trends
Especially in insurance claims management, claims automation, cloud adoption, and customer personalization are important topics.
Every software trend nowadays is about being agile and transformative with the rapid evolution in technology. The current trends in insurance claims management are as follows:
Leveraging artificial intelligence (AI) and machine learning (ML)
Digital transformation in claims management is rising with AI/ML integration into software platforms. These solutions can be used for chatbots, claim analysis, pattern recognition, risk identification, outcome prediction, and fraud detection, which improves the strategic decision making of the business.
Mobile-first solutions
Accessibility and ease of use for customers is the need of the hour. There is a clear shift from manual and web-based claims management to mobile solutions offered with increased responsiveness and customized dashboards.
IoT-based telematics solutions
Especially in accident and vehicular damage claims, vehicle telematics is providing high level accuracy and real-time data about driving behavior, vehicle health, and accident reconstruction which helps efficient claims resolution.
Cybersecurity in insurtech
Compared to other industries, the insurance industry holds sensitive personal data collected over a period. Insurance companies use this sensitive information to offer policies efficiently.
Data breaches can impact an insurance company's reputation negatively. Hence, with the rising risks, there is a dire need for robust security measures against such cyber attacks.
