ClaimFirst

The ClaimFirst Solution focuses on processing and managing life and health claims, encompassing a variety of benefits designed to meet your specific needs. The ClaimFirst Solution provides full lifecycle claim management.

Key Benefits & Capabilities

  • Multiple language and currency options available.
  • Automated workflows and tasks make it easy for your claim assessors to manage claim assignments and ensure all documentation is collected before leave approval.
  • Integration with external systems allows a seamless flow of information between multiple interfaces ensuring all claim information is up-to-date.
  • On-demand reports are only a click away. Operational reports provide insights and identify trends to ensure you use best practice and avail of all opportunities.
  • Claim Notification Wizard collects all necessary claim data at notification allowing faster and more efficient claim processing.
  • Configurable using custom settings to provide a familiar interface and a tailored appearance to appeal to your corporate brand.
  • Configure your specific business rules to drive the automated claims adjudication
  • Payment functionality supports multiple payees, with the ability to exclude individual payees from payment adjustments.
  • Adjustment calculations can be set up to take care of any required adjustment to the payments.

Key Features

Customer Portal

The Customer Portal provides employees and supervisors with mobile access to relevant claim information and documents, allowing the initiation of a claim from anywhere.

Customer Portal

Reporting

Choose between preconfigured best practice report templates, or create your own reports using the easy drag and drop interface.

Reporting

Reflexive Claim Notification

Reflexive questioning ensures all necessary data is collected during the claim submission process, enhancing standardisation and efficiency.

Reflexive Claim Notification

Case Management

The ClaimVantage Case Management Journal allows you to effectively manage Action Plans, Eligibility, Medical Diagnosis, Communications, and Return to Work.

Case Management

Payments

Whether you want to consolidate payments, or set up automated scheduling, the ClaimVantage Solution meets your needs.

Payments

Analytics

Analytical intelligence detects trends in historical and incoming claim data, flagging high-risk claims based on pre–determined indicators.

Analytics

Benefits Supported

The health claims process uses a rule engine to define the core and secondary medical conditions under which a claimant is eligible for a lump sum payment.

ClaimFirst streamlines the health claims process, offering:

  • Tailored rule engine to define the definition to determine eligibility based on medical criteria as defined within policy condition specifications.
  • Flexible lump sum payments based on medical procedures, death, and policy condition rules.
  • Multiple payment structures supported (percentage and lump sum).
  • Flexible elimination periods supported.
  • Claims can be made in multiple categories as defined by business rules.

ClaimFirst uses specific targeted business rules to identify required documents and creates activities in a sequential order to make certain that all documents are collected in advance of any settlement.

ClaimFirst also supports multiple payments, or early advance payments, interest calculations, as well as any other alterations and deductions required to manage the payment process. You define the business rules based on internal processes and claims standards, which direct how the ClaimFirst solution will process all of the following payment calculations:

  • Coverage calculation for multiple products: Term, Universal, and Whole Life supported.
  • Terminal Illness Benefit: based on claim eligibility and any benefit policy criteria e.g. within 6/9/12 months and calculated by rule definitions.
  • Alterations and deductions supported: payment interest.
  • Single or Multiple nominated beneficiaries: as defined by policy & claim relationships.
  • Multiple benefit payments under one claim, up to 100%.

ClaimFirst streamlines the process further by providing configurable reinsurance for both facultative and standard treaty arrangements.

ClaimFirst has a benefit structure that is designed to support simpler life insurance products. ClaimVantage can manage the claim as a stand-alone product or as rider benefit.

Anytime and anywhere, the ClaimFirst personal accident claims management solution is responsive, delivering accurate, accessible, and automated claims processing, from claim notification to adjudication and payment. Features include:

  • Accident specific sum coverage.
  • Coverage type selected from pick list allows flexibility to configure additional coverage without hardcoding.
  • Automated workflows.

Business rules determine required documents.

ClaimFirst has a benefit structure that is designed to support accidental death and dismemberment (AD&D) coverage for a specific loss or death. This is available as a stand-alone solution or as a rider.

  • Death coverage based on a flat amount or multiples of the annual salary.
  • Dismemberment loss for a defined percent based on the specified loss.
  • Automated payment adjustments for additional benefits.
  • Management of maximum percent/amount for all included coverages.

The critical illness claims process uses a rules engine to define the core and secondary medical conditions under which a claimant is eligible for a lump sum payment. The policy can be set up as an individual benefit or as a rider on another product defined in the Policy Administration.

ClaimFirst streamlines the critical illness claims process, offering:

  • Tailored rule engine to define the definition to determine eligibility based on diagnosis criteria as defined within policy condition specifications.
  • Flexible lump sum payments based on illness and policy condition rules.
  • Multiple payment structure supported (percentage and lump sum).
  • Flexible elimination periods supported.
  • Claims can be made in multiple categories as defined by business rules.

Using the automated ClaimFirst solution, you can simply configure and deploy claim rules in line with your business risk appetite policy and guidelines, including future enhancements, quickly to start processing claims immediately.

To optimally manage disability income (DI) claim notification, adjudication, and payments, ClaimFirst provides a streamlined process to ensure DI claims are processed consistently utilizing the following features:

  • Delivers global industry leading practice rules packages for claim operations ‘out-of-the-box’.
  • Ensures speedy time to design and configuration for your business processes.
  • Delivers an enhanced data collection capability and management reporting suite options.
  • Ensures claims assessor errors are reduced particularly in the more onerous gathering phases
  • Supports single and multiple payment frequency, including monthly and lump sum payments.
  • Allows the ability to transition a DI claim to a Lump Sum Disability and/or Disablement Premium Waiver claim, using specific configurable data from the ID claim.

Mortgage protection benefits on disability or life claims can be managed end-to-end using the ClaimFirst Solution. From plan set up to notification, through to payments, the solution can efficiently handle:

  • Automated correspondence.
  • Claim Notification with reflexive questioning.
  • Automated workflows.
  • Flexible benefit set up.

The Terminal Illness has a tailored rule engine to define the definition to determine eligibility for payment based on medical conditions and life expectancy.

  • Tailored rule engine to determine product eligibility criteria e.g. 3/6/9/12 months
  • Multiple sum insured supported (single/joint lives)
  • Exclusions determined based on defined rules
  • Additional Lump Sum payments and configurable ancillary or advanced illness options product rules.

The waiver of premium process uses the business rules engine to generate automatic diary dates and follow ups for review to facilitate claim management.

ClaimFirst assists the process by:

  • Automating follow-ups to client
  • Providing automated internal communications with premium payment system
  • Facilitates auto termination based on business rules
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