ClaimFirst

The ClaimFirst Solution focuses on processing and managing life insurance claims, encompassing a variety of modules designed to meet your specific needs. The ClaimFirst Solution provides an end-to-end claims management solution through the full lifecycle of Life benefits.

Key Benefits & Capabilities

  • Automated workflows and tasks make it easy for your claim assessor to manage claim assignments and ensure all documentation is collected before assessment of the claim.
  • 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 Intake Wizard collects all necessary claim data at the submission stage 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 assessment
  • 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 tax deductions and other offset amounts.

 

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Key Features

Mobile App

The Mobile app provides employees and supervisors easy access to relevant claim information and documents, allowing the initiation of a claim from anywhere, using any mobile device (phone or tablet).

Mobile App

Reporting

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

Reporting

Reflexive Question Claim Submission

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

Reflexive Question Claim Submission

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

ClaimFirst uses specific business rules to identify the documents required to process life insurance.  Automated workflow tasks are generated to ensure all documents are collected in advance of any settlement.

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

 

  • Death benefit under Superannuation paid to the Fund Trustees.
  • Terminal Illness benefit is based on claim eligibility and product criteria.
  • Alterations and deductions e.g. refund of overpaid premiums or interest for late payments on claims.
  • Single or Multiple beneficiaries.
  • Multiple benefit payment under one claim.

ClaimFirst streamlines the process further by providing:

  • Support for multiple joint life policies
  • Rider benefits, such as Accidental Death.
  • Configurable reinsurance for both facultative and standard treaty arrangements.
  • Cover for both single and multiple reinsurers.

Using the automated ClaimFirst solution, you can quickly and simply configure and deploy claim rules in line with your risk appetite framework regarding your policies and guidelines.

To optimally manage income protection (IP) claim submission, assessment, and payments, ClaimFirst provides you with a streamlined solution to ensure IP claims are processed consistently.

  • Delivers global industry leading practice rules packages for claim operations out-of-the-box.
  • Delivers an enhanced data collection capability and management reporting suite options.
  • Ensures consistency particularly in the more onerous gathering phases through embedding specific singular or multiple product rules from the outset.
  • Allows the ability to transition an Income Protection (IP) claim to a Total Permanent Disability (TPD) and/or Premium Waiver claim, using specific configurable data from the IP claim.
  • Allows for waiver of premium during the life of a claim and the reinstatement of premiums once a claim is finalised.

ClaimFirst has a benefit structure that is designed to support Total and Permanent (TPD) coverages, due to illness or injury that prevents gainful employment.

ClaimFirst TPD claim management delivers a responsive, tailored solution with accurate, accessible, and automated claims processing, from claim submission through assessment and payment.

Features include:

  • Specific illness or injury sum coverage amounts as defined by the policy.
  • Reflexive questioning claim-form templates to support claim submission.
  • Specific business rules trigger auto-assessment approach, for both simpler and predictable complex claims outcomes.
  • Supports single and multiple payment frequencies – monthly, lump sum, etc.
  • Automated document creation, determined based on claim type, or group.

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 a rider benefit.

  • Automated workflow tasks to ensure work is completed.
  • Adaptable to specific Insurer’s business rules e.g. eligibility, assessment criteria.
  • Payments based on product or benefit design.

The Trauma benefit has a configurable rules engine to identify the core and secondary medical conditions, which determines eligibility for payment. The policy can be set up as an individual product or as a rider benefit.

ClaimVantage streamlines the trauma claims process as follows:

  • Configurable rules engine to determine eligibility based on diagnosis criteria.
  • Lump sum payments are flexible, based on illness and product rules criteria.
  • Multiple benefit structure supported (percentage and lump sum)
  • Payments can be made on a limited partial payment or full payments.
  • Flexible waiting periods and exclusions are configurable.

If you process claims for a mortgage or simpler direct life products, ClaimFirst can easily adapt your product with defined claim rules to fast track and manage the claim, applying varying levels of assessment and automation—from plan setup to intake to payment.

The ClaimFirst Solution efficiently handles:

  • Automated correspondence.
  • Claim intake with reflexive questioning.
  • Automated workflows.
  • Flexible benefit setup.

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

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

ClaimFirst supports Funeral Insurance claims, as a stand-alone policy or as a rider benefit. ClaimFirst provides a number of features to streamline the process:

  • Automated workflow tasks to ensure work is completed.
  • Adaptable to specific Insurer’s business rules, such as eligibility and assessment criteria.
  • Range of cover options supported.
  • Payments based on a ‘per-member’ basis.
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