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 life cycle 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

Reflexive Claim Intake

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

Reflexive Claim Intake

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.

Mobile App

Reporting

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

Reporting

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

With ClaimFirst, a company can implement claims enhancements faster and start processing disability claims immediately.

To better manage short-term (STD) and long-term disability (LTD) claim intake, adjudication, and payments, ClaimFirst offers optimal disability claims processing results.

  • Delivers industry best practice for claim operations ‘out-of-the-box’.
  • Shortens turn-around time to design and configure for your business process.
  • Can transition an STD claim to an LTD and/or Waiver of premium claim using specific data from the STD claim.

ClaimFirst uses business rules to identify required documents and creates activities to ensure all documents are collected in advance of any settlement.

ClaimFirst supports multiple payees, including interest calculations, as well as other deductions and adjustments required to manage the payment process. You can define rules, based on your business practice, which directs how ClaimFirst will process all of the following payment calculations:

  • Coverage calculation for multiple products: Term, and Permanent Life supported.
  • Living Benefit administration based on life expectancy and calculated by rule definitions.
  • Interest payments: based on provincial tables defined by rules
  • Adjustments: including loan deductions, and dividends.
  • Single or multiple beneficiaries, as defined by claim relationships.
  • Joint life policies supported.
  • Riders of separate benefits, such as critical illness and AD&D.
  • Reinsurance support for facultative and standard treaties.

ClaimFirst has a benefit structure that is designed to support accidental coverage for a specific loss or death. This tool 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 process uses a rules engine to define the medical conditions (ICD codes) 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.

Critical illness (dread disease) claims provide a lump sum cash payment for a specific illness. ClaimFirst supports the selection of one or more coverages and automatically calculates the payment amount.

ClaimFirst streamlines the critical illness claims process, offering:

  • Diagnosis based ICD codes.
  • Flexible lump sum payments based on illness and product rules.
  • Flexible elimination periods supported.
  • Claims can be made in multiple categories as defined by business rules.

The long-term care (LTC) benefit is defined by a maximum daily, monthly, annual, or lifetime rate. The level of care specified in the policy determines the maximum rate. Any number of coverage objects can be added to an LTC benefit, and each has its own calculation formula.

Features of the ClaimFirst LTC benefit include:

  • Claim Initiation: Collect pertinent information to begin claim review
  • Coverage Verification: Automatically verifies plan features
  • Triage: Develop business rules that drives appropriate resources and activities based on certain claim data
  • Ability to upload documents and attach to claim
  • Lump sum payments are flexible based on invoices submitted
  • Documentation: Assessment, telephonic interviews, medical records, diagnosis codes, cognitive status, etc.

Creditor protection benefits on disability or 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.

If you process claims for travel insurance, ClaimFirst can manage the claim, from plan set-up, through the intake to payment.

ClaimFirst efficiently handles:

  • Automated Correspondence.
  • Claim Intake with reflexive questioning.
  • Automated workflows.
  • Flexible benefits set-up.

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

  • Accident specific sum coverage.
  • Coverage type selected from pick list allows flexibility to easily configure additional coverage without requiring development support.
  • Automated workflows.
  • Business rules determine required documents.

The Waiver of Premium (WOP) 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 client follow-ups.
  • Providing automated internal communications with a payment system.
  • Facilitates auto-termination based on business rules.
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