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.
The Customer Portal provides employees and supervisors with easy mobile access to relevant claim information and documents, allowing the initiation of a claim from anywhere.
Choose between preconfigured best practice report templates, or create your own reports using the easy drag and drop interface.
Reflexive Claim Submission
Reflexive questioning ensures all necessary data is collected during the claim submission process, enhancing standardisation and efficiency.
Reflexive Claim Submission
The ClaimVantage Case Management Journal allows you to effectively manage Action Plans, Eligibility, Medical Diagnosis, Communications, and Return to Work.
Whether you want to consolidate payments, or set up automated scheduling, the ClaimVantage Solution meets your needs.
Analytical intelligence detects trends in historical and incoming claim data, flagging high-risk claims based on pre–determined indicators.
With ClaimFirst, a company can implement claims enhancements faster and start processing income protection (IP) claims immediately.
To better manage IP claim submission assessment, and payments, ClaimFirst offers optimal 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.
- Supports the management of Return to work (RTW) activities and automatically calculates the alteration and deduction amounts.
- Supports multiple deferral periods.
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 payments and interest calculations, as well as other alterations and deductions required to manage the payment process. You can define rules, based on your business practice to direct how ClaimFirst will process all of the following payment calculations:
- Coverage calculation for multiple products: Term Assurance and Whole of Life products supported.
- Terminal illness: based on life expectancy and calculated by rule definitions.
- Interest payments: based on defined business rules.
- Alterations and deductions: including loan deductions, additional benefits, and dividends.
- Multiple beneficiaries: as defined by claim relationships.
- Riders of separate benefits, such as critical illness and accidental death.
- Reinsurance: support for multiple treaty types.
ClaimFirst has a benefit structure that is designed to support accidental coverage for a specific loss or death. ClaimFirst offers this benefit type as a stand-alone solution or as a rider.
- Death coverage based on a flat amount or multiples of the annual salary.
- 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 (CCSD or ICD-codes) under which a claimant is eligible for a lump sum payment. The policy can be set up as a stand-alone product or as a rider on another product defined in Policy Administration.
ClaimFirst streamlines the critical illness claims process, offering:
- Diagnosis based medical codes, such as CCSC or ICD-9 and ICD-10 codes, depending on your business requirements.
- Flexible lump sum payments based on illness and product rules.
- Flexible elimination periods.
- Claims can be made in multiple categories as defined by business rules.
Mortgage protection benefits such as income protection, critical illness, or life claims can be managed through the full claim lifecycle using the ClaimFirst Solution. From plan set up to submission, through to payments, the solution can efficiently handle:
- Automated correspondence.
- Claim Submission with reflexive questioning.
- Automated workflows.
- Flexible benefit set up.
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 specified payment system.
- Facilitates auto-termination based on business rules.
The annuity claims process uses the business rules engine to convert pension funds into income or pay-out due to death. ClaimFirst simplifies this process by:
- Automating the calculation of pension funds into income.
- Providing flexible pay-out options (lump sum or instalments).
- Calculating payments taking minimum and maximum limits into account.