The ClaimFirst Solution focuses on Life & Health claims management and encompasses a variety of modules designed to meet your specific needs. The ClaimFirst Solution provides full life cycle claims management.
Key Benefits & Capabilities
- Built on the Force.com platform, this cloud-based solution is easy-to-use and accessible from any web connection.
- Automated workflows and tasks make it easy for your claim administrators 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 claims management 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 intake 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 process.
- 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 Federal and Medicare tax withholdings, as well as Death Proceeds Interest.
The Customer Portal provides easy 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 Intake
Reflexive questioning ensures all necessary data is collected during the claim intake process, enhancing standardization and efficiency.
Reflexive Claim Intake
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, set up automated scheduling, or make a lump sum payment 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 management enhancements faster and start processing disability claims immediately.
To better manage short-term disability (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 a short-term disability (STD) claim to a long-term disability (LTD) and/or Waiver claim using specific data from the STD claim.
ClaimFirst uses business rules to identify documents and creates activities to ensure all documents are collected in advance of any settlement.
ClaimFirst supports multiple payees, and interest calculations, as well as other offsets (deductions and addition adjustments) required to manage the payment process. The customer defines rules which direct how ClaimFirst will process all of the following payment calculations:
- Accelerated Death: Based on life expectancy or a specific illness and calculated by rule definitions.
- Interest Payment: Based on state tables defined by rules.
- Adjustments: Including deductions for loans, addition for dividends and premium refunds.
- Multiple Beneficiaries: As defined by claim relationships.
- AD&D: Supported as a rider or as a separate benefit.
- Reinsurance: Support for facultative and standard treaties.
- Term, Whole Life and Universal Life supported.
ClaimFirst has a benefit structure that is designed to support AD&D coverage for a specific loss or death. This benefit type 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.
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. The policy can be set up as an individual product or as a rider on another product defined in the Policy Administration.
ClaimFirst streamlines the critical illness claims process, offering:
- Multiple coverage categories.
- Flexible lump sum payments based on illness and product rules.
- Flexible elimination periods.
- Various ways to define the coverage amount.
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.
Mortgage 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.
The Survivor Benefit claim can be added to an existing LTD claim. It supports a minimum/maximum coverage amount, which can be configured as a multiple of the LTD minimum/maximum benefit, or set-up directly on the survivor benefit. The intuitive intake wizard walks you through the process.
The payment specification is automatically created as a lump sum benefit payment and the minimum and maximum will be applied to the coverage amount when the payment is calculated.
Anytime and anywhere, the ClaimFirst Voluntary Accident-Only claims management solution delivers a responsive solution with 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 configure additional coverage without hardcoding.
- 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 claims management. The solution assists the process, by:
- Automating follow-ups to the client.
- Providing automated internal communications with a billing system.
- Facilitating auto-termination based on business rules.