ClaimFirst

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

Key Benefits & Capabilities

  • Automated workflows and tasks make it easy for your claim administrators to manage claim assignments and ensure all documentation is collected in advance of any settlement.
  • 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 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.

 

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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 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 any early advance payments, 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:

  • Terminal Illness benefit: based on claim eligibility and any benefit policy criteria e.g. within 6/9/12 months and calculated by rule definitions.
  • Single or Multiple nominated beneficiaries: as defined by policy & claim relationships.
  • Multiple benefit payment under one claim, up to 100%.
  • Multiple joint life policy supported.
  • Accidental Death: supported as a rider benefit or as a stand-alone benefit.
  • Reinsurance: configurable for both facultative and treaty reinsurance arrangements.

ClaimFirst has a benefit structure that is designed to support lump sum disability coverage, for claimants experiencing permanent and total disability due to illness or injury that prevents gainful employment.

 

ClaimFirst lump sum disability claim management delivers a responsive tailored solution with accurate, accessible, and automated claims processing, from claim intake to adjudication and payment.

Features include:

  • Defined illness or injury specific coverage(s) based on either percentage or lump sum.
  • Specific claim form templates to distinguish those situations where decisions can be embedded into effective automated processes most effectively in an outcome driven auto adjudication approach for both simpler and complex claims outcomes.
  • Business rules determine required documents.

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

To optimally manage income protection (IP) claim intake, adjudication, and payments, ClaimFirst provides a streamlined process to ensure IP 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.
  • Business rules ensure claims assessor errors are reduced, particularly in the more onerous claim intake phases.
  • Supports single and multiple payment frequency, including monthly and lump sum payments.
  • Allows transition from an IP claim to a Lump Sum Disability and/or Disablement Premium Waiver claim, using specific configurable data from the IP claim.

ClaimFirst has a benefit structure that is designed to support simpler life insurance products such as funeral cover. ClaimFirst offers this claims tool as a stand-alone product or as a rider benefit.

  • Automated workflow tasks to ensure work is completed.
  • Color-coded fields in tasks view to show service level agreement.
  • 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.

ClaimFirst supports simpler life insurance products, such as accidental death cover, as either a stand alone product or as a rider.

  • Automated workflow tasks ensure all information is gathered for claims processing.
  • Adaptable to specific Insurer’s business rules, such as eligibility requirements.
  • Payments based on product or benefit design.

ClaimFirst is designed to support AD&D coverage for a specific loss of income or death. This benefit type is available as a stand-alone cover or as a rider.

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

The dread disease product has a tailored rule engine to define the core and secondary medical conditions allowance for prognostic eligibility criteria under which a claimant is eligible for payment. The policy can be set up as an individual cover or as a benefit on another cover product defined within the policy administration.

ClaimFirst streamlines the dread disease claims process as follows:

  • Tailored rule engine defines the medical conditions to determine eligibility based on diagnosis criteria as defined within policy condition specifications.
  • Lump sum payments are flexible—based on illness and product rules criteria.
  • Multiple payment structure supported, for both percentage and lump sum.
  • Claims can be made in multiple categories defined by rules, such as limited partial payment or full payment.
  • Flexible waiting periods and exclusions can be configured.

If you process claims for 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 adjudication and automation—from plan setup to intake to payment. ClaimFirst efficiently handles:

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

Bond cover 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 terminal illness benefit 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.
  • Multiple sum insured supported, for both single or joint lives.
  • Exclusions determined based on defined rules.
  • Additional Lump Sum payments and flexible configurable ancillary or advanced illness options can be added using business rules.

The Disablement Premium Waiver 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.
  • Facilitating auto termination based on business rules.
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