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Transform your Claim

Management

Transform your business

Unrivaled speed to market in 45 days, eliminating legacy software, and reducing implementation costs by over 60%.

ClaimVantage is dedicated to providing innovative, cloud-based software solutions that will transform the way you process claims.

Get your Claims in the Cloud

With ClaimVantage

Our claim management software solution is state-of-the-art, and designed to process both group and individual life and health claims on one digital platform. Supporting a broad range of policy benefits, the software leverages a claimant-centric approach to help you deliver a superior customer experience with efficiency and accuracy.

The Claims solution is hosted on the secure Salesforce Lightning Platform, and has a modern, user-friendly interface, with deep functionality built by industry experts that will change the way you process claims forever.

Claim Processing

Software

Our claim management software solution supports the full life cycle of a claim, from intake through to payment
calculation. This claimant-centric process drives accurate and timely claim decisions. Designed with
efficiency and usability in mind, we minimise the number of tabs and screens a user needs to navigate to process and
manage a claim.

Key Features

Claim management software

 One Solution for Multiple Lines of Business

  Configuration

  Configurable Automated Workflows

 Configurable Automated Tasks

 Configurable Auto-Adjudication

One Solution for Multiple Lines of Business

  • Increases efficiency by managing both group and individual lines of business and multiple benefits on one platform.
  • Improve your resource allocation to increase your team’s productivity.
  • Enables your team to share documents and details at the claim level to eliminate duplication.

Configuration

  • Map your business processes and organisational structure into the platform.
  • Reduce costs associated with custom code development to support your specific processes.
  • Point and click configuration allows your system administrators to take control.

Configurable Automated Workflows

  • Minimise the keystrokes and screens for your users to maximise productivity.
  • Increase accuracy by reducing the likelihood of human error.

Configurable Automated Tasks

  • Increase efficiency and reduce operational effort.
  • Ensure the right person is doing the right thing at the right time.
  • Quickly adapt to business process changes.

Configurable Auto-Adjudication

  • Increases efficiency and reduce operational effort.
  • Improves claim turnaround times.
  • Reduces potential human errors to increase accuracy.

We all have a Destination

It’s about how you chose to get there

Automated Workflows

And tasks

Automated workflows and tasks allow you to introduce a level of auto-adjudication to your claims process, ensuring the right person is doing the right work at the right time.

Minimising your reliance on manual processes increases productivity, efficiency and reduces the likelihood of human errors throughout the claims process.

Successfully Manage

Improve your operational efficiency by 30%

Replacing your legacy system with ClaimVantage claim management software can improve your operational efficiency by 30%. Increased efficiency is achieved by:

  • Removing paper files from the claims process.
  • Replacing manual workarounds with automated workflows and tasks.
  • Reducing the number of systems your claims professionals must access.

Life Cycle

Of a claim

Claim Submission

A key feature of the claim management software solution is the claim intake ‘wizard’. The ‘wizard’ guides the user through claim intake to ensure the necessary data is collected to create a claim, enhancing standardisation and efficiency. This process and reflexive questions can be configured to meet your specific business needs.

Once created, a claim can be manually or automatically assigned to a user or team on pre-defined criteria such as geographical location, or team structure.

ClaimVantage Wizard

Auto-adjudication

Auto-adjudication allows you to introduce automated workflows to the claims process based on specific rules, minimising the need for human touch. These rules can be configured to process claims based on the benefit type, the eligibility status, and the payment specification, among other field statues. Assignment rules can also be introduced with due dates to keep claim durations on track. All auto-adjudication rules and workflows can be configured, depending on the level of automation you would like to introduce to your claims process.

Workflows and
Communication

The claim management software solution has best-in-class workflows built-in. We do understand you have unique processes specific to your business. To support this, self-service workflows allow your system administrator to edit the standard configurable workflow sets, or to add new ones specific to your business needs.

Our self-service workflow functionality allows you to create specific workflows, tasks and communications, selecting the timing and event triggers based on your business rules.  These workflow sets can be used to:

  • Create tasks to help your team manage their work.
  • Create and send timely letters.
  • Create and send timely emails.
  • Create and send SMS messages.
  • Automate your business processes through auto-adjudication.

Case Management

The Case Management Journal is the ‘heartbeat’ of the claim, providing your claim manager with the ability to view, add and edit claim information in one central location. The concept of the journal is based on the traditional paper file, divided into several categories for easy access to various sections, such as action plans, medical guidelines, eligibility results, correspondence, financial information, claim documentation, return to work events and more. These sections can be renamed or resorted, and user access can be controlled to particular sections. All information in the journal can also be easily exported in PDF format.

In the case management journal, the claim professional can:

  • View benefit claimed details.
  • Manage medical, return to work events, rehabilitation, document and phone calls.
  • Write a detailed synopsis.
  • Document an action plan and next steps.
  • Review and re-run eligibility rules.
  • Attach forms and documents.
  • Add and review notes in various categories.
  • Document and view information in many sub-categories.
  • View claim status and metrics.

Payments

Our claim management software solution calculates payments based on the claim, policy and benefit information provided. Whether you want to consolidate payments, set up automated scheduling, or make a lump sum payment our claim management software can be configured to meet your needs. Depending on your business process, the payment calculation options can be configured to allow claim level or beneficiary payments.

Insurance Plans

covered

Claim Managed Include

  • Health
    • Gap
    • Hospital plans
    • Specific areas, e.g. cancer
  • Disability
    • Income Protection
    • Critical Illness
    • Lump sum
    • Accidental
  • Health
    • Gap
    • Hospital plans
    • Specific areas, e.g. cancer

These benefits are specific to the South African market.
If you are visiting from another location, please
select your location at the top of the page.

Customer Success Stories

Always keeping you one step ahead

Find out from our customers how ClaimVantage
have transformed their working environment.