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May 3, 2022

How to Use Claims Processing Software to Grow Your Insurance Agency


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Insurance is a collection of products that most people invest in while hoping they'll never need to use it. This can mean that, from a consumer's perspective, an insurance policy feels like a set it and forget it purchase, after which essential details are neatly filed away. Yet, for insurance agents, insurance is a fast-paced industry that requires precise attention to detail and copious amounts of data collection. When insurance claims are filed, details can include litigation, negotiation, settlement communications, relevant policy information, and claim assessments. For a growing insurance agency with many customers, keeping track of data along with the complex workflow associated with filing claims can quickly become challenging to manage effectively. For this reason, claims processing software is a basic necessity for most companies.

What is Claims Processing Software?

Insurance professional reviewing claims processing software

The insurance claims process is a multi-step journey that requires specific information for accuracy. Claims processing software can centralize information and automate tasks to help insurers manage and evaluate insurance claims. Insurance software that works to gather data, produce estimates, analyze claims, automate communication during the claims process, and support claims processing workflows can all be considered claims processing software. For most insurance agencies, multiple software solutions are used in tandem for a streamlined process. Claims processing software is a product that completes one or more of the following tasks.

  • Provide risk assessment capabilities to identify claim complexity and likelihood of litigation
  • Analyze data to detect fraudulent claims
  • Create an automated claim report system for users
  • Support claims and settlement workflows

What Software do Claims Adjusters Use?

Insurance claims adjuster working table

Claims adjusters play a critical role in correctly managing a claim. These professionals must obtain information from various sources to compile the data necessary to provide a fair evaluation that compensates the policy owner and helps the insurance company avoid paying for fraudulent claims. After a customer files a claim, the claims adjuster will likely have to communicate with the client, perform an on-site investigation, communicate with industry professionals about repair costs, gather insurance information, and share information with various parties. Often, an insurance adjuster is likely to be performing tasks related to multiple cases at once. 

  • Customer management software
  • Data collection software
  • Claims estimating software

What is a Claims Management System?

calculation as part of an insurance claims management system

A claims management system is the combination of software offerings used by the professionals in an insurance agency to file a claim. The claims management system manages all aspects of claims, including coverage verification, reserving, reinsurance attachment, salvage and subrogation, monitoring litigation, and customer complaints.

An effective claims management system should have the capabilities to accomplish these tasks.

  • Online coverage verification
  • Document collection
  • Claim intake
  • Reinsurance processing
  • Vendor payment processing
  • Document production
  • Data correlation
  • Salvage and subrogation processing and monitoring
  • Estimation
  • Claim search capabilities
  • Lawsuit and complaint monitoring
  • Automation of repetitive tasks
  • Create a connected, streamlined workflow

What Are the Benefits of Insurance Claims Management Software?

Claims management is a complex process that requires insurance professionals to compile technical data and perform various tasks associated with the terms included in an insurance agreement. The process consists of significant documentation, repetitive tasks, and complex procedures. The use of insurance claims management software can streamline and improve the accuracy of related data to simplify the complex process of claims management and reduce the incidence of human error. Consider how these benefits can improve your claims management process, streamline your business practices, and help you attract new customers.

  • Increased Productivity: By using software to automate repetitive tasks, standardize documents, and collect data, you can reduce the time spent managing each claim. 
  • Error Reduction: Manual data collection and data entry methods leave considerable room for error. Processing software that automates data collection and input eliminates the potential for human error.
  • Standardized Processes: Standardization helps you grow your agency in various ways. The use of standardized procedures allows employees to quickly and accurately complete tasks within the claims process without confusion and redundancies.
  • Reduced Costs: While the initial investment might require an up-front cost, insurance claims management software can help you save money over time by improving efficiency, standardizing documentation, and eliminating mistakes.
  • Increased Customer Satisfaction: Filing an insurance claim is stressful for your customers. Claims processing software can help you provide fast and efficient claims and improve your customer communications during the process.

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What Are Some Good Ideas to Automate Insurance Claims? 

Across all industries, automation is designed to streamline processes and reduce tedious and redundant tasks that fracture the focus of professionals. When automation is integrated with existing IT infrastructure in the insurance industry, it can be used to automate much of the work that goes into insurance claims. Automation software can be used to complete these tasks during the insurance claim process.

  • Claims Processing: Fast and efficient claims management processing is an integral part of success for insurance companies. You can save time and eliminate costly mistakes by automating claims intake (including medical records, police reports, and photos), claims assessment, and claims settlement.
  • Policy Management: When tasks like policy issuance, updates, and management are automated, insurers always have the most up-to-date information at their fingertips, and time to focus on high-value tasks.
  • Underwriting: Automated underwriting boosts speed and accuracy. Depending on your specialty, this may include the automated collection of information concerning health risks, financial limits, creditworthiness, and duplicate policies.

What Kind of Software is Used in Insurance Companies?

Insurance agencies use different types of software for efficient and accurate completion of various tasks. Claims management has the complex role of gathering information from various sources and making relevant connections to determine the outcome of the claim. By using different types of software, the tasks during the claims management process can be completed more efficiently and accurately. The result is a faster claims resolution with a reduced potential for error. Medical claims management processing software carries a more significant burden since the industry is rife with compliance requirements, plagued by fraudulent claims, and subject to more checkpoints in the claims process. Medical claims processing software is a software stack that automates claim processing operations and reduces the risk of fraudulent claims. While medical claims management processing includes some of the same requirements as P&C processing, additional software implementations may be required.

  • CRM Software
  • Data Collection and Quoting Software
  • Agency Management System
  • Communications Software
  • Estimation Software

Insurance Claims Management Software Best Solutions

Claims processing is a vital part of maintaining a successful insurance agency. Selecting an insurance claims management software that fits seamlessly into your existing IT environment and workflows can help you decrease claim processing times and improve customer service. Some of the most important criteria for claim management software include compatibility with current software, document handling abilities, and storage capability. In the healthcare insurance industry, healthcare claims processing software can also benefit from incorporating patients' electronic health records, patient portals, revenue, and clinical cycles. Consider how these highly-rated claims processing software choices could improve your claims process.

FileHandler Enterprise

FileHandler is a scalable and intuitive claim administration system designed to streamline and automate workflows. Top features include new dashboards, reporting functionality, business intelligence tools, and the latest security technology. Teams can also use the options imaging tool to upload attachments and images to further improve claim verification.

  • Pricing: Custom pricing based on the number of users
  • Integrations: EDI, ISO ClaimSearch, CMS, Medical Bill Review, Pharmacy Bill Review, OFAC, and more
  • Required Resources and skillsets to manage internally: Some reviews report a difficult user interface but unlimited support is available
  • Primary Benefits: Work Flow Action designer, real-time dashboards, document management, real-time data, unlimited phone, web, and remote training and support
  • Limitations: Difficulty making edits, interface could be more user-friendly, complex reporting system, expensive upgrades

Guidewire ClaimsCenter

An insurance claims management software solution based in California, Guidewire offers an automated end-to-end insurance claims management. Designed to eliminate the need to perform repetitive tasks associated with managing claims, GuideCenter is useful for organizing cross-department processes, reducing costs, enabling collaboration, and tracking performance.

  • Pricing: Offers custom pricing based on features, customizations, and support and training requirements
  • Integrations: Guidewire advertises a marketplace for specific tasks but offers little information about out-of-the-box integration capabilities
  • Required resources and skillsets to manage internally: Expertise to install and configure, 
  • Primary Benefits: Broker/agent portal, claims management, underwriting management, policy management, billing and invoicing
  • Limitations: Support is limited, expensive, needs to be customized to reach its full potential, limited integrations

Pega Claims Management

An easy-to-use claims management system, Pega Claims Management improves the efficiency and effectiveness of claims management and modernizes your underwriting environment.

  • Pricing: Custom pricing based on customer requirements
  • Integrations: A variety of integrations are offered in the Pega Marketplace.
  • Required resources and skillsets to manage internally: Pega certification is recommended, Pega support is required for deployment
  • Primary Benefits: User-friendly interface, efficient dashboards, case management, low cost, scalability
  • Limitations: Difficult deployment, limited support

Improve Your Claims Process with the Right Software Choices

Claims management is a crucial part of customer satisfaction in the insurance industry. Insurance is a competitive industry, making onboarding and retaining customers a challenge. The time it takes to manage a claim includes many steps which can become time-consuming and expensive. By investing in claims management processing software, you can improve accuracy and streamline the process to allow insurance agents to focus on customer communication and other high-level tasks.

When you take the time to understand the packages available and how you can implement software to your specific agency needs, technology can work in many ways to help you grow your agency. InsurGrid makes it easy for clients to share essential information for their insurance purchase in a few clicks. Remove friction from the sales process and convert more clients. Sign up for an InsurGrid demo.