You’ve made the decision to self-administer some or all of your insurance claims and now you need to decide on which claims administration software best meets your needs. But where do you start? Who do you talk with? How do you determine your needs? Through speaking with 100s of organizations, we know this can be overwhelming, so we created a checklist to help get you started:

Know your claim workflows. This may sound straightforward but many organizations only have a general understanding of how the claim lifecycle works. It is important to define the intricate details of your claim workflow upfront before you choose and implement your claims administration software. Note: your claims software is only as good as the process it supports. And making changes in workflow after you have implemented your software can be time consuming and expensive. Below are some of the key claims administration functions to understand and map out prior to choosing the right software to self-administer your claims:

  • Event reporting
  • Electronic claim file configuration
  • Claims case management
  • Document management
  • Reserve management
  • Payment process
  • Check processing
  • Reporting
  • Regulatory compliance
  • Provider management and integration
  • Reinsurance
  • Policy management
  • Integration with other data sources

Catalog your current systems.   What systems do your adjusters work in each day? Some examples include: HR, finance, accounting, and third parties such as Official Disability Guidelines, ISO, OFAC, document management and regulatory compliance. Now ask yourself: What systems would help make their job easier and more productive by integrating it into your claims administration software? Integration with other systems, whether internal or external, can greatly reduce the time your adjusters spend gathering, prepping, rekeying and submitting data. Having a direct interface within your claims administration software not only saves your adjusters from logging into multiple systems but provides them with more accurate data for their decision making.

Make sure the software is easy and intuitive to use. Claims departments manage heavy workloads and face pressure to settle claims quickly. They spend the majority of their day in their claims system reviewing claims, entering notes and diaries, setting reserves, approving payments, and more. It is critical to choose software that you find easy to learn, intuitive to use, and enjoyable to be in.

Ensure the system has tools to automate your work.  Your claims adjusters and claims supervisors need technology that will take everyday low level tasks off their plate so they can focus on higher value activities to improve claim outcomes. Make sure the claims software can automate tasks, repetitive payments, payment processing, and regulatory reporting.

Confirm you are able to easily capture accurate claim data. Easy and accurate claim entry should be the top of mind when choosing the right claims system. Intuitive, mobile friendly, and standardized forms make it convenient for people to report claims, automate data validations, and ensure the data captured is accurate and complete.

Choose the right vendor. Make sure the claims administration software provider has demonstrated expertise in technology, risk, and insurance – and has the longevity and resources to go the distance with you. A decision to choose an external claims system vendor is significant, and similar to choosing a broker or captive. A formal Request for Proposal (RFP) can help you narrow down your selection process based on claims functionality, price and what is outlined above.  Understanding your needs and doing research on the vendors will help your decision process.

The decision to self-administer claims can be tough.  But with the right claims administration software, you can make your job easier, faster, and more effective!