Industry: Healthcare & Insurance
The Client serves most of the fortune 500 companies in the insurance industry. They provide their client with cutting edge software solutions that helps them in risk management. The comprehensive approach and risk management strategies help their customers to decrease their claim cost.
As business complexities continue to increase, organizations are faced with the challenge of managing their risks, regulatory compliance, incidence and claims management and property exposures. In order to fulfill the Risk Management needs of its industry customers, the client decided to develop a web based risk management information system having below objectives:
- A system capable of automating insurance processes which should manage insurance policies, claim management, risk management, incident management and certificates of insurance
- Manage claims of all lines of business including workers' compensation, auto liability, general liability, executive risk, employment/EEOC, legal matter management, property loss and cargo liability
- A web based solution that is adaptive, customizable, innovative and capable of catering to the needs of different customers or organizations
- A system should also be highly secured, reliable and scalable to protect the sensitive database
- Handling a gigantic database with millions of records with no compromise in performance
TatvaSoft designed and developed a web based solution named "Claim Management System" that manages claims of all lines of business. It is an enormous portal of about 20 different claim management solutions which serves a huge insurance hub. The applications are still under maintenance and are continued to be enhanced by TatvaSoft with yet other functionalities. New applications keep on getting added in the chain at specific time intervals. Following are the important features of Claim Management:
- Data Management
- Manage all necessary details of the claim including witness statements, benefit details, legal proceedings, medical information and police reports
- Manage reserves, payment, subrogation details, COI, different level Letter Generations, record details of property, lease, franchise, assets, inspection, etc.
- Gargantuan data is handled by numerous screens and easy navigation between them
- Customized Business Rule Tool
- Effective work-flow management as rules can be created to automatically update records when certain criteria get fulfilled
- Validations to be kept throughout can also be customized at any point of time
- Attach files into searchable folders and email from within the system
- Data Import
- Monitor claim development by importing one or many sources of claims data as often as needed
- Database jobs keep running periodically so as to keep importing data from concerned sources, thereby keeping database upgraded to the latest
- Easy vendor set up as claims are assigned to particular diaries for vendors
- Maintain risk profiles, incident details, claimed equipment and settlement
- Regulatory Management including Electronic State FROI Reporting and MMSEA Reporting
- Reports, Graphs and Charts
- Generation of policy summary reports, claim summary reports and ad-hoc reports
- Commercially available powerful charting controls are used to portray animated charts and graphs on the screens for impressive and abstract data representation
- Performance Optimizations: Database and query optimizations coupled with client side scripting are implemented to achieve performance benefits of the applications
- Database: Microsoft SQL Server
- External Tools or Components: Fusion Charts
Extensive customization, endless scalability, workflow automation, KPI based dashboard and smart tag attachment features left customers highly satisfied. "Claim Management System" helped client in effective management and maintenance of risk profiles, better monitoring and control over the risk cost, consolidation of insurance related information at a single place and access to right information at right time with customized reports and its auto scheduling functionality.
In summary, "Claim Management System" has enabled organizations to proactively identify and manage risks as well as claims thereby making better investment of time and resources.