ClaimCore

P&C Claims Management

Claims represent the largest cost to insurers and create the greatest vulnerability to leakage. As every insurer’s “moment of truth” with its customer, the presentation of a claim demands a positive customer experience. Exigen’s ClaimCore assures maximum cost containment and the highest levels of customer support for insurers’ most mission-critical business process.

Exigen Edge

By streamlining the high number of tasks associated with claims, ClaimCore accelerates claims resolution and reduces administrative and settlement costs. The solution also provides unprecedented business control — all claims processes and performance can be monitored in real-time. The business rules engine allows claims management to refine processes to meet changing business needs, increase claims efficiency, and improve the customer experience.

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Core Services

• Claims notice of loss, evaluation, opening, triage and assignment
• Claims reserves and financial management
• Fraud detection
• Claims investigation and adjudication through to settlement
• Claims vendor management
• Claims recovery identification and support
• Claims authority management

Core Features

• Support for all claims processes with easy to use "smart forms" for data entry and validation: 
  • First notice of loss with the option to save and retrieve incomplete loss reports
  • Policy validation and coverage verification
  • All claims adjudication, investigation and inquiry transactions
  • Claims financial transactions such as reserves and payments
• Support for salvage, subrogation, and litigation operations
• User views of claims history, such as activity and interaction history; claims contact information about primary parties for the claim, such as insured and claimants; and secondary stakeholders, such as 3rd party providers, attorneys, and authorities
• Consistent application of reserve authority and payment authority based on business rules and user defined authority levels
• Embedded CRM provides “one view” of all customer-related information, including: preferences, products and services, and transaction history; current activities, relationships; integration of all sales and service channels; and pre-integrated CTI capabilities
• Smart Workspaces provide adaptive user interfaces that reflect the profiles of each user (including roles, skill levels, scope of responsibility, and authorization) to substantially reduce user training requirements and increase individual performer productivity 
• Integrated document management, including automatic generation, capture and management of all documents related to a policy, all organized into electronic policy file folders  
• Integrated business activity monitoring service increases accountability of performers, tracks processes for regulatory audit, supports performance management, and enables activity-based costing to enhance financial performance
• Fully integrated business process and workflow management, including: prioritized work queues; automatic or manual task generation and assignment, itemized task lists for all current and future activities with detailed measurement; and monitoring and escalation of service levels associated with each task