Claim Processing Software

The Claim module provides a uniform way of claim processing that applies to all lines of business. The full cycle of handling of a claim is maintained by INSIS. It controls the limits defined in the contract and restricts the indemnity according to the deductibles or respectively to the franchise (if such is defined for the cover). It automatically separates and allocates the reinsurers and/or co-insurers share of the indemnity. The claim subsystem ensures effective control during the claim settlement process against the cover, object, and contract statuses depending on the type of claim and the policy contract conditions. During the claim management process this control minimizes errors, such as double indemnity payment or payment against non-covered event. As all operators’ actions are registered in the system, INSIS can prevent also internal frauds or at least supply information for fraud detection which would significantly lower the risk for such frauds.

• Claim registration. The claim requests are registered against valid policies, already registered in the system. The claim registration module provides a powerful search engine to find the policy using information about the customer, the insured object, as well as information provided in different related documents.

• Damages evaluation. A set of business related interface modules are developed for damage evaluation registration. There are separate evaluation screens for personal disability, car damages, health services, property damages, etc, in which screens business specific data is entered to support the damage evaluation. For the purpose of automatic claim evaluation INSIS can be integrated with other products available on the market. A number of evaluations can be registered against a claim and each of one these claim requests will change the claim reserve accordingly.
• Indemnity calculation.The indemnity calculation in INSIS is based on the claim evaluation – the process sums up all the damages per each insured object. If there are any deductibles and franchises registered in the policy, INSIS automatically applies them when calculating the indemnity. The calculated value is limited up to the insured value of the damaged object. If there are previous damages the amount that has already been paid is deducted from the indemnity value.
• Expense registration. Expenses can be registered against each claim. INSIS allows classification of expenses, based on company’s specific business and the types of expenses they are paying during the claim settlement process. Expenses can be included in the indemnity limit amount or can be paid on top of the indemnity amount.
• Indemnity payment. The calculated indemnity needs payment request to be submitted and approved by an authorized person. Following the approval, the payment request is transferred to the financial system for actual payment processing. INSIS expects payment confirmation to be sent back from the financial system. The final claims settlement payment clears the reserve.
• Automatic indemnity and expense reserve management. INSIS books and maintains indemnity and expense reserves automatically. Any changes in the claim evaluation or payment are immediately reflected in the outstanding loss reserve.