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What to Look for In A Claims Management System

As a claims expert, your role is not just about handling individual claims, but ensuring your claims department operates efficiently and effectively. In the modern era, claims management software is a must to efficiently run a department, and knowing which software fits your department’s needs can be hard. But choosing the right system can do more than keep you current or protect you for the future, it can help you turn claims data into actionable insights, reduce costs, manage your staff more effectively, and stay compliant with industry regulations. 

Make Your Data Work for You 

Modern claims departments live and breathe on advanced analytics, and a modern claims management system should have embedded AI and advanced analytics capabilities that provide you with actionable insights. Data-derived insights are vital in cost reduction, making informed decisions, and improving claims processing efficiency

When evaluating claims management systems, consider their data analytics and reporting features, and pay special attention to systems that offer customizable dashboards and reporting tools. The ability to visualize data, track key performance indicators, and detect patterns in claims data will revolutionize your decision-making by empowering claims managers to make proactive decisions, anticipate issues, and optimize workflow.


Reduce Costs while Improving Data Intake

One of the primary goals of a claim management system is to reduce operational costs, so look for a system that streamlines data intake processes, reducing manual entry and the likelihood of errors. Features like automated data capture, optical character recognition (OCR), and data validation can help ensure the accuracy and completeness of claims information.

This kind of automation not only reduces the potential for data entry errors but also accelerates the claims intake process. Faster claims intake means that adjusters can start working on claims more quickly, which improves customer satisfaction and reduces cycle times.


Better Management of Legal Staff and Claims Administrators

Allocating tasks efficiently and managing a team of adjusters and administrators is a must for claims departments, so think about task assignments, workload balancing, and performance tracking when you’re software shopping. Look for features that allow you to assign claims based on adjusters' skills and availability. Focus on systems that can monitor individual and team performance, ensuring that the workload is distributed equitably and that claims are processed consistently. 


Use Claim Management Software to Spot Macro Trends  

Staying ahead of industry trends is crucial for claims managers, and a proactive claims management system will help identify macro trends in claims data before they’re common. With historical claims data analysis, the system can help predict potential issues, such as an increase in certain types of claims, and allow you to prepare accordingly. Predictive analytics capabilities can help you develop strategies to mitigate risks, allocate resources more effectively, and make necessary adjustments to your claims-handling procedures.

Automate the Claims Process

Automation is a key driver of efficiency in claims management. Claims management software that can automate routine tasks, such as claim assignment, document verification, and correspondence with policyholders reduces manual workload but also minimizes the chances of errors in these processes. An automated claims management system can also send alerts and notifications to the relevant parties, ensuring that everyone involved in a claim is informed and up to date. This streamlines communication and helps prevent delays in the claims process.


Decrease the Cost of Claims

Cost containment is a top priority for any claims manager, and a comprehensive claims management system should offer the following avenues for cost reduction: 

  • Compliance Cost Reduction: Ensure that the system has built-in compliance checks and reporting tools to help you adhere to industry regulations to minimize the risk of fines and also ensure that your operations run smoothly.
  • Adjuster Efficiency: Automated task allocation and integrated communication tools significantly improve adjuster efficiency. Focus on systems that prioritize high-value tasks rather than administrative overhead.
  • Payment Efficiency: The system should facilitate accurate and timely payments to claimants because delayed payments can result in added costs like interest and legal fees.

Stay on Top of Compliance

Compliance is non-negotiable in the insurance industry. A modern claims management system should help you meet regulatory requirements without adding undue complexity to your operations. Ensure that the system has features that assist with compliance reporting, data security, and audit trails. These features should not only keep your organization in good standing with regulators but also help you maintain the trust of your policyholders.

Choosing the right claim management system is a pivotal decision for claims managers and chief claims officers. A system that offers robust features significantly enhances your claims processing efficiency, while reducing costs and improving overall operational effectiveness.  When evaluating potential solutions, remember to consider your specific business needs, as well as your long-term strategic objectives. To make the best choice for your organization, chat with an expert to see how Ventiv’s Claims Solution is right for your organization.

Nov 7, 2023

 | Originally posted on 

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