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Claims Management (FNOL to Settlement) — Insurance

Straight‑through claims from intake to settlement: omni‑channel FNOL, validations & triage, reserving, assessments & survey, provider management, payments & recoveries, subrogation & salvage, and analytics — with full audit and fraud controls.

Faster TATAutomated intake, routing & approvals
Lower LeakagePolicy/coverage validation & fraud checks
Better CXSelf‑service status, e‑docs & notifications

FNOL Intake

Portal/mobile/agent/hospital/partner intake; photo/video upload and geo‑tagging.

Policy & Coverage Validation

Eligibility, waiting periods, exclusions, and limits/deductibles checks.

Triage & Routing

Severity scoring, straight‑through vs adjuster, and SLA queues.

Reserving & Authority

Initial/updated reserves, authority levels, and approvals.

Assessment & Survey

Adjuster assignments, site visits, repair estimates, and approvals.

Provider & Network

Hospitals, garages, and partners with tariffs, SLAs, and e‑referrals.

Payments & Recoveries

Payee validation, EFT/VA, split payments, and recoveries/subrogation.

Salvage & Subrogation

Salvage lots/auctions, settlement with buyers, and legal tracking.

Fraud Detection & SIU

Red flags, rules/ML models, case management, and outcomes.

Customer Updates

Status tracking, communications, e‑letters, and satisfaction surveys.

Dashboards & Analytics

TAT, leakage, reserves vs paid, provider performance, and root‑cause.

Integrations

PAS, billing, payment gateway/VA, DWH/BI, OCR, provider networks, and e‑sign.

Technology & Integration

PAS/Billing Payment Gateway/VA Document OCR & E‑Sign Provider Networks Data Warehouse/BI API‑First & SSO

What You Get

Free customization (flows & letters) Trial access until go‑live Annual maintenance incl. change requests Migration/import tools & training On‑prem or cloud
Ready to customize
Cut claims turnaround time—without losing control.
Share your claim types, provider network, and approval matrix — we’ll configure a working pilot and sample letters.
Request Free Customization