FINEOS Claims for Workers' Compensation

It is becoming increasingly difficult to manage workers’ compensation claim costs.  Successful insurers must be able to increase operational insight while empowering their customers to take a more active role in the management of their claim.

FINEOS Claims for Workers’ Compensation has been engineered to deliver greater operational management of claims and the tools to deliver exceptional customer service. 

Improve Automation of Claims Management

FINEOS Claims for Workers’ Compensation uses rules-driven workflow management and process automation to automate many claims-related activities.  This reduction in manual intervention reduces the amount of time and resources required to process claims. 

The solution supports electronic claim notification (first report of injury), enabling you to quickly initiate medical intervention which helps to improve return-to-work ratios and reduces the likelihood of litigation.  FINEOS Claims for Workers’ Compensation can be configured to prompt for key data during claim intake and throughout the claim lifecycle, ensuring that you have the data necessary to effectively manage your operations and resolve claims.

FINEOS Claims for Workers’ Compensation reduces your reliance on paper-based files and documentation by supporting comprehensive electronic case management. All claim-related activities, documents and images – including correspondence with third-party providers – are managed electronically and linked to specific claims and cases.

Increase Operational Oversight

FINEOS Claims for Workers’ Compensation provides visibility into the claims operation, enabling business owners to monitor the life cycles of claims and make critical forecasts and calculations based on existing volumes and work activities. Integration with industry-leading databases help you evaluate claims status against accepted rehabilitation timeframes.

Business users can leverage the solution’s comprehensive management dashboards to access data such as case histories and activities, in order to make more precise calculations on pricing and reserving. 

FINEOS Claims for Workers’ Compensation enables you to structure your claims cases hierarchically, linking cases together for more complex scenarios such as industrial accidents or disasters. By establishing relationships between cases, claimants and providers, the solution allows you provide multiple views involving a claim. For example, benefits managers may be able to view a collection of claims all associated with a single incident, but individual claimants will only be able to track the status of their personal claim.

Improve the Customer Experience

FINEOS Claims for Workers’ Compensation presents a real-time, single view of the customer, delivering all relevant data to claims handlers and empowering them to deliver personal levels of service. Detailed case management capabilities allow claims handlers to understand all aspects of a workers’ compensation claim, enabling them to provide information on a comprehensive plan of care. 

The solution is configured using your business rules, ensuring that best practices can be enforced throughout the system. Work is routed to claims handlers appropriately, based on authorities and skill levels, reducing the need for hand-offs and transfers. Service alerts can be established based on both operational and regulatory guidelines, ensuring that claims activity is performed within allowable timeframes. 

FINEOS Claims for Workers Compensation goes beyond traditional claims processing to deliver all aspects of a total claims solution:

  • Fully automated claims and case management
  • Integrated customer management
  • Comprehensive financial management
  • Optimal provider management
  • A flexible, modern, rules-driven technology platform