FINEOS Launches Enhanced Solution for Critical Illness Claims

Available for Group, Worksite and Individual Markets

FINEOS Corporation, a market leading provider of Group Life, Accident and Health claims management software, today announced the launch of its latest product for managing Critical Illness claims (CI) and Cancer insurance claims. FINEOS Claims is an out-of-the-box claims solution designed to support the policy provisions and claims procedures encountered in each of the Group, Voluntary/Worksite and Individual markets.

Critical Illness insurance is one of the fastest growing lines for US Life & Health insurance carriers. Sales of Voluntary/Worksite insurance are increasing year on year with new sales exceeding $6 billion annually and critical illness cover representing a growing share of that overall total. This is a marked change to the situation a decade ago when these product lines were still in their infancy and only offered by a minority of carriers.  The Affordable Care Act and the shift in benefit purchasing decisions to the employee have increased the number of insurers entering this market and the variety of products being offered.

FINEOS Claims for CI provides out-of-the-box support for a wider range of CI insurance products while leveraging the latest online communication/enquiry capabilities of the FINEOS Claims platform.  Features included for this insurance line include:

  • Automatically created outbound correspondence (letter, email, SMS, secure message) to acknowledge claim notification.
  • Decision support and investigation alerts (e.g. pre-existing conditions clause) during the claims process.
  • Workflows and forms to manage interactions between the claims analyst and internal business partners such as clinical services and underwriting teams.
  • A dedicated case within the electronic claim file should the claim decision be appealed. Functionality within the Appeal case includes system-enforced separation of duties and workflows to manage any extension/tolling periods required in the decision process.
  • Straight-through processing of wellness benefit claims, where such a coverage is included in the product.
  • Payment authority limits based on whether the user is in a processing or reviewing capacity.
  • Notification to the backend reserving system when the claim is created followed by updates as settlement or denial takes place.

Commenting on the launch, Michael Kelly, CEO, FINEOS Corporation said, “The challenge for carriers selling CI products is to maintain profitability while remaining competitive and relevant to the needs of the market. Not only does FINEOS Claims support improved claims outcomes, it supports product redesigns and enhancements as carriers adapt their CI products to changing market requirements.”

FINEOS is the leading claims solution for the global Life, Accident and Health insurance industry and supports the processing of Life, Disability and a number of related lines. FINEOS supports both Group and Individual business claims on a single platform and can be used by organizations of all sizes, from small departmental claims teams to very large teams with thousands of users and millions of claims.  FINEOS currently works with over 50 insurance carriers and counts six of the top 20 Life and Health carriers in the US and four of the top Life and Health carriers in Australia as customers. FINEOS is also a global market leader in Claims Management for Government Accident Compensation schemes.

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