FINEOS Claims Datasheet

Today’s insurance marketing begins where the insurance value chain ends — Claims. Superior claims service in a socially-transparent, search-engine culture can boost brand awareness and improve customer experience ratings. FINEOS Claims places maximum functionality into the most user-friendly and versatile claims integration package available. It allows insurers to unify all claims systems and processes into a single, efficient claims solution.

FINEOS Claims

Key Features: 

  • End-to-end automation for the entire claims process – from initial notification to final settlement.
  • Fully-integrated functionality across front end, middle and back office functions.
  • Intuitive, easy-to-use claims reporting wizards.
  • Rule-based claims assignments and configurable scripting to streamline workflows and enable case management.
  • Artificial Intelligence (AI) analytics to trigger additional review or potential fraud.

People and Process:

  • FINEOS Claims streamlines standard claims and simplifies complex ones.
  • Understand your customers and gain insights into what they really need.
  • Gain access to all critical information you need to provide an excellent customer experience.
  • Save time with fewer inquiries and spend less time chasing information.
  • Lower operational costs.
  • Improve claims outcomes for claimants, employers and your organization.

Metrics and Profits:

  • Reduce leakage and increase efficiencies.
  • Gain easier access to the right information to measure what matters most – drivers of cost and profitability.
  • Reduce unnecessary payments and improve outcomes with proper case handling, improved fraud detection, complete audit trails and tighter claims management.
  • Bring new products to market while reducing internal and external claims costs.

Flexibility and Usability:

  • Shift dozens of tasks from IT to Business utilizing pre-configured standard forms, workflows, dashboards and reports.
  • Adaptable to meet your specific requirements.
  • Configurable to fit your organization. FINEOS Claims is a standalone system. It can be integrated into any policy administration, including FINEOS Platform. It also includes configurable scripting for call center support.

OUTCOMES

Improve Claims Settlement Outcomes:

  • Reduces time required to complete policy/coverage verification.
  • Intelligent, AI-based adjuster assignments reduces bottlenecks.
  • Integration with 3rd parties means faster payments.
  • Configurable rule-based investigation and fraud triggers.

Reduce Claims Administration Costs:

  • Increased process accuracy and reduced process redundancy means faster service, fewer staff, fewer calls.
  • Configurable, scripting reduces staff training costs.

Enhance Customer Service:

  • 24×7 access to information and real-time updates.
  • Automated follow-ups, reminders, integrated email, text.

Streamline Compliance & Reporting:

  • Processes to manage HIPAA compliance, ERISA and Unfair Claim Practice statutes.
  • ACORD-compliant interfaces.
  • Easily integrates with Social Security Death register.
  • Always available and easily accessible change history for audits.
  • Automated claim file assembly (PDF, print, etc.) to support freedom of information and other legal requests.

Cultivate Customer Insights:

  • Automated tracking and reporting of customer inquiries fuels future innovation and product enhancements.
  • Leverage customer insights to accurately forecast reserves.

 

FINEOS AdminSuite – the only modern component-based group, voluntary and individual core system for Life, Accident and Health on a single technology platform.  

FINEOS AdminSuite is designed specifically for the Life, Accident and Health industry. A comprehensive suite, it includes absence, billing, claims, payments, policy, and provider. FINEOS AdminSuite is built on the robust Platform Capabilities and designed to connect to the partners and digital platforms that increasingly define the insurance landscape.

FINEOS Claims is designed to accelerate innovation and the transition to digital platforms by flexing to fit digital channels and products. It is easy to implement, and it is instantly efficient.