FINEOS Claims Datasheet

FINEOS Claims brings insurance value to life through superior claims handling. With its AI-enhanced workflows and comprehensive management capabilities, insurers can provide interactive and efficient experiences that increase customer satisfaction, produce better outcomes, and reduce costs. The purpose-built design of the FINEOS Claims management system ensures user-friendly interactions every time, resulting in unparalleled levels of service.

Key Features of FINEOS Claims management solution

Technology 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
  • Role-based portals for 24×7 self-service
  • Accessible on smartphones and tablets
  • AI-powered claims scoring with auto-escalation to trigger additional review
  • Automated follow-ups, reminders, texts, and integrated email
  • Intuitive, easy-to-use claims reporting wizards
  • Rule-based claims assignments and configurable workflow scripting

People and Process Features:

  • FINEOS Claims streamlines standard claims and simplifies complex ones
  • AI-powered workflows to guide claim processing
  • Integrated policy and claims information for faster coverage verification
  • A single view of customer information with complete claims history
  • 24×7 role-based self-service to reduce unnecessary inquiries
  • 3rd party integration for improved case management and faster payments
  • AI-generated management alerts for proper handling of complex claims

Improve Results:

  • Reduce operational costs and improve efficiencies with streamlined, low-touch, no-touch claim processing
  • Measure what matters most in the claims experience with easier access to the right information
  • Reduce claims leakage with integrated 3rd party information, auto-escalation, and tighter claims management
  • Produce better outcomes with proper case handling, improved coordination of benefits, and accurate information
  • Detect potential fraud faster with fully configurable AI-powered alerts to claims management

Flexibility and Usability:

  • Configurable to fit your organization. The FINEOS Claims management solution is a SaaS standalone system that can be integrated into any policy administration system, including the FINEOS Platform
  • Out-of-the-box accelerators for deployment, including data migration tools, to reduce setup requirements and ensure smooth integration with other systems
  • Highly configurable, scalable platform to support claims service delivery
  • APIs that matter to support transactions and customer interactions throughout the entire claims lifecycle
  • Trusted and compliant platform to support the most stringent security and regulatory requirements

Outcomes with FINEOS Claims management solution

Increased Customer Satisfaction:

  • Enhanced customer experience through smoother interactions
  • Less time spent waiting on coverage verification and payment approvals
  • Reduced bottlenecks in claims processing from increased automation
  • Faster payment processing with 3rd party integration
  • Better outcomes and faster return-to-work from improved coordination of care and communications

Reduce Costs and Risks:

  • Fewer inquiries with self-service and access to information
  • Reduced claim leakage from earlier detection of overpayments and potential fraud
  • Increased accuracy in forecasting reserves by leveraging customer and 3rd party information to gain deeper insights
  • Reduced litigation and settlement costs from better case management
  • Reduced fraud risk from integration with Social Security Death Index
  • Improved claims handling and settlement time with comprehensive access to all claims and payment history

Improved Operational Efficiency and Effectiveness:

  • Reduced cost of compliance with streamlined reporting, including HIPAA, ERISA, and Unfair Claim Practice statutes
  • Increased data accuracy and consistency with ACORD-compliant interfaces
  • Automatically generated audit trails for all claims history
  • Increased automation to support Freedom of Information and other legal requests
  • Enhanced agility from improved resource utilization and streamlined processes

FINEOS Claims is supported by the FINEOS Platform which is purpose-built for the Life, Accident and Health industry and the Employee Benefits market to seamlessly support insurers, employers, and employees on their insurance journeys. The FINEOS Claims management solution is deployed as an end-to-end core solution or as components for incremental transformation on secure, scalable SaaS cloud technology.

The FINEOS AdminSuite delivers industry leading capabilities across core administration including absence management, billing, claims, payments, policy administration, provider management and new business and underwriting; all of which are configurable to operate independently or as one suite. The machine learning enabled FINEOS Engage solution enables robust people-first digital engagement pathways and the FINEOS Insight solution provides predictive analytics and reporting across the business.

Contact us today to learn more.

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