FINEOS Claims for Voluntary Insurance Datasheet

Purpose Built for You

Accident  ||  Critical Illness  ||  Hospital Indemnity

Voluntary Insurance has become an integral part of most employee benefits. It provides a cost-efficient way to offer additional insurance to employees based on their specific needs. As more employees take advantage of these offerings, implementing claims integration becomes a must-have feature. Fully integrated with the FINEOS Policy, Billing, Payments and Provider solutions, FINEOS Claims for Voluntary Insurance offers a modernized, SaaS-based technology platform with innovative features to provide a faster, hassle-free claims experience. It is available for Accident, Critical Illness and Hospital Indemnity insurance products.

Streamline Claims Intake and Workload Administration

• Customized workflows for your organization’s unique roles and servicing needs
• Web-based portals with guided intake paths for claimants, employers, call-center staff and others
• Online validity, coverage verification and eligibility at the point of intake
• Configurable, rule-based assignments, escalations, authorizations, alerts and approvals
• Seamless navigation and consistent user experience across products
• Utilizes MDGuidelines for estimating costs and recovery times

Improve Claims Outcomes

• Instant access to recent communications, prior claims and provider cost history
• Dashboards and reports for actionable insights on treatment options and benefit duration
• Integrates with Policy and Billing to enable Straight Through Processing
• Enables monitoring of Claims management and payment trends against industry benchmarks
• Integrated scheduling and follow-ups with 3rd party service providers on patient progress
• Drive contract negotiations, reduce costs and prevent fraud with integrated claims, payments and provider information

Increase Value Add

• Reduce claims expense by monitoring provider diagnosis and practice patterns
• Optimize staff utilization and productivity with consistent interfaces across products
• Identify bottlenecks and rarely used paths in workflows with process heatmaps
• User-configured triggers for intuitive claims life-cycle management and faster identification of abnormalities
• Reduce service inquiries and errors through improved communication and collaboration with carriers, service providers, rehab centers and claimants


• Cloud-based, self-service portals that work on multiple platforms and are integrated to support the entire claims lifecycle including individuals, roles, organizational entities, benefits and other services
• Comprehensive search engine for real-time information sharing and collaboration among case managers, carriers, service providers, and claimants
Robust API Set for easy data and process integration with 3rd party service providers and vendors
• Extreme flexibility in configuring claim structures, claims assignments, case management, follow-ups and payments (including multi-lingual and multi-currency)
• Feature-rich payment structures including detailed calculations with explanations, backdating, audit-trails,
recurring, one-time and full payment histories
• Rule-based analytics and extensive reporting for audits, performance management, fraud control and payment accuracy


Increase Carrier Satisfaction
— Deepen customer and provider relationships through streamlined and seamless requests for information, prior approval authorizations, payment processes and follow-ups
— Proactively keep claimants and other key stakeholders informed throughout the process
— Improve carrier’s ability to manage claims and provider performance
— Pay claims faster and more accurately with integrated provider authorizations and payments
— Improve patient outcomes through more effective collaboration between case manager, service providers and rehabilitation centers
— Respond sooner to changes in the market

Improve Operations
— Simplify interface with external systems through a robust API layer
— Decrease service backlogs and bottlenecks waiting on policy and coverage verification
— Increase productivity with fewer service inquiries and requests for information
— Streamline compliance and audits through automated file assembly – available anytime

Reduce Expenses
— Increase accuracy in claim payments by reducing manual payment calculation errors
— Reduce variability in claims payments from coordinated treatment plans
— Improve negotiations with discounted rates for preferred service providers rehabilitation centers
— Reduce outside claims expenses associated with commercial mapping software to locate service providers
— Escalate complex cases or potential fraud faster with analytics and smart workflow automation

FINEOS AdminSuite is 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 of AWS and is designed to connect to the partners and digital platforms that increasingly define the insurance landscape. FINEOS Claims for Voluntary Insurance is a comprehensive, component-based software solution that seamlessly integrates with FINEOS Policy, Payments and Provider to provide a  streamlined and fully integrated approach to claims processing, one of the most critical interactions a carrier has with its customers and service providers.

To find out more about FINEOS Claims for Voluntary Insurance or to request a demo, please contact us.

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