Stephen Applebaum, senior analyst, property & casualtyinsurance, Aite Group

Recent Aite Group research had carriers rate their existingClaims Management Systems. The areas of greatest focus identified,in order of importance, were:

1. Next-generation features/functions  
2. Overall user experience 
3. System performance/vendor support 
4. Integration capabilities 
5. Total cost of ownership
6. Professional services skills/resources
7. Basic features/functions 
8. Line-of-business coverage/suitability

Among Insurance IT executives who have had experience choosingand implementing these systems, the most satisfactory outcomes wereachieved by the carriers that most completely defined theircomplete requirements and expectations at the most detailedpossible level and included their most experienced front-linesystem users early in the process.

The highest satisfaction realized by carriers who recentlyimplemented claim management systems were derived from;

• Higher levels of claims excellence through customer-centricityand business analytics
• Improved compliance and reporting
• Enabling of multi-channel customer distribution andengagement
• Consistent enterprise-wide customer informationavailability

Karen Furtado, partner, Strategy MeetsAction

Insurers should begin the journey with a view of capabilitiesthat includes both today's urgent needs as well as functionalitythat will support the differentiation that each company is strivingfor. Four foundational capabilities should be in the 'must have'column of the claims system selection criteria. They are:

• Real ease-of-use that streamlines workflows through the use ofrules and external risk data integrations as well as createssophisticated, well-orchestrated correspondence
• Information transparency that gives policyholders and agentsaccess to real-time claims status and information in the deliverymodel they choose, including mobile representations,
• Integration to the claims supply chain to yield a moreefficient and effective claims fulfillment process, and
• Power to handle both the straight-through transaction claims aswell as the sophisticated case managed claims.

Karlyn Carnahan, principal, Novarica

Carriers looking for modern claims systems should focus on threekey areas.

• Functionality: Look for functionality out-of-the-box withlittle to no customization needed.  A robust claims systemsupports automated processing with integrated workflow managementand task or process management. Adjuster portals, wizards to opennew claims, scripting, and dynamic questioning all allow carriersto deliver consistent service levels. Look for a modern userinterface with easily navigable screens and easy-to-find contextualhelp.
• Flexibility for the future: Nearly as important as those linesof business, rules, or workflows that are already built within thesystem is the relative ease with which additional capabilities canbe added. Look for easily configurable rules, workflows, roles,pages, and forms.
• Technology: Make sure the architecture of the solution alignswith your desired architecture.  Verify the data model isrobust and flexible and that the upgrade process isstraightforward. 

Donald Light, director, Americas property & casualtypractice, Celent

Selecting, implementing, and deploying a new core claims systemrequires an insurer to make a major investment of time andresources. Making the correct selection decision is a major (thoughnot the only) determinant of the business value an insurer willreceive from its new claim system over the next 10 to 15 years thatit will be using the system.

Celent recommends that insurers evaluating new core claimsystems consider three broad areas: what kind of relationship itwill have with a given vendor; how modern and configurable thesystem's architecture is; and the range of features and functionsthe system offers.

An insurer is entering into a long-term relationship with avendor. Are the vendor's people (senior executives, technical,support, sales) compatible with the insurer's staff? A good claimsystem should be built on a modern service-oriented, componentizedframework. Features and functions should include both basic andadvanced functionality such as an adjuster desktop, rules, andworkflow capabilities.

John Lucker, principal, Deloitte Consulting

The investment in a modern next-generation claims system shouldinclude a richer and more holistic set of capabilities than legacysystems.  For starters, such systems should be technicallyarchitected to optimize connectivity, expandability, maintenanceflexibility and service orientation.

Beyond workflow and case management, such expanded operationalcomponents should include native features like businessintelligence, document management, fraud detection, subrogation,resource allocation, workforce management,legal/regulatory/compliance management, andanalytics. 

Some of these categories require secondary components to providefull function—for example advanced analytics like predictivemodeling typically require some form of enterprise scoring andenterprise rules engine to process input data through algorithmsand then process output scores through business rules fordownstream action. While all of these modern and evolving featuresmay not be built into the claims system core, such services areincreasingly necessary options—or bolt-ons—and key to high-endmodern claims department functionality.