You can't call it a changing of the guard — yet. Plenty ofwell-established industry names produce tried-and-true claimsmanagement and administration tools. But companies fresh on thescene are redefining the way claims solutions are conceived andfinally implemented by end users.

What's the secret to their successes? Collaborative developmentmethods involving customers-carriers-as well as exploring nichessuch as process automation and automobile lines, and creatingproducts flexible enough to allow IT departments to decide theirfates.

Even though you won't see 30-second commercials for thesecompanies during the World Series, their products are taking claimssolutions in a new direction. Here's a look at the fresh faces andproduct premieres.

FileNet: Acenza Claims

Web content management and “e-process” provider FileNet branchedinto customer-driven e-business applications with its Acenza lineof products; they're designed to extend business practices andrelated content to the Web.

The company's first e-business offering is Acenza Claims,designed to allow sharing of content and processes betweencarriers, brokers, and other parties. That means moving customerservice to the Net, providing electronic access to claimsdocuments, balancing and distributing workloads, and measuringproductivity.

Of course, the entire product is for sale as a standaloneapplication, but if a carrier wants to add Acenza's functionalityto existing systems, it can opt to buy pieces of the technology andhave a systems integrator customize and integrate the application.“More than half of our customers want the entire solution,” saidSoumya Das, FileNet's senior applications marketing manager. “Butin the future, they can always add on new functions.”

FileNet makes its standalone product open enough to customizeand address specific customer pains by using a modular approach toapplication development. This is part of Das's vision; he believesinsurance companies should stop purchasing parts and focus onfull-featured standalones. “You don't have to buy piecemealtechnologies and build them up yourself. Now you can have aninfrastructure on which you can build value,” he said.

The core of FileNet's technology is its XML platform, originallydeveloped as part of the company's Panagon brand of workflowproducts. Using XML, they provide end-to-end connections within thevarious elements of the solution, as well as communication withother vendors' products-fraud detection and outsourcing services,for example.

One advantage of this design, according to Das, is that it makesAcenza Claims a good candidate for use by field adjusters carryingPDAs because the XML core allows data to be easily reformatted forsmall screens.

Acenza Claims takes claims from paper to the Web, andstreamlines processes by automating workflows. That's done byproviding the software with a 'workflow library' that establishesuser groups and routing rules. Those rules can, of course, bemodified by users; values such as the monetary value associatedwith a claim, timing of the loss compared to the policy'sactivation, and more can be tweaked to match each company'sworkflow and business process. Acenza Claims helps ensure the rightdocuments reach the right people, based on the establishedmanagement rules. It also works with task assignments andappointment scheduling.

Users of the system also include policyholders. When a customerfills out a claim form on the carrier's Web site, he isautomatically issued a login, password, and claim number by AcenzaClaims through e-mail. From that point, the customer can visit aWeb-based status page throughout the claims process.

According to Das, “End-to-end paperless business is a piece ofthe puzzle. We're offering [an] enterprise content managementinfrastructure.”

Castek: Insure3 Claims

Coming soon is Castek's Insure3 Claims (no release date has beenset). Designed as a claim-processing add-on to the company'sInsure3 product suite, the claims component features tools for lossratio improvement, adjudication and finance, and more.

While Insure3 Claims can function as a standalone product,Castek CEO Yung Wu said there's an advantage of combining it withthe Insure3 suite: “This offers 100 percent coverage of all claimsprocesses-from first notice to subrogation to reinsurancerecovery-and all products at all times.”

Castek turned to its customers during Claims's developmentprocess, inviting those pre-committed to the product to consultwith developers about its functionality. The end result is aJ2EE/Java base with XML Web Services interfaces. Wu said Castek'sintention is to not only drive cost reduction for customers, but tocreate a highly implementable solution.

As such, the company designed Insure3 Claims to be interfacedinto call center or broker applications from the time first noticeof loss data are captured. Adjusters can connect to the systems ofvarious providers (body shops, contractors, etc.) where they canreserve services, get processing details, and view managementreports.

To secure a timely release for Insure3 Claims, Castek acquiredclaims process management developer InsuroCity from VitalInnovations. In doing so, Castek has added features that facilitatecommunication between all parties involved in a claim, managesupplier relationships, and automate the supply chain. “In thecurrent economic environment, insurers have switched focus to costcontrol and more effective processes,” Wu said. “By providingcoverage of business processes, we can knock points off ofoperating costs.”

Demonstrating ROI varies by customer. A new business can showshort-term results by making a product and writing it in the fieldin a matter of days, while a well-entrenched organization buying into configure 20 systems-including legacy claims systems and productsilos-can expect to take a year to install and connect the system.That means two to three years to demonstrate ROI, according toWu.

But users can immediately work with tools such as wirelessaccess; a financial manager that handles claim payments, receivesinvoices, and tracks and identifies potential fraud; and anactivity journal that can be used by an SIU should suspiciousbehavior be detected. Users can also configure Insure3 Claims tosend claimants notification of processed policies, loaner caravailability, and more.

According to Wu, the Insure3 Claims design follows Castek'sbelief that software can automate business and make it moreeffective.

You heard it here first.

Systems Task Group: Renaissance Claims AdministrationSystem

Systems Task Group was founded on the philosophy that verticalapplications have long-term influence on the insurance industry.STG president Praful Nikam began studying the industry and soonrealized it needed solutions that address specific classes ofproblems.

“We went directly to the problem, identified it, and built toolsto deal with it, rather than acting as an intermediary between thecarrier and its problem,” Nikam said.

According to Anil Chitale, STG's vice president of products, themove to concentrate on claims was natural. He said the companyfound an intrinsic need in the industry to control communicationand manage workflow securely; STG set out to design a solution thatwould seamlessly deal with these issues. The company met with usersfor validation and with executives for perspective; development ofthe Renaissance Claims Administration System-a tool forcommunication and automation-was then underway.

Claims processes lend themselves well to Web-based technologies,as Nikam put it, because geographically-separate entities and othercarrier associates need access to claims data-from body shops andTPAs to attorneys and reinsurers. Renaissance Claims keeps everyoneon the outside connected. It helps assign priority to incomingclaims and routes them based on the nature of the claim, keepingthe flow of inside jobs steady.

“You don't want a fender-bender report to be handled the sameway as a death,” Nikam said. “If you have people who handle allreports in the same manner, it's important to have a claims systemthat identifies transactions that need exceptional cognizance. Youwant your claims systems to warn you of a potentially serioussituation.”

Renaissance Claims features a user-configurable workflow engine,useful when setting up the system for automated routing andassigning. Web based and using Oracle and Java technology,Renaissance Claims provides HTML interfaces to back-end operations.The solution relies on SSL, and user departments are assigned tocontrol access to certain data levels or functions.

Renaissance Claims can integrate with legacy systems-assuminginteraction between intermediate data in Oracle tables ispossible-providing a Web front end for a DB2 database. According toPramod Desai, STG's vice president of product development, thecompany can customize the solution to work with other databases.Each time a carrier purchases a suite of Renaissanceproducts-Renaissance Policy Admin, Claims Admin, and MGA-SystemsTask Group steps in as systems integrators, selecting hardware andthird-party vendors, planning capacities, databases and workflows,and performing needs analyses.

Mitchell International: E-Claim Manager

Mitchell's E-Claim Manager is a central claims repository.Designed as an all-in-one electronic folder and claim settlementsolution, its workflow relies on as few as four steps.

Rather than focusing solely on the people involved in claimsprocessing, E-Claim Manager also handles related documents —administrative materials, image files, legal documentation,reviewer comments, estimates, and more-storing them all in onefile.

Thomas Julius, senior product manager of E-Claim Manager andMitchell's Wireless Initiatives, said the product encompasses alladjuster tasks and creates a seamless workflow. A single login andpassword will grant access to any part of the single file theproduct outputs. To track use, E-Claim Manager attaches anencrypted date and time stamp to the file each time it's accessedor modified.

To top it off, the solution works in conjunction with MitchellWireless to make sending data to the home office easier.Professionals in the field use CDPD-based connections to transfercomplete files quickly, and Mitchell is looking to Bluetooth andEDGE for future connection-speed enhancements.

While many products on the market are customer- orbusiness-centric, Mitchell says its E-Claim Manager isclaim-centric; it allows users to work with UltraMate-the company'sflagship product, as well as its ValueMate and others. The solutionintegrates into existing workflow, and is capable of launchingMicrosoft Office and other off-the-shelf apps. Additionalconnectivity is on the way: While unable to give a specifictimeframe, Julius said Mitchell plans to add XML to theproduct.

In the meantime, users connect to E-Claim Manager by way ofwireless Internet through RSA 128-bit encryption and multiplefirewalls on the application side. The application receivesassignments and stores them in adjusters' In boxes. The adjusterthen logs in, retrieves the assignment, writes an estimate,attaches additional documentation, and sends the finished filesthrough E-Claim Manager for carrier review. Because the solutionprovides access to all claims data, any related party can view thefile should subrogation be the next step. Otherwise, the reviewedfile is processed for payment to the body shop or claimant.Archived data can be backed up to tape, CD-ROM, or opticaldisk.

A GUI is the gateway to an on-screen task list, providingtracking and auditing so managers can keep watch on status at anytime and be aware of what the next step should be.

Trends in new claims solutions are leaning toward fixing theproblems and pushing the professionals. Software helps enhance thecustomer experience by influencing the way claims are received andprocessed. Similarly, these solutions address productivity behindthe scenes, making carriers' operations more productive andcost-friendly. A new guard? Maybe not. But without a doubt, newclaims tools will make your business more effective.