Automating processes, detecting fraud and saving bottom-line costs are just a few of the reasons insurers look to new claims technology, and vendors are eager to provide a wide array of solutions.

The following is a sampling of new claims tech products introduced or updated during the past year.

o Guidewire Software Inc., based in San Mateo, Calif., offers ClaimCenter 3.1, the latest version of its claims system for property and casualty insurance carriers.

The Web-based claims system can be used for all lines of business to improve the claim process, reduce claims costs and enhance customer service, the company said. ClaimCenter 3.1 is designed to improve insurer control over core claim operations by increasing visibility into key performance metrics, automation of the claim process and overall system flexibility.

The latest release features out-of-the-box integration with ISO ClaimSearch to “dramatically enhance fraud detection while eliminating re-keying for adjusters and integration work for [information technology] staff,” the company stated. Improved document management and robust capabilities for tracking claims litigation are also offered.

According to Guidewire, the new version also features cross-claim tracking (to detect possible fraud indicated by the same contacts used across claims) and the flexibility of allowing users to configure their own searches. Users can add new search terms and specify search behavior.

Pricing is typically through an annual subscription fee based on premium revenues, ranging from $200,000 to multiple millions, a company representative said. Further details are available at www.guidewire.com.

o SPSS unveiled PredictiveClaims, a software application based on “real-time predictive analytic technology” that integrates with existing claims management systems to determine which claims qualify for approval and which are potentially fraudulent.

According to Chicago-based SPSS, the new product will “reduce insurance fraud, significantly improve the claims process and cut costs. 'Fast-track claims handling' considerably improves the efficiency of claim handling and customer service,” the company noted.

PredictiveClaims automatically analyzes all claims entering a system from any channel against risk profiles and external fraud databases, said SPSS. The product either approves a claim for processing or flags it for further investigation. It can also provide “smart” questions that prompt a claims handler to ask customers for new information that could confirm the likelihood of fraud.

The company added that PredictiveClaims helps p-c insurers to understand why certain claims are flagged as suspicious, so special investigation units know where to focus their inquiries. The software combines and analyzes data from multiple sources, including federal and insurance industry databases.

The software integrates with existing claims management systems “without extensive customization or lengthy implementation periods,” said SPSS.

Pricing is based on the number of claims processed, and “is generally in the range of several hundred thousand dollars,” a company representative noted. Further details are available at www.spss.com.

o Computer Science Corp. will announce the release of its new Claims Desktop for p-c insurers this month, according to the Austin, Texas-based company.

Claims Desktop is a browser-based system that integrates multiple claim functions, applications and data, “enabling adjusters to introduce new capabilities such as claim profiling, claims routing and functional collaboration,” the company stated.

Adjusters can share data across multiple applications from a single Claims Desktop screen, eliminating the need for redundant entry.

The new software will also include task management software to guide adjusters when they investigate and evaluate claims, said CSC. Claims Desktop employs an external rules engine, “making it easier and faster to define and modify business rules and calculations,” said the firm. “The product integrates work management and imaging/document management capabilities along with process orchestration.

Pricing will begin at $100,000 and is dependent on the direct, written premium of the company using it, the company noted. Further information is available at www.csc.com.

o The Insurance Services Office Inc. and the National Insurance Crime Bureau last month announced they are collaborating on SIU Case Manager, an anti-fraud tool for insurer special investigation units to be released later this year.

The new platform will integrate many functions associated with managing underwriting and claim investigations, said Jersey City-based ISO. It provides workflow automation required by SIU professionals.

NICB, based in Palos Hills, Ill., is a nonprofit organization dedicated to preventing, detecting and defeating insurance fraud and vehicle theft.

“SIU Case Manager will help investigators document, assign, report and archive claims being investigated,” said the ISO announcement. “It will include a customer response diary, expense tracking, time-triggered mailings, and streamlined NICB and state fraud bureau reporting features for enhanced SIU productivity.”

SIU Case Manager will be integrated with ISO ClaimSearch, a comprehensive all-claims system, and ClaimDirector, a claim-scoring service. SCM will also assist insurers with enterprise-level reporting and compliance with regulatory requirements for antifraud programs, said ISO.

The company declined to provide pricing information. Further details are available at www.iso.com.

Special Reports /

Claims Tech Products Help Insurers Better Target Fraud, While Cutting Costs

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