Claims Operations & Settlement (Xebia's Insurance Suite)

Overview

Claims Operations & Settlement is is one of the many applications offered as part of Xebia’s Connected Claims Insurance Suite. Each of the applications in the suite can be deployed independently or in combination with other applications as per the business requirements.

The Claim Settlement application aims to solve the problem of high claim leakage by reducing high operational costs through an efficient claims settlement process. This application also addresses the following problems:

With high volumes of claims it becomes challenging for insurers and supervisors to triage and assign claims to the right claim adjusters to ensure claims get settled in minimum time.
Lack of a claim approvals decision framework also requires adjusters to invest time on the claim that looks simple and easy to approve resulting in focusing time on less complicated claims.
Claim adjuster has no direct and easy way to enrich claim information and to request additional or supporting documents from customers or internally, which results in inaccurate or incomplete claim details.
Claims are often settled and the claim adjuster initiates payment despite the fact the fraud investigation team thinks there is a high chance of a fraud on the given claim. This eventually becomes cost-intensive for insurers due to a large amount of settlement amounts going to fraudulent claim settlements.
Adjusters have to make the settlement offer to the customer, which can be a complex task depending on nature of the damage and the cost involved towards the damaged parts in loss (repair cost or replacement cost). This impacts the customer experience and creates a lot of back and forth communication with the customer.
Difficulty in collaborating with third-party inspection and survey teams for concluding on inspection results.

Key Features & Functionality

Configurable case settlement workflows based on different claim types such as motor, property, and marine.
Automatic assignment of a best claim adjuster on each claim depending on how complex a claim is through an automatically evaluated "claim-complexity-score". This ensures each claim goes to the right adjuster in the first place thus avoiding random assignment.
Auto-approval rules help Claim Adjusters and expedite the settlement process straight through payment initiation.
During any point of claim processing, before a claim is settled, the claim details can be enriched. This includes the request for any missing or additional required documents thereby ensuring each user working on a claim sees the most up-to-date and correct information.
Adjuster can initiate any inspection or survey with the internal or 3rd party inspection team. This brings inspection information on the same settlement record with full visibility of inspection status, and thus providing the surveyor comments if required to make the settlement decisions.
Personalized claim adjuster dashboard to enable them to view and work on claims immediately as they are assigned, resulting in faster turnaround time and increasing customer experience.
Full visibility if the claim has a fraud alert or is under SIU investigation on the same claim settlement record. Thus, enabling adjuster not to settle and initiate claim settlement until confirmed ensuring no fraudulent claims are paid out.
Interactive claim damage assessment center to help adjuster settling claims faster than before - All in one view! Solution annotates the damages areas automatically, helping adjuster understand the damaged areas, and evaluate its repair/replacement cost through the automatic corresponding image center, showing reserved price and more.
Interactive, rich and informative claim dashboards, displaying claims, milestones and related entities all in the same view!

Appcino's Connected Claims Insurance Suite of apps offers a complete claims management solution built on Appian. The suite has the following applications: