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

FileNet makes its standalone product open enough to customize and address specific customer pains by using a modular approach to application development. This is part of Das's vision; he believes insurance companies should stop purchasing parts and focus on full-featured standalones. “You don't have to buy piecemeal technologies and build them up yourself. Now you can have an infrastructure on which you can build value,” he said.

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

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

Acenza Claims takes claims from paper to the Web, and streamlines processes by automating workflows. That's done by providing the software with a 'workflow library' that establishes user groups and routing rules. Those rules can, of course, be modified by users; values such as the monetary value associated with a claim, timing of the loss compared to the policy's activation, and more can be tweaked to match each company's workflow and business process. Acenza Claims helps ensure the right documents reach the right people, based on the established management rules. It also works with task assignments and appointment scheduling.

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

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

Castek: Insure3 Claims

Coming soon is Castek's Insure3 Claims (no release date has been set). Designed as a claim-processing add-on to the company's Insure3 product suite, the claims component features tools for loss ratio 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 with the Insure3 suite: “This offers 100 percent coverage of all claims processes-from first notice to subrogation to reinsurance recovery-and all products at all times.”

Castek turned to its customers during Claims's development process, inviting those pre-committed to the product to consult with developers about its functionality. The end result is a J2EE/Java base with XML Web Services interfaces. Wu said Castek's intention is to not only drive cost reduction for customers, but to create a highly implementable solution.

As such, the company designed Insure3 Claims to be interfaced into call center or broker applications from the time first notice of loss data are captured. Adjusters can connect to the systems of various providers (body shops, contractors, etc.) where they can reserve services, get processing details, and view management reports.

To secure a timely release for Insure3 Claims, Castek acquired claims process management developer InsuroCity from Vital Innovations. In doing so, Castek has added features that facilitate communication between all parties involved in a claim, manage supplier relationships, and automate the supply chain. “In the current economic environment, insurers have switched focus to cost control and more effective processes,” Wu said. “By providing coverage of business processes, we can knock points off of operating costs.”

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

But users can immediately work with tools such as wireless access; a financial manager that handles claim payments, receives invoices, and tracks and identifies potential fraud; and an activity journal that can be used by an SIU should suspicious behavior be detected. Users can also configure Insure3 Claims to send claimants notification of processed policies, loaner car availability, and more.

According to Wu, the Insure3 Claims design follows Castek's belief that software can automate business and make it more effective.

You heard it here first.

Systems Task Group: Renaissance Claims Administration System

Systems Task Group was founded on the philosophy that vertical applications have long-term influence on the insurance industry. STG president Praful Nikam began studying the industry and soon realized it needed solutions that address specific classes of problems.

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

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

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

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

Renaissance Claims features a user-configurable workflow engine, useful when setting up the system for automated routing and assigning. 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 to control access to certain data levels or functions.

Renaissance Claims can integrate with legacy systems-assuming interaction between intermediate data in Oracle tables is possible-providing a Web front end for a DB2 database. According to Pramod Desai, STG's vice president of product development, the company can customize the solution to work with other databases. Each time a carrier purchases a suite of Renaissance products-Renaissance Policy Admin, Claims Admin, and MGA-Systems Task Group steps in as systems integrators, selecting hardware and third-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 settlement solution, its workflow relies on as few as four steps.

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

Thomas Julius, senior product manager of E-Claim Manager and Mitchell's Wireless Initiatives, said the product encompasses all adjuster tasks and creates a seamless workflow. A single login and password will grant access to any part of the single file the product outputs. To track use, E-Claim Manager attaches an encrypted date and time stamp to the file each time it's accessed or modified.

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

While many products on the market are customer- or business-centric, Mitchell says its E-Claim Manager is claim-centric; it allows users to work with UltraMate-the company's flagship product, as well as its ValueMate and others. The solution integrates into existing workflow, and is capable of launching Microsoft Office and other off-the-shelf apps. Additional connectivity is on the way: While unable to give a specific timeframe, Julius said Mitchell plans to add XML to the product.

In the meantime, users connect to E-Claim Manager by way of wireless Internet through RSA 128-bit encryption and multiple firewalls on the application side. The application receives assignments and stores them in adjusters' In boxes. The adjuster then logs in, retrieves the assignment, writes an estimate, attaches additional documentation, and sends the finished files through E-Claim Manager for carrier review. Because the solution provides access to all claims data, any related party can view the file should subrogation be the next step. Otherwise, the reviewed file is processed for payment to the body shop or claimant. Archived data can be backed up to tape, CD-ROM, or optical disk.

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

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