Claims Management for the London Market

Transcription

1 for the London Market is a complete lifecycle claims solution, driving efficiencies and speed of handling claims. It guides claims handlers through the complex process of dealing with the progress of a transaction through the entire claims process. It informs and alerts claims managers and senior executives by providing vital claim operating information through realtime dashboards and regular information reports. DOCOsoft T: +44 (0) E: information@docosoft.com

2 for the London Market guides practitioners through the complex route of a transaction passing through the entire claims process. Management Solution Overview Data driven claims lifecycle Displays real time information on claims Customised workflow routing Target Date Processing Diary, Notes and Calendar functions Static Claims Management Interfaces to Underwriting systems and DMS Management of Third Parties ECF Module Direct link to ECF2 Claims Agreement Screens (CAS) Rules defined by Syndicate, Class of Business and Risk Code or Risk Code Group Supports Lloyds Claims Metrics Reporting Lloyd s CTP 2012 compliant SCM reconciliation Full search capabilities Above authority claims referrals Manager Approval & Peer Review Standard and Bespoke Reporting Audit history KPI Reporting Separate process for Lead, Agreement Party and Follow claims Takes hourly Claims Workflow Triggers Non-Bureau Module Supports paper Claims Files Manual Data Input or interface to UW system Data Export to Financial Systems DMS interface for storage of paper claims documents & s Automated and pre-populated templates for appointment of Experts Supports Claims Adjusters based remotely allowing customers to handle claims in regional markets DOCOsoft Claims Features for Handlers Routing allows claim transactions to be routed to particular adjusters. Routing requirements can be: Role (Lead, Second Lead or Follow) Syndicate, Class of Business and Risk Code a previously allocated adjuster. the Syndicate Share of the financial values the Incurred Movement of the claim Process Workflow Engine Automatic Claims Escalation incorporates a claim escalation process. For each user there is a hierarchy of escalation limits and when the total syndicate incurred claim value exceeds such a point, a separate work stream is generated for the appropriate manager. Reassignment An adjuster can re-assign an item to another colleague if it is more appropriate for them to manage the claim. The permanent re-assignment ensures that all future movements on the same UCR will go to the new adjuster. Diary For each item, the user can choose to enter a diary entry. A diary reminder appears in the handler s workflow inbox on the predetermined day. Notes has the ability for an adjuster to add and store notes against a particular transaction. The specific notes that are included for transfer and escalation are also retained within the system. Search You can easily search for claims items in the Claims Management System. Search criteria can be based on many fields including UCR, Risk Code, Class of business etc. Holiday Absence Cover A simple calendar entry can be made to temporarily allocate claims to another user during periods of absence. Users can set up their own holiday cover entries, and a manager role can also create entries for other users. Static Claims Management The system has the ability to display a list of claims on which there has been no movement for a configurable period of time. Claims File Central Claims History The system can display a complete history for a claim and has filters for Movements, Notifications, Diary items, Static Claims and Referral activities. Sorting and Filtering The system can sort and filter items in an adjuster s inbox based on various criteria. A UCR filter can just list all activities for the one claim. Management of Third Parties allows for details relating to third party appointment to be held against the claim transaction. The system holds a drop down list of approved third parties including Brokers and Experts.

3 for the London Market DOCOsoft Claims Features for Managers Target Date Processing has the ability to set target processing times for particular transaction types such as: 1st advice Advices Settlements Large Settlements (value configurable) CTP Triage category ECF Indication Manager Approval Where entries are above authority the class line manager needs to be able to review the entry and this can be based on the syndicate share of the total incurred value or other rules. Audit History Every action that is undertaken is captured within an audit log. This audit history is also available for reporting. Reporting supports a level of KPI reporting and graphical management dashboards including Daily intake Claims handled within target, outside target Claims Timelines Claims awaiting within target, outside target Individual and Team KPIs It is possible to drill down to individual data items. These dashboards are available to all users requiring reporting capabilities and are controlled through user permissions. Workflow Management allows management users to view adjuster s worklists and has the ability to transfer items from an adjusters work basket to another. A note can be applied to support this transfer. Integration with Internal Systems Data from can be integrated with internal underwriting systems and data warehouses. System Administration includes an administration function to allow syndicate management to manage the rules engine to support the workflow functionality. Only certain users have the ability to maintain these functions. This includes the ability to Maintain operator settings Amend routing rules Amend escalation routes Amend escalation limits Amend Peer Review rules Add or amend Brokers and Experts Claims Dashboard ECF Module Linkage to ECF2 The workflow system has a simple link to the transaction within the Claims Agreement Screens (CAS) within ECF2. Case Management (Follow Me) Subsequent claims transactions within a UCR will be automatically routed to the adjuster that handled the previous transaction. Claims Priority All tasks have a priority which is displayed with Traffic Lights colours based on various target date processing conditions such as Number of days since claim task has been assigned Lead, Second Lead, or Follow CTP Triage category The system also has the ability to allow users to manually send claims for Peer Review. Manually selected claims will behave as above. Supports Lloyd s Claims Metrics Reporting provides reporting to support the Lloyd s Principles and Minimum Standards. Peer Review Based on pre-defined business rules, claims are automatically selected for peer review. Items that require peer review will appear in the handler s Outstanding inbox. Non Agreement Party transactions routes non agreement party claims in the same manner as those that require agreement but are sectioned separately within the workflow display. If a syndicate is subsequently selected as a second agreement party the transaction will automatically transfer to the claims awaiting action list and apply all of the target date rules. Follow Claims Review Similar to Peer Review, based on pre-defined business rules, a Follow claim can be selected for follow claim review. Non-Bureau Module Supports Paper and Claims Files Non Bureau Module can support files submitted in paper or format which can then be stored automatically to your DMS. Expert Appointments Automated templates will be created and prepopulated for the appointment of Experts. Data Input and Export can provide input from your Underwriting System or by direct manual data entry and data can be exported to your Financial Systems. Supports Claims Adjusters based remotely Non Bureau Module will allow organisations to set up users accessing remotely allowing customers to handle claims in regional markets. Direct Data Input

4 Broker loads documents to IMR Claims Management DownloadRs Message IMR Option 1 Solution REQUIRED ACORD Building Blocks NOTIFICATION Gateway (XAG) UPLOAD Option 2 Claims Management Solution Building Blocks UploadRs Message ALL DOCOSOFT DRI MODULE Carrier loads any other documents to claim file Claim File in Customer or available to all authorised parties All of DOCOsoft s systems have been developed in a modular fashion to enable companies to tailor the components as a best fit for their different requirements. The following shows an overview of the Management solution modules and it demonstrates our ability to fill the business requirements in today s marketplace. Claims Management Solution The Complete Claims Solution for the London Insurance Market For Carriers For Claims Handlers For Claims Managers Claims Workflow ECF Claims KPI Reporting Module Integrated Administrators Configuration Non Bureau Claims Integrated Document Management Timeline Dashboards SharePoint Integrated Underwriting interface Management MS Office Integration IMR / ECF Internet Explorer MI Reporting Module ACORD DRI Module CRM Module Templates Module Geo Location Module Supporting Lloyd s Claims Metrics Technology is a browser based application that does not require installation of local components to run. The architecture uses standard Microsoft.NET technology and Microsoft SQL Server Databases which makes the solution extremely scalable.

5 Solution Building Blocks Automatic Delivery of IMR DOCOsoft now provide a facility where Carriers can get an automatic download of all documents loaded to the Insurers Market Repository on risks in which they participate. from the Insurers Market Repository Automatic download using ACORD Standards Policy and Claims in original formats (MS Office Word or Excel, with attachments, PDF, etc.) Loaded directly to folders in your Document Management System Metadata included Full Claims Files available to all business units Broker loads documents to IMR Carrier loads any other documents to claim file IMR Option 1 NOTIFICATION ACORD Gateway (XAG) UPLOAD Option 2 DownloadRs Message REQUIRED UploadRs Message ALL DOCOSOFT DRI MODULE Claim File in Customer or available to all authorised parties Document Management Supports Enterprise and SharePoint DMS Seamless integration of Claims System & Document Management System In-house Electronic Claims Folder Structure Supports Automatic IMR documents & Manual document upload using Outlook, Word, Excel etc. View specific Claims quickly The Interface Complete from ECF2 IMR with Claims ACORD standard Solution DRI for the Update London accurate claims financials Insurance Market Plugins for MS Outlook and Lotus Notes, MS Office suite, Internet Explorer and Adobe PDF Scanning solution for paper document storage OCOsoft Claims For Carriers CRM Module Claims Customer Relationship Management Claims Workflow system Recording of Claims Client Visits and Claims Meetings Attach Claims Files to a Client Visit Integrated Administrators Configuration MI Reporting Tools Interface to UW system For Claims Handlers Geo Location Module Generation ECF of location Claims aware risk intelligence Seamless and quick viewing of risk information Claims location specific pop up data Selection tools for data analysis Non Bureau Claims Integrated Document Management Underwriting System Interface Supports all standard London Market Underwriting Systems Links the claims file to Policy Information Automatic retrieval of Policy information for the claims file Data Validation of the Claims File Seamless interface SCM reconciliation For Claims Managers Geo Location Screen KPI Reporting Module Timeline Dashboards Document Templates Module KPI Reports Module SharePoint Integrated Underwriting interface MS Office IMR / ECF Internet Automatic Generation of Market Management Claims Generation Integration of Market MI Report Explorer New Easy to Read Reports Large Loss Notification Reports, Claims File Meets the Lloyd s Principles and Minimum Reports, Peer Review Reports, Expert & 3rd Standards ACORD DRI Module Geo Location CRM Module Templates Module Party Reports Meets the Lloyd s Claims Reporting Suite Module Customisable Template Design Standards KPI Report MI Reporting Module Supporting Lloyd s Claims Metrics

6 London Market DOCOsoft in the London Insurance Market DOCO CMS has built up an impressive portfolio of customers in the London Market and continues to engage with both Lloyd s and IUA Company carriers to promote a bespoke solution that will help them achieve the same benefits as our existing clients. About DOCOsoft DOCOsoft is an innovative developer of document management and workflow software solutions for the global insurance and financial services markets. The company s pedigree is well established in the UK and our software is widely used in the London Insurance Market, where we provide highly-effective claims management, document management, scanning, and connectivity solutions. With over 15 years experience in the London Insurance market, our innovative, cost effective solutions are continuously improved to keep pace with the many changes in the market place, and this is reflected in our ever expanding client base. DOCOsoft would like to thank the following organisations for their continued support in the use of our claims and document management solutions: DOCOsoft T: +44 (0) E: information@docosoft.com