ClaimCore. Putting Customers at the Core of Your Claims Processes. Integrated Customer Database. R es y me. Ad j u d ic ati o n

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1 ClaimCore for Benefis Overview Feaures & Benefis The Core Suie Technology Services/Educaion Conac Us ClaimCore Puing Cusomers a he Core of Your Claims Processes Handle growh wih a rules-based, cusomer-focused workflow ha speeds claims handling and improves compliance Manage claims on new insurance producs Adjus and resolve claims more accuraely in less ime Design and configure he claims soluion layou o mee workflow bes pracices Deliver consisen service levels for claimans flow Com plia nc e Inegraed Cusomer Daabase Wo rk Par of he EIS Suie insurance sofware sysem, ClaimCore helps insurers build a faser, beer, sronger insurance business by enabling hem o: Fr & es s e r v n R es y me Pa EIS Group addresses hese issues wih ClaimCore a configurable claims managemen soluion wih direc access o eligibiliy informaion o allow claims organizaions o be self-sufficien. The sofware provides auomaic and manual ask generaion and assignmen for exreme flexibiliy o design and manage he claims process from beginning o end for adjuser-managed claims as well as auo-adjudicaed claims. By using ClaimCore, insurers can gaher more complee claims informaion, assign claims more efficienly, improve compliance, boos fraud deecion, and sreamline paymen processing. Inake/FNOL ing cor ds au As insurers pursue growh in he volunary markes, heir claims eams mus handle higher volumes of claims on new and changing insurance producs and adminiser hem in less ime, wihou having o burden he employer for eligibiliy informaion. Legacy claims sysems were buil for a differen paradigm and are unable o adap easily o changing business needs. This resuls in a decrease in cusomer saisfacion, which pus growh in he volunary markes a risk. Ad j u d ic ai o n

2 ClaimCore for Benefis Overview Feaures & Benefis The Core Suie Technology Services/Educaion Conac Us ClaimCore Feaures and Benefis Increase Cusomer Saisfacion Respond quickly when your policyholders need you mos. Key feaures include: Auomaion and scrips o speed he gahering of firs noice of loss (FNOL) informaion hrough call cener saff, agens, and adjusers Self-service capabiliies for claimans via a web poral and mobile app Highly configurable workflow for evaluaion and paymens Self-sufficien eligibiliy deerminaion Enhance Claims Oucomes Maximize he effeciveness of your saff. Key feaures include: Abiliy o manage offses wih Social Securiy Disabiliy Insurance and overpaymen recovery Third-pary inegraion o asse reenion and value-add programs o increase uilizaion Inegraed noificaions and correspondences o improve communicaion Inegraed diary and noes o keep your eam informed and ensure follow-up Rule-based escalaion and reassignmen o rive compliance wih Employee Reiremen Income Securiy Ac of 1974 sauory requiremens, and SLAs Rule-based bes pracices and workflow o manage benefi evaluaion and calculaions Srenghen Fraud Deecion Save ime and money by idenifying poenially fraudulen claims. Key feaures include: Fraud scoring wih an inegraed rules engine and/or inegraion wih hird-pary soluions Auomaed flagging and alering of suspicious claims Auomaed rouing of flagged claims o reviewers and he SIU (Special Invesigaion Uni) Improve Operaional Efficiencies Sreamline processes o resolve and pay claims more accuraely in less ime. Key feaures include: Manual or auomaic claims assignmens based on rules ha consider ype, cusomer, complexiy, severiy, or workload Fully suppored auo adjudicaion hrough inegraed workflow and rules Flexible workflows for classificaion, verificaion, confirmaion, and auhorizaion of approvals and paymens, including muliple payees, recurring and supplemenary paymens, and bulk paymens Inegraion wih paymen and check-prining sysems

3 ClaimCore for Benefis Overview Feaures & Benefis The Core Suie Technology Services/Educaion Conac Us There s Power in he Suie The EIS Suie is he indusry s only cusomer-cenered core insurance sysem, and i has been designed from he ground up o suppor muliline, muli-channel, and muli-segmen flexibiliy hroughou he lifeime of cusomer ineracions. Combining a robus plaform wih a family of feaure-rich applicaions PolicyCore, BillingCore, ClaimCore, and CusomerCore he Suie frees you from radiional echnology consrains and pus he power in your hands o creae he produc, disribuion, and cusomer experience differeniaion you need o compee. The Suie is modular, so each core applicaion can be used alone and can be inegraed wih oher insurance sysems, bu leveraging he full power of he unified soluion delivers more benefis han he sum of is pars: EIS Suie Core Applicaions Inegraed Daa Model Agen PolicyCore Documens Mobile Web BillingCore ClaimCore Cusomer360 Conac Cener CusomerCore A modern, open, scalable adminisraive plaform ha suppors muliple insurance segmens Segmen Conen Group & Volunary Benefis P&C Personal Lines P&C Commercial Lines Core insurance processing applicaions ha combine every quoe, policy, bill, claim, conac, and ineracion o deliver a rue 360-degree view of your cusomer Omnichannel suppor, including suie-wide mobile capabiliy A library of specific line-of-business producs and processes Configuraion Facories In-he-Box Services & Tools Producs Workflow & Rules Raing & Pricing Workflow/BPM Business Aciviy Monioring (BAM) Documen Generaion and Mgm. Sub-Ledger Daa Conversion Billing Claims Third-Pary Sysem Inerfaces Analyics & Reporing CusomerCore DXP (Omnichannel) Sysem Admin. & Mgm. Securiy/Privacy Mgm. Sophisicaed configuraion ools o configure and exend he soluion wihou coding Seamlessly embedded services for analyics, business inelligence, business process managemen (BPM), business aciviy monioring (BAM), and documen generaion and conen managemen Robus hird-pary inegraion Abiliy o deploy he sysem on premise or in he cloud Learn more abou EIS Suie on our websie

4 ClaimCore for Benefis Overview Feaures & Benefis The Core Suie Technology Services/Educaion Conac Us Technology Tha s Buil Righ The modular, SOA-based BuilRigh archiecure of EIS Suie is engineered o scale, inegrae, and evolve as your business needs change. In addiion, he Suie can be deployed in he cloud or on premise, whichever bes aligns wih your IT sraegy. Buil o Scale Buil o Inegrae Buil o Upgrade Scale horizonally and verically as your business grows wihou sacrificing performance. A sandard Java EE applicaion wih an open infrasrucure, EIS Suie can be deployed on sandard plaforms o maximize common verical and horizonal scalabiliy paerns using clusering and load balancing. EIS sofware is proven scalable o suppor housands of concurren users and millions of policies, ensuring ha you ll never ougrow i. Ensure ineroperabiliy and inegraion wih exising and fuure echnology invesmens and daa sources. EIS Suie is based on a serviceoriened archiecure (SOA) wih a rich se of applicaion and service programming inerfaces, including pre-inegraed enerprise service bus capabiliies. This archiecure makes i faser, simpler, and less cosly o inegrae wih oher core sysems, business-criical operaional applicaions, and new daa sources as you grow. Configure and exend he sysem wihou modifying he base sofware or impeding your abiliy o deploy fuure upgrades. Our BuilRigh archiecure separaes he base sofware layer from oher funcions, proecing exensions and oher configurable componens during core produc upgrades. The plug and play design also works in he oher direcion, insulaing core operaions from poenial disrupions caused by replacemens and enhancemens o services such as documen managemen. You enjoy he mos curren feaures and funcionaliy, while ensuring opimal performance a all imes. Learn more abou our echnology on our websie

5 ClaimCore for Benefis Overview Feaures & Benefis The Core Suie Technology Services/Educaion Conac Us Your Success Is Our #1 Goal EIS Group offers a full complemen of services and suppor o ensure a successful deploymen, encourage self-sufficien operaions, and proec your echnology invesmen over ime. Professional Services and Suppor Training and Educaion Cloud Services Our services and suppor eams are armed wih he knowledge and skills needed o ensure your ongoing success. Our professional services eam can parner wih your sysems inegraion vendor or in-house IT saff or handle all implemenaion services for you from projec planning o go-live and beyond. Wih each projec, we are focused on he singular goal of a successful deploymen. Leveraging a combinaion of insurance experience, echnical know-how, and proven mehodologies, we can provide a wide breadh of services including projec scoping, program and projec managemen, business analysis, configuraion and developmen, archiecure design, qualiy assurance, cusom inegraion, and full daa inegraion/conversion. We also provide 24/7 pos-implemenaion suppor. We realize self-sufficiency is paramoun, so we provide raining and educaion services where and when you need hem. EIS Group Universiy is our online, always-on source for raining, wih a broad range of on-demand raining videos, assessmens, and produc documenaion for EIS Suie. We complemen our web-based and virual raining wih on-sie insrucor-led raining o accommodae cusomer needs. Wheher virual or insrucor-led, our comprehensive courses are designed o be hands-on and address a range of roles from business users o IT adminisraors. Our cloud services ge you up and running faser and help you improve sysem qualiy before and afer go-live. Used during implemenaion, upgrade cycles, or producion, our cloud-based services are designed o help you improve qualiy, reduce cos, and speed ime o marke. Our soluions accelerae sofware implemenaion and include predefined processes and es cases inegraed wih paen-pending auomaed esing ools ha reduce QA expense while dramaically increasing es coverage. They also provide a secure, high-performance cloud environmen for operaing your producion sysem. Learn more abou cusomer success on our websie

6 ClaimCore for Benefis Overview Feaures & Benefis The Core Suie Technology Services/Educaion Conac Us Compee Wihou Consrain A EIS Group, we believe core insurance sysems should be a source of business freedom, no consrain. Tha means freedom o innovae wih producs and disribuion models and deliver consisen cusomer experiences ha are enriched, no hindered, by echnology. Wih our cusomer-cenered core sysems, you no longer need o rely on cusom code o creae differeniaion or worry ha your sysems will no be able o evolve o mee he changing needs of your business and he marke. Insead, you have he power in your hands o build a uniquely beer, coninuously faser, and forever sronger insurance business. Now, we undersand ha core ransformaion is a complicaed and risky endeavor, bu your success is our number one goal. Through he enire journey and beyond, we will parner wih you o ensure a successful business ransformaion ha delivers boh near-erm benefis and long-erm sraegic flexibiliy. More Informaion? Le s connec and explore how ClaimCore can help build a faser, beer, and sronger insurance business: info@eisgroup.com So, isn i ime o free yourself of your echnology barriers? Choose EIS and posiion your business o sar compeing wihou consrains EIS Group Properies, Ld. All righs reserved. EIS, EIS Group, he EIS Group logo, Powering Insurance Innovaion, BuilRigh, EIS Suie, PolicyCore, BillingCore, ClaimCore, CusomerCore, and Cusomer360 are rademarks or regisered rademarks of EIS Group Properies, Ld., in he Unied Saes and oher counries. ClaimCore-Benefis-2015-v01