DOCOsoft Claims 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 real- time dashboards and regular information reports. www.docosoft.com DOCOsoft | T: +44 (0) 20 7959 2278 | E: [email protected]Claims Management for the London Market
Transcript
DOCOsoft Claims 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 real-time dashboards and regular information reports.
DOCOsoft Claims guides practitioners through the complex route of a transaction passing through the entire claims process.
DOCOsoft Claims 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 �
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 �
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 �
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 & emails �Automated and pre-populated templates for appointment of Experts �Supports Claims Adjusters based remotely allowing customers to handle �claims in regional markets
ECF Module Non-Bureau Module
RoutingDOCOsoft Claims 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 EscalationDOCOsoft Claims 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.
ReassignmentAn 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.
DiaryFor 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.
NotesDOCOsoft Claims 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.
SearchYou 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 CoverA 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 ManagementThe 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 HistoryThe system can display a complete history for a claim and has filters for Movements, Notifications, Diary items, Static Claims and Referral activities.
Sorting and FilteringThe 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 PartiesDOCOsoft Claims 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.
DOCOsoftClaims Features for Handlers
Claims Management
for the London Market
ECF Module Non-Bureau Module
Target Date ProcessingDOCOsoft Claims has the ability to set target processing times for particular transaction types such as:
Manager ApprovalWhere 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 HistoryEvery action that is undertaken is captured within an audit log. This audit history is also available for reporting.
Reporting DOCOsoft Claims 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 ManagementDOCOsoft Claims 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 SystemsData from DOCOsoft Claims can be integrated with internal underwriting systems and data warehouses.
System AdministrationDOCOsoft Claims 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
Linkage to ECF2The 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 PriorityAll 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 �assignedLead, 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 ReportingDOCOsoft Claims 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 transactionsDOCOsoft Claims 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.
Supports Paper and Email Claims FilesDOCOsoft Claims Non Bureau Module can support files submitted in paper or email format which can then be stored automatically to your DMS.
Expert AppointmentsAutomated templates will be created and pre-populated for the appointment of Experts.
Data Input and ExportDOCOsoft Claims 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 remotelyDOCOsoft Claims Non Bureau Module will allow organisations to set up users accessing remotely allowing customers to handle claims in regional markets.
Direct Data Input
DOCOsoftClaims Features for Managers
Claims Management
for the London Market
Broker loads documents to IMR
IMR
ACORD Gateway
(XAG)
DownloadRs Message
Xchanging send a copy of
REQUIREDDocument (s)
UploadRs Message
Xchanging send a copy of
ALLDocument (s)
UPLOAD
Option 1
Option 2
NOTIFICATION
Claim File in Customer or DOCOsoft DMS
DOCOSOFT
DRI
MODULE
Carrier loads any other
documents to claim file
Documents available to all
authorised parties
The Complete C la ims Solut ion for the London Insurance Market
ECF Claims
DOCOsoft ClaimsFor Claims Managers
DOCOsoft ClaimsFor Claims Handlers
DOCOsoft ClaimsFor Carriers
Geo Location Module
Claims Workflow KPI Reporting Module
Templates ModuleCRM Module
Timeline DashboardsIntegrated Administrators
Configuration
Non Bureau Claims
Integrated Document Management
Integrated Underwriting interface
MI Reporting Module
ACORD DRI Module
Email Management
MS Office Integration Explorer
InternetIMR / ECF Documents
DOCOsoft DMS SharePoint
Supporting Lloyd’s Claims Metrics
Claims Management Solution Building Blocks
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 DOCOsoft Claims Management solution modules and it demonstrates our ability to fill the business requirements in today’s marketplace.
Technology
DOCOsoft Claims 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.
Claims Management Solution
Claims ManagementSolution Building Blocks
Broker loads documents to IMR
IMR
ACORD Gateway
(XAG)
DownloadRs Message
Xchanging send a copy of
REQUIREDDocument (s)
UploadRs Message
Xchanging send a copy of
ALLDocument (s)
UPLOAD
Option 1
Option 2
NOTIFICATION
Claim File in Customer or DOCOsoft DMS
DOCOSOFT
DRI
MODULE
Carrier loads any other
documents to claim file
Documents available to all
authorised parties
The Complete C la ims Solut ion for the London Insurance Market
ECF Claims
DOCOsoft ClaimsFor Claims Managers
DOCOsoft ClaimsFor Claims Handlers
DOCOsoft ClaimsFor Carriers
Geo Location Module
Claims Workflow KPI Reporting Module
Templates ModuleCRM Module
Timeline DashboardsIntegrated Administrators
Configuration
Non Bureau Claims
Integrated Document Management
Integrated Underwriting interface
MI Reporting Module
ACORD DRI Module
Email Management
MS Office Integration Explorer
InternetIMR / ECF Documents
DOCOsoft DMS SharePoint
Supporting Lloyd’s Claims Metrics
CRM Module Geo Location Module
Document Templates Module KPI Reports Module
Documents from the Insurers Market Repository �Automatic download using ACORD Standards �Policy and Claims Documents �Documents in original formats (MS Office Word or Excel, Email with �attachments, PDF, etc.)
Loaded directly to folders in your Document Management System �Metadata included �Full Claims Files available to all business units �
Supports Enterprise DOCOsoft DMS 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 Documents quickly �Interface from ECF2 IMR with ACORD standard DRI �Plugins for MS Outlook and Lotus Notes, MS Office suite, Internet Explorer �and Adobe PDFScanning solution for paper document storage �
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 �Update accurate claims financials �
Automatic Delivery of IMR Documents
Claims Customer Relationship Management �systemRecording of Claims Client Visits and Claims �MeetingsAttach Claims Files to a Client Visit �MI Reporting Tools �Interface to UW system �
Generation of location aware risk intelligence �Seamless and quick viewing of risk information �Claims location specific pop up data �Selection tools for data analysis �
Automatic Generation of Market Claims �DocumentsLarge Loss Notification Reports, Claims File �Reports, Peer Review Reports, Expert & 3rd Party ReportsCustomisable Template Design �
Generation of Market MI Report Documents �New Easy to Read Reports �Meets the Lloyd’s Principles and Minimum �Standards Meets the Lloyd’s Claims Reporting Suite �Standards
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.
Document Management Underwriting System Interface
Claims Management Solution
Geo Location Screen
KPI Report
Claims ManagementSolution Building Blocks
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.
DOCOsoft would like to thank the following organisations for their continued support in the use of our claims and document management solutions:
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.
