Life Insurance Claims Vendors in North America: Evaluating ... Group Life... · Technology vendors...

© 2018 Aite Group LLC. All rights reserved. Reproduction of this report by any means is strictly prohibited. Photocopying or electronic distribution of this document or any of its contents without prior written consent of the publisher violates U.S. copyright law, and is punishable by statutory damages of up to US$150,000 per infringement, plus attorneys’ fees (17 USC 504 et seq.). Without advance permission, illegal copying includes regular photocopying, faxing, excerpting, forwarding electronically, and sharing of online access.

Life Insurance Claims Vendors in North America: Evaluating Stand-Alone Systems

MARCH 2018

Samantha Chow

Life Insurance Claims Vendors in North America: Evaluating Stand-Alone Systems MARCH 2018

© 2018 Aite Group LLC. All rights reserved. Reproduction of this report by any means is strictly prohibited. 101 Arch Street, Suite 501, Boston, MA 02110 • Tel +1.617.338.6050 • Fax +1.617.338.6078 • [email protected] • www.aitegroup.com

2

TABLE OF CONTENTS IMPACT POINTS .............................................................................................................................................. 3

INTRODUCTION .............................................................................................................................................. 4

METHODOLOGY ........................................................................................................................................ 4

AIM COMPONENTS ......................................................................................................................................... 5

THE MARKET ................................................................................................................................................... 7

AUTOMATION THROUGH WORKFLOW AND RULES ................................................................................. 7

CREATING OPERATIONAL EFFICIENCIES .................................................................................................... 8

A DIGITAL MOVEMENT ............................................................................................................................. 9

SEAMLESS INTEGRATION ........................................................................................................................ 10

ANALYTICS AND REPORTING ................................................................................................................... 11

KEY FUNCTIONALITY AND MARKET ANALYSIS .............................................................................................. 13

AIM RATINGS ................................................................................................................................................ 15

AIM COMPONENT ANALYSIS................................................................................................................... 15

AIM AWARDS .......................................................................................................................................... 16

EIS GROUP ............................................................................................................................................... 22

CONCLUSION ................................................................................................................................................ 24

RELATED AITE GROUP RESEARCH ................................................................................................................. 25

ABOUT AITE GROUP...................................................................................................................................... 26

AUTHOR INFORMATION ......................................................................................................................... 26

CONTACT ................................................................................................................................................. 26

LIST OF FIGURES FIGURE 1: AIM KEY COMPONENTS ................................................................................................................. 5

FIGURE 2: KEY FUNCTIONALITY TRENDS ....................................................................................................... 13

FIGURE 3: AIM COMPONENTS ANALYSIS BY HEAT MAP .............................................................................. 15

FIGURE 4: AIM .............................................................................................................................................. 17

FIGURE 5: AIM—INTEGRATION .................................................................................................................... 18

FIGURE 6: AIM—WORKFLOW ....................................................................................................................... 19

FIGURE 7: AIM—DIGITAL CAPABILITIES ........................................................................................................ 20

FIGURE 8: AIM—OPERATIONAL .................................................................................................................... 21

FIGURE 9: AIM—ANALYTICS ......................................................................................................................... 22

LIST OF TABLES TABLE A: THE MARKET .................................................................................................................................... 7

TABLE B: VENDOR INFORMATION ................................................................................................................ 14



3

IMPACT POINTS

Claims solutions are typically part of a larger core policy administration system (PAS),

making solutions that can stand alone and integrate with other core systems a key

opportunity for life insurance carriers to transform the claims operation. This report

utilizes the Aite Impact Matrix (AIM) methodology to compare stand-alone claims

vendors supporting North American life insurance carriers in their overall

competitive position, focusing on vendor stability, client strength, product features,

and client services.

Stand-alone claims vendors supporting North America have strong solutions to

support the basic needs for claims processing. Key differentiators can be found when

closely comparing functions and features to support digital transformation,

analytics, and automation.

Workflow and rules are key to successful claims processing, and vendors in this

space offer little differentiation and solid support. The key area of differentiation is

in configuration options that include templates rather than require users to start

configuration from scratch.

Stand-alone claims solutions offer great support to reduce operational costs.

Automating processes to reduce costs in the claims department is done through the

use of robotics process automation (RPA) and chatbots, yet very few vendors

support these tools.

Most vendors understand the need for digital transformation and have a solution to

fit the basic digital needs of the claims process. Where many fall short is the ability

to provide a device-agnostic solution, offer group employer portals, and accept e-

signature.

Not all stand-alone claims vendors allow for full mobile claims processing, but all

recognize the need for and provide the mobile support for submitting the first notice

of loss (FNOL).

Claims vendors provide strong reporting capabilities to support business intelligence

and basic descriptive analytics. Most lack the ability to support more advanced

predictive and prescriptive analytics or unstructured data to support testing or other

actuarial or underwriting functions.



4

INTRODUCTION

As more of a back-office function in comparison to front-office, customer-facing technologies

and processes, claims has not yet been given much attention by life insurance carriers. As the

U.S. life insurance industry starts to shift its focus to include back-office operations, claims is

becoming a primary focus. The new attention to claims is occurring because of two main

reasons, the first being operational cost. Claims processes are old and very manual, driving up

the cost of operations in this area for the life insurance carrier. The second key driver is the

customer experience, or the beneficiary experience in the claims scenario. The very manual

process of submitting a claim is driving a poor experience for the beneficiary and can impact the

speed at which a claim is paid. Life insurance carriers are looking to develop more digital claims

processes to support the beneficiary experience as well as to improve on the operational costs.

One of the main challenges carriers face as they consider updating or improving tools within

their technology ecosystem or their core PAS is the inability to tackle only one component of the

system, such as claims, at a time. Many core PAS tools available in the U.S. do not allow for their

claims solutions to stand alone, pushing U.S.-based life insurance carriers to maintain the

solutions they have and create workarounds to improve the process. This lack of a stand-alone

option is impeding carriers’ ability to improve processes and the customer experience.

Life insurance carriers in the U.S. looking to improve their current tools to reduce operational

costs, support digital capabilities and analytics, and improve the overall beneficiary experience

without the cost of replacing a core PAS have limited options. A handful of technology vendors

recognize the need to support the U.S. life insurance industry’s mission to upgrade claims tools.

These vendors also recognize the carriers’ inability or refusal to invest in a complete PAS. This

Impact Report provides a detailed assessment of the technology vendors that support the U.S.

life insurance industry with a stand-alone core claims system. The vendors analyzed in this report

are EIS Group, FINEOS, Intellect SEEC, Oracle/Equisoft, and Vitech.

METHODOLOGY

Leveraging the AIM, a proprietary Aite Group vendor assessment framework, this Impact Report

evaluates the overall competitive position of each vendor, focusing on vendor stability, client

strength, product features, and client services.

This research is based on 24 qualitative Aite Group interviews and quantitative surveys with life

insurance IT executives and with technology vendors currently offering a stand-alone life

insurance claims solution in the U.S. IT executives at top life and annuity companies provided

input on their current strategies and views on the challenges they face with regard to claims and

integrations, and they completed client reference check surveys.

Technology vendors were provided a request for information (RFI) and required to provide high-

level demos providing an overview of their solution, including their key strengths, underlying

technology, and key differentiators, and completed a full quantitative survey. To be included in

the report, vendors must have at least one U.S.-based carrier actively utilizing the claims

solution, and it must be able to be integrated as a stand-alone tool rather than only as a part of a

larger PAS.



5

AIM COMPONENTS

The AIM comprises four key components (Figure 1).

Figure 1: AIM Key Components

Source: Aite Group

V E N D O R S T A B I L I T Y

The vendor stability component evaluates the overall strength of the vendors in terms of

financial stability, management reputation, risk management, and global presence. This

component determines whether a given vendor has the basic foundation to compete and

sustain its overall market presence.

C L I E N T S T R E N G T H

The client strength component focuses on the number and diversity of customers, the vendor’s

reputation among the clients, and overall customer turnover. This component measures whether

a given vendor has a strong foundation of clients and a robust client pipeline to sustain its

growth trajectory.

P R O D U C T F E A T U R E S

The product features component analyzes the key features and functionality of vendor solutions

and services, including implementation options, user experience, and the strength of the future

product roadmap. This component measures whether the vendor offers enough key features

and functionality to remain competitive.

• Number of clients• Diversity of clients• Diversity of products• Client turnover• Vendor reputation

• Number of employees• Quality of management• Risk management• Office presence• Financial stability

• Key features• Implementation options• Ease of user experience• Ease of implementation and

integration

• Level of support and service

• Training programs• Online support• Pricing structure• Perceived value of product

AIM

Vendor stability

Product features

Client strength

Client services



6

C L I E N T S E R V I C E S

The client services component evaluates the pricing structure and its various attributes as well as

the comprehensive nature of the vendor’s client support and service infrastructure. This

component measures whether the vendor provides robust service and support to provide real

value to the clients.



7

THE MARKET

Legacy claims systems are crippling life insurance carriers’ ability to advance the way they handle

claims and meet customers’ expectations. As customer experience is high on the list of priorities

for life insurance carriers in North America and globally, carriers are focused on solutions

designed to meet consumers’ demands and provide a top-level customer experience. Functions

such as workflow and rules, digital capabilities, and analytics and reporting are key to creating

the right customer experience while also supporting the need to reduce the operational costs

that are rising because of outdated processes (Table A).

Table A: The Market

Market trends Market implications

Need for advanced automation through workflow and rules

Carriers have been utilizing workflow tools and minimal rules to support a better operational process and to speed up the end-to-end claims process, but it hasn’t been enough to provide extensive automation. Without utilizing a combination of the two tools, carriers will not meet the automation goals they strive to attain.

Mandate to improve operational inefficiencies

Operational costs continue to drive down life insurance carriers’ profits. The claims department’s manual and paper-driven processes must be improved by using tools that monitor processes closely or provide streamlined automation, such as RPA and chatbots, or carriers risk a continued rise in operational expenses.

Push for digital capabilities to support customer experience

Customers demand the anywhere, anytime experience, and carriers fall short of providing this in the life insurance claims process. Without digital technologies, the customer experience will continue to decline.

Demand for seamless integration both internally and with external data sources

The number of systems within the carriers’ technology ecosystem continues to rise as does the number of third-party data sources, driving the need for integration. Limited integration within the ecosystem limits the carrier’s ability to use analytics, automate, and create efficiencies.

Desired improvements in analytics and reporting for process improvement and predictive analysis

Carriers are using analytics across the organization, but, because of their legacy systems, they struggle to use it properly.

Source: Aite Group

AUTOMATION THROUGH W ORKFLOW AND RULES

The cost of handling life insurance claims has increased over the years, driven by manual

processes and regulatory mandates. Over time, carriers have implemented workflow tools to

help streamline and manage the process, but workflow isn’t enough on its own. Even workflow

tools can require a lot of manual intervention to ensure agents are supporting equal workloads.

Integrating rules engines along with workflow helps to support the automation of certain



8

processes and eliminate manual intervention. Life insurance carriers are moving toward

automated claims payments to speed up the payment process where applicable, and without

the rules and workflow combination, this type of automation is not possible.

Claims solutions have refined these tools over time and are developed to pay claims via a

straight-through process. Where these solutions differ is in their ability to configure basic

templates and to configure workflow. In all cases, a business analyst can support the

configuration of workflow, but not entirely on his or her own. An IT/technical person is usually

still needed to support configuration.

Key workflow capabilities supported include the following:

User tasks

Picking tasks

Picking tasks from a shared list

Routing

Creation of activities

Rules engine

Workload management

Supported methods of workflow configuration are as follows:

Rules configuration

Templates

Wizard-based configuration

Skill sets needed to configure workflow follow:

Subject-matter expert

Business Analyst

IT/technical

CREATING OPERATIONAL EFF IC IENCIES

Continuing on the theme of reducing costs, life insurance carriers have been focusing on creating

efficiencies across the organization. The claims operation is not immune to these struggles with

inefficiency. Carriers have worked to improve processes by implementing workflows and have

eliminated unnecessary bottlenecks over time, but even these changes have not had the desired

impact.

Most U.S. stand-alone claims solutions support the necessary functions to improve the claims

process and reduce the cost of operations for this area. They provide cycle-time tracking for



9

continuous improvement as well as automated communications to support straight-through

processing. Where carriers will find the most opportunity to support automation however, is

through the use of RPA and chatbots. This is where stand-alone claims vendors differ in their

ability to support the life insurance industry. Very few incorporate the use of RPA or chatbots,

yet they recognize the benefits that these features can provide the carrier. Some vendors have

these items on their roadmaps for future implementations.

Key functional support for operational efficiencies include the following:

Cycle-time tracking

Automated communication to customer

Automated claims payout

Use of RPA

Use of Chatbots

Agent skillset tracking

Agent product capabilities tracking

Agent role-based tracking

Agent rights and permissions tracking

Agent access control

A DIGITAL MOVEMENT

Carriers have two needs that move them toward a more digital claims process. The first is to

reduce the operational costs within a highly manual process area. Processes are outdated and

typically handled completely through human interaction. The movement to more digital

processing allows carriers to reduce manual handling, automate some processes, and handle

claims more quickly.

The second opportunity carriers are looking for with digitization is the ability to create a positive

customer experience. During the time of loss, consumers do not want to have to interact with

someone or deal with manual processes. A digital, self-managed claims process supports the

anywhere, anytime experience consumers are looking for. Providing a digital solution enables

the consumers to manage and track their own claims at their convenience.

Most stand-alone claims solutions in the U.S. provide the basic tools needed to support a digital

claims experience, such as uploading documents or accepting the FNOL via websites or mobile

apps. They lack the ability to accept e-signature for documents as well as digital group/employer

portals. More importantly, though, is that carriers admit to a failure to use the digital tools these

solutions make available to them.



10

Key digital capabilities supported include the following:

Digital upload of claims documents

Digital claims FNOL

Automated email notifications

Device agnostic

Mobile app ready

E-signature

Customer web portal

Agent web portal

Group employer portal

Key mobile capabilities supported include:

Text notifications

Mobile scanning and upload of documents

Mobile picture upload

FNOL

Death claim

Claim status

E-signature

Android-capable

IOS-capable

SEAMLESS INTEGRATION

The legacy systems that plague most life insurance carriers hinder the integration with most

stand-alone technology systems. All types of technology vendors have had to overcome the

challenge of integrating with many different types of legacy systems across the life insurance

technology ecosystem, claims vendors included. In addition to the many different legacy systems

life insurance carriers house, the number of third-party data providers supporting the claims

process has grown over time, and automating the inclusion of those data elements into the

claims process is necessary to maintain or reduce cost.

Stand-alone claims solution vendors understand the value of integrating with multiple systems

across the life insurance technology ecosystem as well as with third-party data providers. Where

they fall short is in their ability to integrate with third-party artificial intelligence (AI) tools and



11

third-party chatbots. While these are more advanced features, the ability to integrate and

provide a fully automated and scalable solution sets some vendors apart.

Integration support features include integration with the following:

Other core systems

Document management systems

Built-in document management systems

Medical Information Bureau (MIB)

Death master file

State-specific data systems

Real-time third-party data integration

Batch third-party data integration

Single sign-on

Carriers’ security layers

AI tools

RPA tools

Chatbots

Pre-integrated with third-party AI tools

Pre-integrated with third-party chatbots

ANALYTICS AND REPORTING

Life insurance carriers have invested a lot of time and money into analytics and reporting

capabilities across the organization. Basic reporting and business intelligence has been utilized in

claims to support business improvement and to track claims-agent production. The use of more

advanced analytics, such as predictive and prescriptive analytics, to support automation in the

claims area has only just begun.

Stand-alone claims vendors have strength in supporting the life insurance industry’s basic

reporting needs. Vendors understand the need for many different types of reports and

dashboards to help the claims department be successful. Agent reporting and financial reporting

are shortcomings for some vendors, however. Advanced analytics support is also an area in

which stand-alone vendors need to develop, as very few offer features beyond basic descripting

analytics, including the ability to utilize unstructured data. It is noted that analytics is another

key roadmap item for stand-alone claims vendors.



12

Available reporting functions follow:

3-D visual reports

Business intelligence

Agent reports

Basic dashboards

Graphical reporting dashboards

Audit reporting

Financial reporting

Ad hoc reporting

Self-documenting for audit and regulatory reporting

The following analytical capabilities are available:

Descriptive analytics

Predictive analytics

Prescriptive analytics

Unstructured data for analytics

Analytics to support testing



13

KEY FUNCTIONALITY AND MARKET ANALYSIS

There isn’t much differentiation across the vendors in this market, so some minimum

requirements must be met to sustain the basic needs of the life insurance industry. These

minimum requirements are the same across the globe and are typically found in nearly all

vendors in this region (Figure 2). Some key competitive differentiators and next-generation

functionality will set vendors apart. Competitive differentiators might not be attractive to all

potential clients but could mean the difference for those firms looking for specific functionality.

Features noted as next-generation could become the standard industry practice within a decade;

on the other hand, they could be completely ignored.

Figure 2: Key Functionality Trends

Source: Vendors, Aite Group

Most vendors in the U.S. are offering a claims solution that is part of a larger core PAS. Stand-

alone solutions, or solutions that can be used independently of the full-scale PAS, are few and far

between. The vendors in this space recognize the need to offer the claims component free and

clear of the PAS. Some of these vendors have been around for many years and have grown their

clientele within the U.S., such as FINEOS and Oracle/Equisoft, while others are younger or newer

to the U.S. and are growing their client bases, such as EIS Group or Intellect SEEC.

Minimum requirement

Competitive differentiators

Next generation

• Support of individual and group individual on a single platform

• Self-service portals for agents and consumers

• Straight-through processing

• Rules configuration and workflow tools

• Operational and audit reporting

• Ability to integrate with other core systems

• Automated third-party data collection

• Ability to run in real time and batch

• Customer web portals• Web and mobile

acceptance of FNOL and documents

• Automated communication

• 24/7 global support• Single platform for

multiple countries, currencies, and languages, and all lines of business

• Cloud implementation• E-signature • Consumer and agent

dashboards• Agent web portals• Device-agnostic• Digital

communications• Third-party

administrator options• Predictive analytics• Financial reporting

• Blockchain• Advanced analytics

and machine learning• RPA or chatbot

integration• Use of unstructured

data for operations and analytics

• Minimum requirement: Basic list of functionalities considered competitive requirements

• Competitive differentiators: List of functionalities that might not be attractive to all potential clients but could mean the difference for those firms looking for specific functionalities

• Next generation: List of ambitious functionalities that could become the standard industry practice within a decade or, on the other hand, that could be completely ignored



14

Each of the stand-alone claims tools have similar functions and features, and some stand out

with certain strengths. The technology alone isn’t going to drive a carrier’s decision on which

vendor is the best option; culture plays a very important role in that decision as well. A vendor’s

makeup, including location and product support, can play into the vendor selection process.

Table B introduces who these vendors are, how long they have been established, and their

ownership, all of which can have an impact on a carrier’s perception of the bet cultural fit.

Table B: Vendor Information

Vendor Headquarters Product name Established Ownership

EIS Group San Francisco ClaimCore 2008 Private

FINEOS Dublin FINEOS Claims 1993 Private

Intellect SEEC Jersey City, New Jersey Intellect Claims 2003 Public

Oracle/Equisoft Redwood City, California/Montreal

OIPA 1997/1994 Public/Private

Vitech New York V3 1986 Private




15

AIM RATINGS

This section will break down the individual AIM components, calling out the vendors that are

strong in each area and how they are differentiated in the market.

AIM COMPONENT ANALYS IS

Figure 3 overviews how each vendor scored in the various areas of importance. Each vendor is

rated based on its own information as well as by its clients’ feedback to support a

multidimensional rating. The AIM helps to identify those that are best-in-class or still have areas

for development.

Figure 3: AIM Components Analysis by Heat Map


V E N D O R S T A B I L I T Y

Intellect SEEC stands above all other stand-alone claims vendors in the category of vendor

stability, scoring 100% (Figure 3). It is a large company with a global presence that is committed

to investing in R&D for its life insurance products. Intellect SEEC’s clients are also very satisfied

with its management team.

Other leaders in this category falling not far behind at 92% and 91%, respectively, are EIS Group

and FINEOS. Both are smaller than Intellect SEEC but have a global presence, strong commitment

to R&D investment, and strong support from clients.

C L I E N T S T R E N G T H

Under the category of client strength, FINEOS stands out among all vendors at 98% (Figure 3).

FINEOS has a large number of U.S. clients, supports all life product types (including long-term

care, which is a key differentiator). It also has strong client references as it relates to vendor

reputation.

Other vendors, such as EIS Group and Intellect SEEC, have strong solutions but are just now

building their stand-alone claims customer base, resulting in lower scores.

C L I E N T S E R V I C E S

The client service category is one in which all vendors have room for development and

improvement. Development areas within this category are 24/7 support, user working

VendorsVendor

stability

Client

strength

Client

service

Product

features

EIS Group 92% 64% 74% 87% Legend:

FINEOS 91% 98% 80% 84% 91% - 100%

Intellect SEEC 100% 71% 85% 81% 81% - 90%

Oracle/Equisoft 88% 88% 89% 81% 65% - 80%

Vitech 83% 82% 72% 84% < 65%

Best in class

Emerging



16

groups/client forums, and pricing structures. The Oracle/Equisoft team stands only a few

percentage points below best-in-class territory at 89%, with Intellect SEEC falling only four

percentage points below that at 85% (Figure 3).

P R O D U C T F E A T U R E S

Claims vendors, whether their products are stand-alone or part of a larger PAS, are less likely to

show much differentiation when it comes to product features. These vendors make it their

business to know and understand the claims process and create an efficient, smooth, and

streamlined approach to supporting the claims department. Stand-alone claims vendors, also

typically part of a larger PAS solution, understand the need for improved customer service in

addition to reduced operational cost and need to be digital. With that said, vendors form a tight

cluster in the product features category, with EIS Group scoring the highest at 87% (Figure 3).

Outside of EIS Group’s score on key features and functionality, one key differentiator in this

category is its ability to act as a TPA.

AIM AWARDS

Each U.S. life insurance carrier looking to focus its efforts on improving the claims operation and

process will have very different objectives. Life insurance carriers will be looking for stand-alone

claims vendors to help them solve their challenges related to digitization, workflow, data

integration, cost control, and analytics.

When looking at product performance, which combines product features and client service, and

vendor strength, the stand-alone claims vendors provide a strong front. These stand-alone

vendors all perform similarly and cluster close together. The Oracle/Equisoft team, however,

stands out a bit because of its strong client service offering and analytical capabilities as well as

its solid product features and functionality (Figure 4).



17

Figure 4: AIM


With so many similarities among these stand-alone claims vendors, it is important to call out

those that are differentiating themselves in carriers’ key challenge areas. The feature-specific

prizes are awarded because of holistic, qualitative analysis of features that are innovative or

differentiating, which the figures might not reflect.

A W A R D F O R M O S T C O M P R E H E N S I V E I N T E G R A T I O N : E I S G R O U P

Integration is key for life insurance carriers in North America, as most have many different core

systems across their technology ecosystems. In the area of integration, EIS Group stands out as

best in class (Figure 5). EIS Group offers all of the necessary integration functions and features

for a life insurance carrier. It stands out in its investment in and dedication to AI and chatbots to

support the claims process. EIS Group’s claims solution, ClaimCore, comes preintegrated with

third-party tools that support both AI and chatbots.

FINEOS also stands out as a strong solution for integration. FINEOS falls short of EIS Group in its

inability to support chatbots. While FINEOS does offer integration for systems providing

chatbots, unlike EIS Group, it is not preintegrated with third-party chatbot tools.

EIS Group

FINEOSIntellect SEEC

Oracle/Equisoft

Vitech

Vendor strength

Pro

du

ct

pe

rfo

rma

nc

e

Emerging

Best in class

Challengers



18

Figure 5: AIM—Integration


A W A R D F O R B E S T W O R K F L O W T O O L : E I S G R O U P

As carriers look to reduce operational cost and drive a more consistently operated claims

department, workflow and rules engines can support the well-managed process life insurance

carriers need. While scores in general were very close, the award for workflow goes to EIS Group

(Figure 6). EIS Group provides a more complete workflow solution as it relates to configuration.

EIS Group offers workflow configuration that is supported by rules configuration, templates, and

wizard-based tools. EIS Group also has strong client references as it relates to workflow,

reporting complete satisfaction with workflow capabilities.

Intellect SEEC and Vitech also have very strong workflow capabilities. Intellect SEEC falls short in

its support of templates for workflow configuration, but it has very satisfied clients. Vitech’s

workflow tools provide all the reported functionality, yet its clients appear to be less satisfied

with the functionality than are EIS Group or Intellect SEEC’s clients.

EIS Group

FINEOS

Intellect SEEC

Oracle/EquisoftVitech

Vendor strength

Inte

gra

tio

n

Emerging

Best in class

Challengers



19

Figure 6: AIM—Workflow


A W A R D F O R M O S T E X T E N S I V E D I G I T A L C A P A B I L I T I E S : E I S G R O U P

The desire for a more digital claims process is driven not only by life insurance carriers’ need to

reduce the cost to process claims but also by the demand for a more positive customer

experience. Both Vitech’s and EIS Group’s claims solutions support all the primary web and

mobile capabilities a carrier needs to move to a fully digital claims process, and both have strong

client references. EIS Group however, is awarded the digital award (Figure 7).

EIS Group’s solution is fully digital: Capabilities are built at the platform level rather than at the

component level. It offers more advanced mobile features, including keychain and autofill,

camera and photo gallery for easy scanning and uploading of documents, audio recording for

transmitting messages to the carrier, location recognition, optical character reading or barcode

scanning, credit card scanning for easy payout, and bots for automation.

EIS Group

FINEOS

Intellect SEEC

Oracle/Equisoft

Vitech

Vendor strength

Wo

rkfl

ow

Emerging

Best in class

Challengers



20

Figure 7: AIM—Digital Capabilities


A W A R D F O R B E S T T O O L F O R O P E R A T I O N A L E F F I C I E N C Y : F I N E O S

To meet the primary demands of the life insurance industry, stand-alone claims vendors must

provide tools that support operational efficiency to reduce the cost of claims operations. Both

FINEOS and EIS Group provide the basic functionality needed to provide operational efficiencies,

including a strong claims-agent management tool, and have strong client references supporting

the functionality. FINEOS, however, takes the lead and is awarded for its operational efficiency

capabilities (Figure 8).

FINEOS’ workflow tool is graphically oriented; users can see the full process and steps within the

claims process and make modifications very easily. Business process management is also built in,

allowing graphical reports of the process to show areas of service-level breach and monitoring

the process for continued improvement.

EIS Group

FINEOS

Intellect SEEC

Oracle/Equisoft

Vitech

Vendor strength

Dig

ita

lc

ap

ab

ilit

ies

Emerging

Best in class

Challengers



21

Figure 8: AIM—Operational


A W A R D F O R M O S T A D V A N C E D A N A L Y T I C A L C A P A B I L I T I E S :

O R A C L E / E Q U I S O F T

Data is the way of the future, yet most claims vendors fail to satisfy clients with advanced

analytics tools. The Oracle/Equisoft team supports not only basic reporting functions for

business intelligence but also advanced analytics, such as predictive and prescriptive analytics.

These analytical tools are used to support the claims experience and business processes as well

as develop and maintain the rules engine. In addition, the Oracle/Equisoft solution supports

predictive modeling for testing changes. These more advanced capabilities push Oracle/Equisoft

into the lead and grant it the analytics award (Figure 9).

EIS Group

FINEOS

Intellect SEEC

Oracle/Equisoft

Vitech

Vendor strength

Op

era

tio

na

l

Emerging

Best in class

Challengers



22

Figure 9: AIM—Analytics


EIS GROUP

A privately held company headquartered in San Francisco, EIS Group was founded in 2008. EIS

Group supports life insurance, annuities, health insurance, and property and casualty insurance

for group, worksite, and individual channels on a single end-to-end PAS called EIS Core Insurance

Suite. EIS Group’s core solution is based on the premise of providing a full 360-degree view of a

policyholder regardless of whether the carrier utilizes the full suite or only a single component.

EIS Core Insurance Suite is not hard-coded, allowing the individual suite components to interact

via web services. This eliminates any concerns with using core admin components outside of the

EIS suite. The suite is also built with integration points throughout, enabling other enterprise

systems, such as document management tools, analytics tools, and business intelligence tools, to

easily integrate without using the EIS Group tools.

ClaimCore covers the full life cycle of the claims process from intake and coverage verification to

payments and recoveries. Claim Factory, taking a layered approach to the claims design, is a

single source of truth for developing the claims process. It enables carriers to easily design the

process through definitions of the user interface, workflow and rules, roles and security, life

cycle actions, interfaces and integrations, and documents.

The EIS Core Insurance Suite is a fully digital platform. Digital capabilities are built at the

platform level rather than at the component level, creating a fully digital claims system. All

digital capabilities happen in real time and incorporate many features that home in on the true

concept of omnichannel and that provide the flexibility for consumers to interact any way they

wish. ClaimCore utilizes these functions, including the bots from the Microsoft Bot Framework,

to support advanced claims automation and auto-adjudication. The cognitive functionality

recognizes photos, documents, and customer voices and sentiment.

EIS Group

FINEOS

Intellect SEEC

Oracle/Equisoft

Vitech

Vendor strength

An

aly

tic

s a

nd

rep

ort

ing

Emerging

Best in class

Challengers



23

Policyholders can upload claims documents via mobile or computer. The ClaimCore system can

then evaluate the document and extract necessary elements and prefill relevant data points

within the system. Rules and workflow help to automate the flow of the claim, including

communication (via email, text, letter, etc.). The system also allows for digital two-way

communication and can integrate with other key digital solutions such as e-signature.

Fraud detection is another key function of the ClaimCore system. Using the integrated scoring

engine, carriers can build rules to help detect fraud and flag certain cases for further review. The

rules-based predictive analytics is designed by the carrier, with the support of EIS Group, within

the Excel paradigm, making it simple to create and manage without the need of IT.

The ClaimCore solution utilizes Sisense for operational reporting but is developed to integrate

with other core business intelligence and analytics solutions. Document management is also an

out-of-the-box function that is built into the user interface and easily accessible by the claims

processor. Template tools are also available out of the box but are not necessary for complete

automation, as the ClaimCore system is built to integrate with any system.

O U R T A K E

While young in comparison to many other claims solutions in the industry, EIS Group’s ClaimCore

provides a more modern technological approach to claims administration. The digital

capabilities, allowing for multiple lines of business on a single platform and for mobile

management, communication, and a fully digital customer experience, are ready for the future

of life insurance claims. Additionally, the web service communication that allows the solution to

integrate seamlessly with other systems gives the carrier flexibility.



24

CONCLUSION

Life insurance carriers:

Stand-alone claims solutions provide a great opportunity to upgrade legacy systems

and should be considered able to support a complete claims transformation without

the core system price tag or integration time.

In order to meet customer experience demands and reduce operational costs, digital

transformation is a must. Life insurance carriers must use the digital tools (both web

and mobile) available to them through the claims solution.

Advanced analytics, RPA, and chatbots are necessary tools to create complete

automation without accepting undue risk. Evaluate and select vendors that support

these tools and use them to support the claims process.



25

RELATED AITE GROUP RESEARCH

Top 10 Trends in Insurance, 2018: Merging Into the Fast Lane, January 2018.

Analytics in Life Insurance: Case Studies Across the Value Chain, December 2017.

Life Insurance Policy Administration Systems: An EMEA View, April 2017.

https://aitegroup.com/report/top-10-trends-insurance-2018-merging-fast-lane

https://aitegroup.com/report/analytics-life-insurance-case-studies-across-value-chain

https://aitegroup.com/report/life-insurance-policy-administration-systems-emea-view



26

ABOUT AITE GROUP

Aite Group is a global research and advisory firm delivering comprehensive, actionable advice on

business, technology, and regulatory issues and their impact on the financial services industry.

With expertise in banking, payments, insurance, wealth management, and the capital markets,

we guide financial institutions, technology providers, and consulting firms worldwide. We

partner with our clients, revealing their blind spots and delivering insights to make their

businesses smarter and stronger. Visit us on the web and connect with us on Twitter and

LinkedIn.

AUTHOR INFORMATION

Samantha Chow

+1.617.398.5049

[email protected]

CONTACT

For more information on research and consulting services, please contact:

Aite Group Sales +1.617.338.6050

[email protected]

For all press and conference inquiries, please contact:

Aite Group PR

+1.617.398.5048

[email protected]

For all other inquiries, please contact:

[email protected]

http://aitegroup.com/

https://twitter.com/AiteGroup

https://www.linkedin.com/company/aite-group

mailto:[email protected]




Date post:	26-Mar-2020
Category:	Documents
Upload:	others
View:	4 times
Download:	0 times

Life Insurance Claims Vendors in North America: Evaluating ... Group Life... · Technology vendors...

Documents