Processing life claims has changed in recent years with changes in technology and regulations in the industry. Traditional claims processing systems were more claims payment systems rather than claim processing systems. There has also being significant changes to product and many hybrids have been introduced with riders for Long Term Care and Disability Income, this can add a level of complexity to the claims process.

The life claim can be broken into four clearly defined steps, Submission, Inquiry, Status and Settlement. To process a claim the Claims Analyst will need to have details of the policy provisions that are normally stored on the administration system. Policy plan data will need to be downloaded to the Policy Integration Layer™ in the claims system. ClaimVantage provides this view of the policy detail using the Policy Integration Layer™ to store and maintain policy data in the claim system.

During the claims submission process various documents will be collected including the death certificate and beneficiary details. In some cases additional life policy information and marriage certificate(s) may be required. When the claim submission process is complete the claim can be passed to a Claim Analyst to ensure it is complete and to schedule follow up activities. In some cases imaging may be used to scan and view relevant forms collected during the submission process, the ClaimVantage product suite supports image technology.

In some cases there may be a need for additional inquiries in order to process payment. This may include working with third parties where secured access can be provided to the claims system via the Web. At any time in the process beneficiaries may request information regarding the status of the claim. With the ClaimVantage claims system this information is readily accessible via the Customer Call Center where the agent will have a restricted view of the claim but will have sufficient information to provide status and next action on the claim process.

When the claim is complete and the payment is ready for processing it will be important that all beneficiaries are setup on the system and that any additional interest payments have been included before full settlement is completed. In some cases the Insured person may have chosen a payment plan. This will allow the beneficiary to select a regular payment option where the Insurance carrier needs to be capable of processing these regular payments. ClaimVantage provides a flexible rules based payment system that can support indemnity payment and/or lump sum payments based on the needs of the beneficiary.

ClaimVantage understands that Life & Health claims are complex and need a very flexible approach to rules and workflow processes. To deliver this level of flexibility, ClaimVantage has integrated the JBoss rules and workflow engine so that you can control your work processes, meet your customers expectations and react to market changes in product plans.