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Claims Systems reimagined
Modern claims administration solutions have to help reduce leakage, improve productivity, aid retention of competent adjusters,
reduce cycle times and improve customer service … all while providing managers with a set of key measures to continually improve
processes and optimally deploy staff. These are table stakes for any new claims systems. But they are no longer enough to operate
in a fully optimized manner.
By rOdNEY GrIFFIN, CpCu, CI, ACII, ASAII, SENIOr VICE prESIdENt, prOduCt MANAGEMENt
Claims systems today need to go beyond these capabilities. They must be
renewable in the sense that any component or service can be swapped out for
another with minimal impact to the overall system. The result is that you can take
advantage of new capabilities quickly.
No longer do adjusters gather data only from claimants, witnesses, assessors,
etc. and First Notice of Loss. Today they operate in a much broader data-rich
context. Relevant information comes from both public and proprietary sources.
It’s now vital to have spatial map overlays to show proximity to approved vendors,
emergency services, storm paths, etc. For medical case management, optimized
treatment protocols are essential to ensure best outcomes and cost containment.
These kinds of additional data sources need to seamlessly integrate into the
adjuster workbench so adjusters can work claims in the context of applicable
Many companies also recognize they cannot operate as efficiently as specialized
business partners focusing on salvage, hazmat cleanup, managed health care, fault
evaluation, medical utilization and bill review, and other areas. Consequently,
new claims systems must be built to seamlessly integrate and orchestrate the
interactions between partners and carriers. A system with coded interfaces to
published static APIs and single protocol interfaces is no longer acceptable.
To meet this integration need, the best solutions will take an embedded
enterprise service network (ESN) approach that uses an enterprise service bus to
publish and subscribe to services along with highly flexible end-point definitions
covering Web Services, pure XML, RMI, RPC, F TP and many more. Embedded
OEM’d capabilities provided by solutions such as MuleSoft’s ESB/ESN
Enterprise Edition provide this kind of capability.
A real-time console allows operators to monitor the traffic and performance
within the ESN. The system alerts them to bottlenecks and issues in real-time.
This allows for a true head-up display with full situational awareness not only of
the carrier’s own claims operation but also of partners’ systems. These capabilities
will transform a claims system so it can easily integrate and real-time manage
third party interfaces. As an example, if a third party decides to change the access
protocol, the carrier can reconfigure the interface with a few mouse clicks.
Claims systems need to exploit the new capabilities of Internet browsers and
Rich Internet Applications (RIA). They also need to support the many devices
and screen form factors that have emerged rapidly over the past few years. The
Web Architecture needs to be well separated from the back-end services. The
Web Architecture Development tools should be able to generate both RIA Web
Experiences as well as support downloadable apps for devices such as iPad and
Android tablets using capabilities such as Adobe AIR. Support for emerging
HTML5 standards should also be available in the Development Tools.
This is an area of rapid change and flexibility is key. StoneRiver chose Adobe
FLEX for these reasons for Claims Stream™ because of the easy integration of
extremely powerful graphic and image tools such as Adobe PhotoShop, InDesign
and others that are the gold standards for graphic artists and image retouchers.
The business benefit of an outstanding user interface experience is significant.
If it is intuitive, consistent and widely deployed, then a carrier’s workforce is more
mobile. When a major CAT event occurs and extra hands are needed, users from
other parts of the organization can be brought on board who are already familiar
with the user interface and common tools.
The ability to maximize the real estate of the screen form and save customizations
of preferences at the local level is very helpful. Resizing panels and docking
components on the side ensure easy multi-tasking and understanding of context.
And an easier to use efficient user interface is a great retention tool for scarce
Many carriers are undergoing claims initiatives currently. These carriers
and others considering such a move have the perfect opportunity to focus on
renewable technology that addresses business objectives. n
StoneRiver, Inc., 475 14th St., Suite 600, Oakland, CA 94612
800.943.2851 | www.stoneriver.com