Claims Engine

The Claims Engine is an innovative claims solution that automates the majority of insurance claims processing, seamlessly integrating with existing policy admin systems. It presents claimants with reflexive questions, verifies policy details, and provides decisions or action plans based on the insurer's philosophy and case specifics. This solution allows claims assessors to focus on complex cases that require human expertise, while significantly improving efficiency and customer satisfaction.

UnderwriteMe's Claims Engine has the following key features:

• Automation: The Claims Engine can typically handle 80% of claims cases without human intervention, from reporting to payout.
• Integration: It seamlessly integrates with the insurer's policy admin system and can easily connect with third-party systems like work bench and accounting software.
• Reflexive questioning: The engine presents claimants with a dynamic list of required questions tailored to their specific case.
• Policy verification: It automatically verifies policy details.
• Decision making: The engine provides decisions on claims based on the insurer's philosophy and case specifics.
• Action plan generation: For cases requiring human intervention, it creates a comprehensive action plan of recommendations.
• Customizable rules: It comes with a base set of claims rules that insurers can easily customize to fit their unique philosophies and products.
• Efficiency improvement: The system significantly reduces the need for manual processing, improving overall efficiency.
• Faster claim resolution: By automating a large portion of claims, it enables faster resolution times for policyholders.
• Triage capability: The engine effectively sorts cases into simple and complex categories, allowing human assessors to focus on cases that truly require their expertise.

The Claims Engine is designed to transform the insurance claims process by automating circa. 80% of cases from reporting to payout. It integrates with existing policy admin systems and allows claims managers to present claimants with key questions which can then be verified to make decisions or provide comprehensive action plans based on the insurer's philosophy and case nuances. The system comes with a base set of customizable claims rules, allowing insurers to tailor the engine to their unique needs and products. For cases requiring human intervention, the Claims Engine provides claims assessors with structured action plans, making their work faster, more organized, and more thorough. By streamlining the claims process, the Claims Engine improves efficiency, reduces costs, and enhances customer satisfaction, ultimately transforming the insurance industry's approach to claims management.