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Claims Management

Claims Management™ is a software platform for processing claims that standardizes and automates processes necessary for the resolution of cases activities. SysOne Claims Management ™ assists users in making decisions thereby reducing manual management to minimize losses and estimation errors. Based on the BPM approach, the system integrates the various internal areas of the company with external actors, processing claims more agility to respond to the customer in less time. So internally, inspectors users and producers have at their disposal a complete view of the case by obtaining the information updated in real time.

The inclusion of a rules engine allows automation of concurrent decisions optimized for handling business logic, thus environment consistent responses are obtained even under a high volume of transactions. SysOne Claims Management has the ability to process thousands of events constantly to identify patterns and determine throughout the process potential fraud in the incident.


Features

Platform 24×365 Warranty and service availability 24 hours a day, 365 days a year, providing convenience and accessibility for users full time.
Assigning the most appropriate charge for each claim Categorization of the policy of each user for faster case resolution, depending on their characteristics.
Send notifications, warnings and alarms Tracking each case more accurately.
Global information on a single platform Collecting, organizing and storing information via the data loaded into the system.

Benefits

Improved customer satisfaction Implementation of an agile, quick, visible and consistent platform.
Decrease of the costs of indemnification Proactive generation fraud patterns.
Elimination of errors and information loss Generation of a digital file,avoiding manual management.
Online communication Updated information of the clients portfolio and/or insurance policies.

Modules

Collector

Web application to receive reports of casualties through various channels. Helps the user to detail the casualty in the complaint form, then this information is distributed to each actor involved in the process.

Fraud Detector

Through the analysis of complaints received and claims history of each customer, SysOne Claims Workflow can detect patterns of fraud. Being integrated into the monitoring process claims automatically generates alerts to users involved in research to prevent losses.

I-BPM

Automates and executes a claims management through the management of business processes. Also it integrates information from different areas of the company or third parties providing a full view in each case and data updates in real time. This module allows business analysts modify processes to suit each event and create or change rules responses to each case without the intervention of a technical user.

Reporting

From the information collected from all areas involved infinite configurations of performance indicators can be established to evaluate and manage the performance of the operation.

Architecture

Insurance Core™ architecture combines a focused processes and services designed to scale (SOA) with application integration and service partners approach. The platform supports both modules can be implemented with Open Source tools as container owners, obtaining a high availability environment.

Presentation layer

100 % Web, supports multiple devices. It is not necessary to realize discharges to be able to use the system, it is enough to have only the direction URL.

Services layer

It is service-oriented (SOA), based on REST API. HTTP services can be consumed by a wide range of clients including web browsers, mobile, other systems or tablets.

Each process and resource data is exposed through an HTTP service enabling communication and integration between various current or future devices.

Process layer

The platform has an extended BPM (BPMN 2.0) with ability to solve RunTime time domain objects (insurance business). These objects can potentially be mapped to the data layer (relational database, partner service, etc).

This extension of the BPM generates an added value that gives simplicity and ease of reading process. Thus the processes have the ability to understand the business model with their corresponding objects in a natural way, avoiding technical actions within the process.

The process layer also has the ability to execute business rules thanks to embedded rules engine.

Business logic layer

It maintains business rules, constantly updating.

Base layer and data access

The data access layer provides a separation of code by its function. This approach provides flexibility to change the data persistence mechanism in the desired time.