investment in Enterprise improvements
Web services or SOA
Standards such as the
ACCORD ML standards
(Sarbenes-Oxley) or reporting
Corporate or enterprise perform–
ance management solutions
Business process management
Source: gartner (March 2010)
20% 40% 60% 80%
percentage of Respondents
document management and imaging capabilities that are
fully integrated with the claims-management system a key
element of their technology strategy
■ ■ Publishing solutions—When integrated with the claims-management and document-management systems,
publishing solutions enable the automatic generation of important communications with claimants, insureds, and other
parties. They also allow the claims professional to create and
edit various (including custom) documents through the use
of pre-populating templates that contain claims-specific
data and draft narratives. Many of these are time sensitive
or required at certain points in the claims life cycle. The integration of publishing solutions can be designed to create
these documents automatically or to prompt the claims professional to complete them at the appropriate time.
■ ■ Payment-processing and check-writing functionality—
This ability, which is tied heavily to finance and accounting,
often exists outside the core claims-management system.
Integration with payment processing systems can simplify accounting, tax-reporting, and other functions critical
to completing the claims transaction. On the other hand,
clumsy integration (or the lack of integration capabilities)
between the claims-management system and billing and
payment systems often results in manual reconciliation
processes that can be costly to maintain.
■ ■ Expanded reporting capabilities—Insurers need enter-prise-wide reporting tools that can be integrated with claims
management and other core insurance systems to provide
more holistic views of customers, product lines, or regions.
Such tools enable an organization to focus reporting on the
core claims function (claims metrics and key reports, such
as large loss reports) while aligning with other sources, such
as regulatory reporting and policy information, to provide
appropriate views of claims performance.
Bringing this functionality to claims is vital to expanding the
claims process beyond what is achievable with a core claims-management system. But these solutions have applicability
across the insurance enterprise. In developing a technology
strategy, insurers need to adopt a holistic approach that incorporates and prioritizes the requirements for each operational area.
Make use of enabling tools.
Integrating new enabling or integration tools such as rules
and scoring engines, process management, and middleware
has allowed insurers to make tremendous strides in improving
operations. These tools have allowed insurers to implement
straight-through processing, automation, and self-service capabilities. As they have evolved, the tools have been easier to
integrate with existing infrastructures. To take advantage of
these capabilities, however, insurers must keep their enterprise
The need for integration tools is becoming more important
as insurers combine core claims-management systems with
other modules and tools. In the past, legacy systems had a limited number of key integrations, such as financials and data
extracts, some external vendors such as direct repair shops,
and bill-review systems. Integrations now can include customer
portals, mobile applications, and a greater depth of integration
to a broader base of vendors and suppliers. Without a robust
integration architecture that facilitates interchange through
service-oriented and open-messaging standards, any enterprise
application strategy is doomed.
For many claims organizations using legacy systems, business
rules are deeply embedded in the system’s code. Changing these
rules requires technical understanding of the system’s architecture and design. Today’s business-rules and business-process
engines provide flexibility for a user or analyst, for example, to
adjust triage rules for assignment to fast-track claims or special
investigation units. They also can help direct work flow to facilitate the process—generating activities and notifications to
claims handlers or even external parties. These engines also
often simplify the management of hidden processes (such as
updating security) through a document-management structure
that enables various systems and modules to communicate and
integrate more effectively.
The goal is usable information, not just data.
Understanding claims exposure and customer base trends is
fundamental for an insurance company. Insurers that leverage
data most effectively have a competitive advantage in understanding and exploiting trends and can recognize more quickly
drivers of productivity and efficiency.
While claims organizations always have used industry meas–
ures and metrics, they are just beginning to understand how
much usable data they have, both internally and from external
sources. Even with legacy and multiple systems, new techniques