• On February 17, 2023
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An insurance claim management is a necessity for insurees, beneficiaries, and vendors alike to partake in an insurance processing; however, not many are aware how does the claim management system works.

Insurance claim management system is a one-stop tool to process claims; claim submission, claim review, payment processing, reporting and analytics, and communication and collaboration with different parties.

However, not all claim management systems are the same. Some have adopted automation to make the processing quicker and hassle free, while other are still stuck with dated technology that makes each process cumbersome.

Benekiva.io is an example of ultimate claim management solution for vendors who wish to provide a simpler, quicker, and automated insurance claims processing to their clients.

Ultimate Guide To Insurance Claim Management System

The insurance sector is experiencing a rapid shift towards digitalization. According to EY, 80% of customers prefer digital and decentralized channels over traditional insurance platforms.

Such an increase in digital trends is forcing incumbents to collaborate with insurtech, a technology with AI, data science, and machine learning to make claims process faster.

Nonetheless, here is how any insurance claim management usually works and how automation helps make it more efficient.

1. Claim Submission

Claim processing begins with submitting the claim to the insurance company by a concerned party; beneficiary, agent, funeral home, hospital, etc.

For both the policyholder and the insurance company, the claim submission process is made simpler by the insurance claim management system.

It allows policyholders to submit claims online or via a mobile app, with the ability to upload relevant documents, forms, and photos.

Claim submission

Insurance claim management system makes claim submission easier in numerous ways, including:

  • Allowing policyholders to submit their claims electronically eliminates the need for paper forms and reduces the time it takes to process a claim.
  • The system automatically receives the notice of claim from the policyholder, which opens the client file.
  • The system securely stores and organize all relevant claim documentation, making it easy for adjusters to access the information they need to review and process the claim.
  • Policyholders can access their claim information and status updates through an online portal, making it easy for them to stay informed and track the progress of their claims.
  • The claims management system will facilitate communication between the policyholder, the adjuster, and other relevant parties, helping to ensure that all questions are answered and any issues are resolved quickly.

The insurance claim management system makes the claim submission process more efficient and accurate, ultimately leading to a more satisfactory experience for all parties involved.

2. Claim Review

After claim submission, the claims examiner review and investigate claims. In fact, they will have their respective login details and system permissions

The review process is a critical part of the overall insurance claim management process, as it helps to determine the claim’s validity, amount of coverage, and whether the policyholder is eligible for coverage.

Claim review

It is made more accessible with the automated insurance claim management system in numerous ways, including:

  • The system automatically checks the policy documents and verifies that the policyholder is within the coverage period.
  • It can automatically enter information from the claim form into the system, reducing the need for manual data entry and minimizing errors.
  • It stores and organizes all relevant documents related to the claim, such as medical records, receipts, and police reports, making it easy for adjusters to access the information they need.
  • It can assign tasks to different adjusters and track the claim’s progress, ensuring the review process is completed on time.
  • It automatically validates the claim information provided by the policyholder, reducing the likelihood of errors and speeding up the claim review process.
  • The built-in messaging or email functionality facilitates communication between adjusters, claimants, and other stakeholders, such as medical providers.
  • Based on the information gathered during the assessment and documentation review, the insurance claim management system will validate the claim to determine if it is eligible for coverage.

Insurance claim management systems automate and streamline all these steps, reducing the amunt of tasks need to be carried out by the claims examiner.

It provides real-time updates to the policyholder, funeral home/hospital, and the insurance company, ensuring that everyone is kept informed throughout the process.

3. Payment Processing

Leveraging the insurance claim management system will process the payment once the claim has been reviewed and approved.

  • Verifying the policy information to reduce the risk of incorrect payments.
  • Calculating the amount of pay based on the policy terms and conditions.
  • Deducting any applicable copays or deductibles.
  • Providing a wide range of digital payment solutions to their clients so that payments can be made quickly and securely.
  • Issuing payment to the policyholder.
  • Tracking payments, ensuring that claims are paid accurately and on time.

Payment processing

Policyholders often experience the frustration of waiting days, weeks, or even months before receiving a payment from their insurer after submitting a claim.

In fact, payment tasks are automated for quicker processing, where the claims examiner or auditor would only need to review and confirm the payment, payment modes, etc.

By automating these tasks, the claim management system makes the payment processing process more efficient and less time-consuming for policyholders and insurance providers.

4. Reporting and Analytics

Reporting and providing analytics (stats) is crucial to determine the success rate of claim processes and possible discrepancies.

Insurance claim management generates valuable reports and analytics to help insurers monitor claims, identify patterns, and make data-driven decisions.

Adopting predictive modeling tactics has increased revenues and accuracy for many insurers.

A study from Valen Analytics found that companies that used analytics and predictive modeling saw their loss ratios improve 3%-9% more than companies that did not.

Reporting and analytics

Here are a few advanages.

  • It tracks and store data on each claim, such as the date it was submitted, the type of claim, the status, the cause, and the outcome.
  • These data can then be analyzed to identify trends and patterns, such as the most common types of claims, the length of time it takes for claims to be processed, and the success rate of claims.
  • It helps insurers better understand their claims experience, identify risk areas, and make more informed decisions about managing their claims operations.
  • It reduces the time and resources required to process claims while improving the accuracy and completeness of the data captured.

Moreover, the insurance claim management system can even use advanced analytics tools to analyze large amounts of data, providing insights that can improve the overall.

Through this data and information, insurance companies can make data-driven decisions to improve their claims process, optimize operations, and better serve their customers.

5. Communication and Collaboration

Insurance claim management systems can help improve communication and collaboration among stakeholders involved in the claim process.

For instance, Geico’s “Kate” is a virtual assistant that communicates with customers via text or voice, aiding in policy questions and coverage inquiries, and is available 24/7.

More and more insurance companies are investing in insurance claim management technology like this, and capabilities are expected to increase in the coming years.

Communication and collaboration

  • A policyholder can easily upload relevant documents or provide updates on their claim, while the insurance company can easily track the claim’s status and respond to questions or requests from the policyholder.
  • It facilitates communication and collaboration between all parties involved in the claims process, including policyholders, adjusters, service providers, and management.
  • All parties can access relevant information and communicate in real time, reducing the need for manual correspondence and reducing the potential for miscommunication or lost information.
  • Through effective communication and collaboration, an insurance claim management system can help ensure that the claim process is handled efficiently and effectively, reducing the time and effort required for both the policyholder and the insurance company.

Insurance claim management systems can help reduce the time, improve accuracy and transparency, and ultimately enhance the customer experience.


With the continued advancement of technology, the insurance claim management system will continue to play a critical role in modernizing and optimizing the insurance industry.

Whether you are an insurance company, healthcare provider, or policyholder, understanding the benefits and leveraging this system is essential to keeping pace with the changing landscape of the insurance industry.

Besides, adopting digital technology such as Benekiva, the insurance claim management system, will help improve transparency and security in the claims process.

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