SAP Claims Management is one of the most powerful offering for the insurance industry with lots of features, functionality, interfaces and a lot more. Many insurance companies are looking for a claims management software that could handle majority of their business processes like claims handling, regulatory reporting, payment management, handling negotiations & litigations and not to forget load balancing of claims being handled by claim adjusters. While there are some claims solutions out there, I believe that SAP can offer the most powerful tools and functionality that would make the entire claims management a robust business activity.
SAP Insurance solution has been widely acknowledged in the European countries till date and it has been gaining a lot of interest since its introduction to the US industry recently. I thought of putting my experience with this product at SAP out here and sharing my knowledge on what SAP can offer for the insurance industry. Since my expertise has been with Workers Compensation, I would gladly share the power of SAP for Workers Compensation claims management.
What can SAP offer for Workers Compensation Claims Management ?
A comprehensive claims management solution
Manage regulatory formulas and restrictions for all US states and automatically update the same using an external interface
Calculate benefits for a Workers Comp claim based on formulas for each state based on their rules from the benefit catalog
Creation of automatic periodic payments to the claimant using the repetitive payment solution
Manage claims using your own business rules using SAP Business Rule Framework (BRF) which is one of the most powerful utility to customize the claims management as per customer business requirements
Handling Subrogation, Litigation and Negotiation
External Bill Review for any medical invoices
Fraud detection for any Workers Compensation claim
Maintenance of Workers Comp benefit catalog and also interface with third party to update the benefit formulas
Capture First Notice of Loss/Injury (FNOL/FROI) and subsequently create a claim automatically based on the FNOL/FROI data
Auto-assignment of claims and also load balancing between claim handlers using the Role Based Performer utility
Transfer claims data from your legacy system to SAP Claims Management system
Archiving old Workers Compensation claims
Assign and manage claims by roles using role based performer utility to handle different aspects in claim handling like fraud detection, subrogation/recovery, litigation, negotiation, etc)
Generate MS Word or Lotus WordPro documents with claims data to satisfy any business need using the SAP Office Integration
Powerful claim search to look for claim based on claimants, policy holders, time periods, etc
Memo pad to store comments on claim or add special remarks on a claim so that same remarks can be later used as search criteria to search for the claim.
View the policy data using the policy snapshot on the claim
Setting of individual and batch reserves
Create/change existing payments to reflect limits and deductibles using the compensation calculator
Create, change and management different payments including disability, medical, rehabilitation, legal, etc expenses
Automatic periodic payment handling for all disability classes that lead to wage loss for the duration of the injury while meeting all the regulatory benefit conditions set by each jurisdiction states in the US or Canada
Manage and track one or more litigations on a Workers Compensation claim
Customize the entire claims management application by changing the standard delivered application layout or even add your own business logic to the standard using the BRF tool or implement customer specific logic using Business Add-In
Interface to policy system to import the policy data into the claims management system
Interface to Collections and Disbursement system to pay the payments created in Claims Management system to the recipients
