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SAP Claims Management for Workers Compensation

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
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  • Hi Deepak,

    Nice to read your blog, it was quite informative from Worker’s Compensation point of view. You have elaborately focussed from WC’s perspective. Let me add to your blog, the other business perspectives I mean General Insurance, Health and Motor are too vividly handled by FS-CM.

    Inclusion of some strong functionalities like Business Rule Framework (BRF) , Business Data Tool Set (BDT) and clubbed along with Structured Facts Capture , Coverage Referrals, Task , Notes and Payments makes it a unique and easy to handle tool for any normal claim handler.

    Business functionalities like Subrogation, Salvage and Litigation are some of those which can be handled quite efficiently as compared to any Legacy systems. Unique Automated Claim Reserving functionality clubbed with various reserving techniques makes the system tightly accountable.

    And of course it integration with Policy Management / Collections and Disbursement (SAP or non SAP) is another feather in the Cap for this product.

    I’m not sure of the US market, however yes Insurance modules like Claim management, collections and Disbursement and Incentive and Commission are widely used in European markets.

    Anish Kumar

    • Hi Anish,
        Here in the US there are a lot of insurance companies implementing FSCD and ICM. The FSCM implementations are picking. All the features you mentioned are very true and valid. I have covered only Workers Compensation line of business as I have been responsible for this line of business while at SAP.
        My company (iii Technologies) only serves SAP Insurance implementations and I personally believe that SAP Claims Management along with SAP FSCD & ICM has a lot to offer for the US and the customers will keep on growing. I appreciate all your feedback.