Sapiens ClaimsPro for WC

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Sapiens ClaimsPro for Workers’ Compensation is part of the Sapiens CoreSuite for Workers’ Compensation and is an advanced claims solution that allows insurance organizations to handle unexpected changes that may arise throughout the workers’ compensation claim lifecycle, from FROI, to settlement/resolution and closure.

Its advanced processing expedites the loss reporting and assignment processes and offers significant savings in loss adjustment expenses. Claims automation manages the entire claims cycle and offers strong financial controls. It provides claim professionals with the tools to improve overall productivity, focusing their time and expertise on more critical activities.

ClaimsPro automates the resolution of simple injuries without manual intervention by claim professionals. It also provides a web-based first report of injury (FROI) component, enabling agents, customers and call centers to quickly enter claims via a directed workflow.

By providing the right systems integration and control, and supporting key decision-making with an organization adjudication process, ClaimsPro enhances workforce productivity. A diary and alerts mobilize and focus the workforce on claims requiring their expertise. The suite prevents unnecessary payments, offering control of where all payments are going and ensuring financial accuracy.

ClaimsPro will help insurance organizations achieve their goal of streamlining processes, increasing operational understanding and improving overall service quality.

Key Features

The Sapiens CoreSuite for Workers’ Compensation offers larger carriers, administrators and state funds the technology solutions that enable them to adapt quickly to business and market conditions, offering high levels of accuracy and efficiency. The suite provides broad functionality throughout the entire insurance lifecycle for workers’ compensation, via a core suite, as well as policy, claims and Intelligence modules that can be deployed individually, or as an integrated solution on a single technical platform using the same tools.

CoreSuite for Workers' Compensation includes:

1) PolicyPro for WC, which enables you to quickly adapt to changes in the workers’ compensation market by offering the ability to easily modify an existing product or program; and 2) ClaimsPro for WC, which allows insurance organizations to handle unexpected changes that may arise throughout the workers’ compensation claim cycle, from FROI to final benefit resolution and closure. The suite provides a 360 degree comprehensive view of the Customer's involvement in any manner within the application.

Sapiens DigitalSuite for Workers’ Compensation is a rapid development tool that gives injured workers, policyholders and providers self-service access to ClaimsPro for WC information.

Sapiens Intelligence provides insurance carriers with information in easy-to-use formats for analysis and enhanced decision-making for workers’ compensation.

Key Benefits

Claims Business Benefits:

  1. Improves operational performance by reducing growing claim inventories through seamless workflow driven by claim best practices, and ensures better closure ratio results
  2. Containment of medical costs through outcome-based case management that focuses on the injured employee’s health and productivity
  3. Comprehensive, real-time payment processing supports automatic payments, split payments, offsets and deductions, refunds, transfers and 1099 processing for financial efficiency
  4. Comprehensive benefit calculator includes wage calculations and calculations for all benefit types and handles overpayment recoveries out of the box.
  5. Rules-driven auto-adjudication and decision support allows for proactive case management to reduce time to settle and close claims, improving customer retention
  6. Role and participation based security for external parties to access ClaimsPro for WC directly alleviating the need to build out portal functionality for Providers and Business Partners

Product/Service details