Workers’ Compensation

Sapiens ClaimsGO

Insurers are seeking a wide range of cost-effective and efficient features that address the day-to-day challenges encountered by claims professionals. From new business quoting, to underwriting processing and injury management, through claims settlement adjudication – one partner for all your business and technical requirements is key.

Our Solution

Sapiens ClaimsGO for Workers’ Compensation offers comprehensive features for the effective management of the claims lifecycle, including compliance with regulatory reporting. It is a component of SapiensGO for Workers’ Compensation and a comprehensive, full‐featured system developed for specialized administration of workers’ compensation policies and claims, offered in a hosted environment.

ClaimsGO intake expedites entry into the claims processing lifecycle and its processing architecture shows what’s important at a glance. Comprehensive data capture guarantees compliance with regulatory reporting and other critical claims data. Payment request processing includes comprehensive options and enables financial integrity.

Regulatory extract processes include WCSTAT, EDI for FROI and SROI, Medical EDI, DCI and CMS. The compliance page provides a quick review of mandatory fields for EDI, which improves the efficiency and accuracy of your review process, reducing the risk of potential fines. Online FROI submission validates policy coverage, pre-populates the first report of injury forms with policy-specific data, and provides drop-down lists to ensure valid code selections.

ClaimsGO features can be selected based on the organization’s unique processing requirements. They include multi-company and program management for unique configuration and processing rules per program; self-configuration and administration functionality that allows business users to easily change configuration and workflow rules, state compensation benefits, reserve cushions, etc., by company or program; ad hoc letter and form generation based on business user configuration, and more.

Business Benefits

  • Hosted environment reduces costs, including annual release upgrades, and requires minimal implementation effort
  • Increased productivity from comprehensive, user-friendly functionality and delivery of a turnkey solution in just 120 days
  • Increased workflow efficiencies from digitizing and automating manual processes, and improved overall service quality and customer satisfaction
  • 360-degree view offers claims professionals a centralized way to view and analyze all the incident, claim and claimant information for quick resolutions and increased customer satisfaction
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Contact Sapiens for more information