Workers’ Compensation

Sapiens ClaimsPro

Insurance organizations are challenged by their ability to effectively mitigate their overall risk exposure, while maintaining profitable growth. In today’s insurance market, effective claims management is key to success and profitability. Carriers, self-insureds, administrators and employers can benefit from the value of claims automation by tightly managing the entire claims process and maintaining strong financial controls.

Our Solution

Sapiens ClaimsPro for Workers’ Compensation (formerly called StoneRiver PowerSuite Claims) 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.

Claims Business Benefits

  • Improves operational performance by reducing growing claim inventories through seamless workflow driven by claim best practices, and ensures better closure ratio results
  • Containment of medical costs through outcome-based case management that focuses on the injured employee’s health and productivity
  • Comprehensive, real-time payment processing supports automatic payments, split payments, offsets and deductions, refunds, transfers and 1099 processing for financial efficiency
  • Rules-driven auto-adjudication and decision support allows for proactive case management to reduce time to settle and close claims, improving customer retention
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