SaaS Claims Management for Self-Insurers

With self-insurance, you control your destiny. You can also choose how to manage your claims.

Self-Insurance — also known as self-funding —is an alternative risk transfer strategy used by tens of thousands of employers across the United States to finance workers’ compensation, general liability, and other insurance programs, where expenses are paid as they are incurred as opposed to paying a fixed premium to a traditional insurance company.

If done right, self-insurance provides an employer with the highest degree of flexibility and control, and the greatest opportunity for cost savings.

Key Challenges for Self-Insurers

Incident Reporting

When an incident involving customers or employees is under investigated by your security department, all information is reported and documented in an incident reporting system such as Omnigo’s iTrak. This information then needs to be quickly and accurately conveyed to your claims department. This manual, double entry process is inefficient and prone to human error.

HR System Integration

Once the initial report of a workers’ compensation claim is filed, all employee indicative information must be acquired and transcribed from your HR system into the claims system. Not only is this a time consuming task and prone to human entry errors, but it also exposes your company to risk of employee privacy breaches.

Resolution Partner Integration

As a self-insurer, you often partner with TPAs, medical networks, and law firms to adjudicate and resolve workers’ compensation and general liability claims.  Most legacy or homegrown systems do not have the API capability to be seamlessly integrated with your resolution partners, making it difficult to keep your claims systems up to date with adjudication and associated financial information as the transactions are executed by the resolution partner.

Omnichannel Communications

Your insureds expect real-time communication across multiple channels (text, email, chat, phone, video) – corresponding just by snail mail or even email is no longer an option.  Unfortunately, most claims insurance technology is outdated and does not support omnichannel communications, leading to frustrated customers and unhappy adjusters.

The Benefits of Five Sigma's CMS for Self-Insurers

Our cloud-native data-driven claims management solution makes your claims processing simple and smart.

Automated Claims Submission

Our digital claims management solutions (CMS) provide:

  • All FNOL data received from the insurers/digital channels are embedded automatically into our workflows and ready for the next step in the process
  • Rapid system identification of claim types
  • Automated triage and adjuster assignment

Embedded Omnichannel Communications

Our CMS includes an API-level communication module that support all types of communications including: SMS, mail, voice video calls, and even WhatsApp. All claims-related communication is documented, stored and analyzed automatically.

Just-in-time Recommendations

Our systems flags coverage and liability issues and presents the adjuster with relevant information and investigative steps within the claims system.

Damage Assessment and Negotiation

The key to effectively negotiating a claim begins with accurate damage assessment. Our CMS includes a digital bodily injury evaluation module to itemize, assess and aggregate damages.

Monitoring and Management

Based on our advanced data modeling, we enable insurers to monitor your operations and receive actionable insights that will help you make strategic management decisions.

Replacing a Legacy Claims Management System

A large self-insurer was using a stand-alone legacy system to oversee and manage their workers’ compensation and general liability claims. An internal audit revealed:

  • a significant amount of their adjusters’ time was being spent on re-entry from their security and HR systems into their claims system and manually referring claims to their resolution partners.
  • a few claims employees had been abusing their access to the HR system by viewing non claims related employee information.
  • the organization was wholly reliant on their vendors’ reporting for critical claims adjudication and financial data.

Learn how within 12 months of deploying Five Sigma’s SaaS claims management solution, claims had been successfully insourced with immediate improvement in efficiency, accuracy and resolution.

Go live in weeks with the state-of-the-art claims management platform.