Claims Administration System

System Highlights

  • The Mail Tracking feature of the system provides the following advantages for claims processing:
    - On-line management and review of claims status
    - Generates company correspondence required for claims evaluation
    - Monitors the length of time each claim is pending
    - Monitors compliance for processing completion
    - Notifies the user automatically when additional requested documents are received
  • Accident and Health Indemnity benefits automatically calculated
  • Life and Annuity death claim proceeds automatically calculated
  • Due and paid premiums adjust claim proceeds amount
  • Life Supplemental Contract proceeds supported
  • Claims history review provided on-line
  • Claims tracked by insured and incident
  • User defined benefit codes
  • Automatic update of general ledger accounts as defined by benefit code
  • Claim payment reconciliation manual payment override
  • System assigned claim numbers
  • Multiple Beneficiaries and/or Providers per claim
  • Automatic generation of checks and EOB letters
  • On-line examination of policy claim history
  • Lag studies with user-defined periods
  • Additional Claims reporting available by user request
  • Inception-to-date payment register
    - Claims paid by State and/or Plan