Provides end-to-end claims processing automation with advanced analytics, real-time reporting, and integrated systems that support a faster claims resolution process.
End-to-end platforms that manage the entire claims lifecycle from first notice of loss through settlement and payment. These systems streamline workflows, track claims progress, and maintain documentation.
More Claims Processing Systems
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First Notice of Loss (FNOL) Capture Ability to record and process the initial notification of an insurance claim. |
Product provides claims intake including FNOL as part of end-to-end claims processing. | |
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Automated Workflow Management System automates routing, escalation, and approvals for claims processing stages. |
Automated workflow management highlighted as a key function of the automation platform. | |
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Coverage Verification Functionality to verify the claimant's policy coverage and eligibility for the specific loss. |
Coverage verification occurs automatically within integrated claims workflows. | |
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Claim Assignment System can assign claims to adjusters or service units automatically or manually. |
Claims can be assigned automatically to adjusters and third parties. | |
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Claims Segmentation Ability to route claims to different workflows based on value, complexity, or risk. |
Platform routes claims by complexity and other criteria as per documentation. | |
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Duplicate Claim Detection System detects and flags potential duplicate claims. |
Duplicate claim detection is a standard feature in automated claims platforms of this class. | |
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Subrogation Handling Capability to support subrogation processes, including recovery pursuit. |
Subrogation processes are supported and referenced in solution briefs. | |
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Litigation Management Integration or module to manage litigated claims and legal correspondence. |
No information available | |
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Automated Claim Settlement Calculation System computes recommended settlement amounts based on policy terms, guidelines, and prior payments. |
Automated settlement calculations are referenced as part of advanced analytics and automation. | |
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Fast-Track Processing Ability to fast-track simple claims for rapid settlement. |
Fast-track and intelligent claims routing mentioned for urgent/simple claims. | |
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Claim Re-Open and Reconsideration Support for claim re-opening and reconsideration workflow. |
Ability to reopen and reconsider claims exists in standard workflow engines. | |
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Partial Payment Processing Supports partial settlements and scheduled payments. |
Partial payments and scheduled settlements are managed by the system. | |
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Claim Closure Management Tracks and manages closure of claims, with reasons and audit logging. |
Claim closure, status, and audit trails referenced as standard process management. |
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Document Upload & Management Allows users to upload, store, retrieve, and tag claim documents and images. |
Document upload and management is available as part of digital claims processes. | |
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E-signature Support Integrated electronic signature capture for approvals and claimant statements. |
No information available | |
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Email and SMS Integration System integration with email/SMS to send updates and receive correspondence. |
Email/SMS/integrations for notifications and correspondence are included in platform suite. | |
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Template Generation Automated generation of letters, statements, and claim forms using templates. |
No information available | |
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DMS Integration Integrates with enterprise document management systems (DMS). |
DMS integrations are available, as per Cognizant insurance solutions documentation. | |
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Optical Character Recognition (OCR) System extracts text from scanned claim forms and documents for automation. |
No information available | |
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Bulk Uploads Allows users to upload multiple claim documents at once. |
Bulk document uploads are available as part of claims document workflows. | |
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Voice Notes and Call Recording Ability to attach audio notes or record calls within a claim file. |
No information available | |
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Automated Document Indexing Tags and indexes claim documents automatically for fast retrieval. |
No information available | |
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Notifications & Reminders Automated reminders and alerts related to claim documents and deadlines. |
Automated notifications and reminders are mentioned as part of workflow automation. |
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Automated Fraud Scoring Assigns a risk/fraud score to each claim based on configurable rules and data sources. |
Fraud scoring is referenced in solution overviews for risk management. | |
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Link Analysis Identifies relationships between claims, claimants, and third parties (network mapping). |
No information available | |
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Red Flag Rules Engine Configurable business rules to flag suspicious claim characteristics automatically. |
Red flag and rules-based detection highlighted as part of claims fraud capabilities. | |
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Watch List Screening Checks claim participants against internal and external watch lists. |
No information available | |
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SIU Referral Workflow Enables automatic or manual referral of claims to the Special Investigations Unit (SIU). |
SIU referral workflows included in advanced fraud modules. | |
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Historical Claim Analysis Analyzes claimants’ and third-party history for prior suspicious activities. |
No information available | |
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Geolocation & IP Tracking Logs and analyzes where claims are filed from to detect anomalies. |
No information available | |
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External Data Integration Integration with fraud databases, public records, and third-party data for enhanced analysis. |
Integrations with fraud, public record, and third-party data sources referenced. | |
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Automated Alerts & Escalation Automatic notification/escalation to fraud teams based on risk thresholds. |
Automated alerts and escalation features are mentioned in risk/fraud modules. | |
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Monitoring Volume of Flagged Claims Tracks percentage of claims flagged for review. |
No information available |
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Core Policy Administration Integration Bi-directional data sync with core policy administration and billing systems. |
Integration/sync with core policy and billing is part of the offering. | |
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API Capabilities System exposes and consumes APIs for claim data exchange and service integration. |
Product supports API-based claims data exchange and service integration. | |
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External Adjuster Portal Secure portal for external adjusters and providers to interact with claim files. |
Secure portals for external parties/adjusters present as per claims management overview. | |
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Supplier & Vendor Management Integration with repair shops, healthcare, legal service providers, etc. |
Supplier/vendor management referenced in integration documentation. | |
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Banking/Payment Gateway Connectivity Links to payment platforms for automated claim disbursement. |
Connection to payment gateways is listed as a feature supporting automated disbursements. | |
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Regulatory Data Exchange (e.g. EDI) Supports required data exchanges with regulators or industry databases (e.g. ISO, EDI). |
No information available | |
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Real-time Data Feeds Ability to consume real-time third-party data feeds (weather, medical, etc.). |
Real-time third-party data feed integrations mentioned in technical solution sheets. | |
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Bulk Data Import/Export Facilitates large scale data import/export for reporting and analysis. |
Bulk data import/export for analysis and reporting is standard in the platform. | |
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Custom Integration Adapters Support for building/adapting custom connectors to non-standard partner systems. |
Custom adapters and integration tooling referenced for non-standard partner systems. |
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Customer Portal Allow customers to file, track, and update claims online. |
Customer portal for claims submission, tracking, and updates provided. | |
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Mobile App Support Dedicated smartphone/tablet app for claim notification and updates. |
Mobile accessibility for claim notification and status supported (web/app). | |
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Omnichannel Communication Claimants can interact over web, app, phone, email, or chatbot seamlessly. |
Omnichannel communication (web, phone, email, chatbot) described in solution content. | |
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Status Tracking Customers can see real-time status and timeline for their claims. |
Real-time claims status and timeline visible to users via portal/dashboard. | |
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Self-Service Document Upload Customers can securely upload claim-related documents and images. |
Self-service upload of claim docs/images by customers supported. | |
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Claim Payment Update Customers can view remittance/payment status directly. |
Customers see real-time remittance/payment status online. | |
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Live Chat Support Embedded live chat with support staff or adjusters. |
Live chat and support channels referenced for claimant assistance. | |
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Customer Satisfaction Survey Automated feedback surveys for post-claim service assessment. |
No information available | |
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Online Appointment Booking Schedule assessments, inspections, or adjuster visits online. |
No information available |
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Standard Claims Reporting Wide range of pre-built, regulatory, and operational claims reports. |
Standard/regulatory claims reporting is emphasized in analytics modules. | |
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Ad-hoc Report Builder Users can define and produce custom reports on claims data. |
Ad-hoc/custom report builder is standard for advanced analytics. | |
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Dashboard Visualization Graphical dashboards for claims KPIs, SLAs, trends, and volumes. |
Dashboards/visualizations highlighted as major part of analytics offering. | |
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Loss Ratio Calculation Tracks claim payments versus earned premium for profitability monitoring. |
Loss ratio calculations available as part of reporting KPIs. | |
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Drill-down Analytics Interactive analysis from summary to underlying case detail. |
Drill-down analytics referenced in dashboard/tooling marketing content. | |
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Automated SLA Monitoring System tracks and reports service level agreements/turnaround time adherence. |
SLA monitoring/tracking built into service management modules. | |
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Export to Multiple Formats Download/export analytical results in Excel, PDF, CSV, or other file formats. |
Multi-format export (Excel, PDF, CSV) referenced in datasheets. | |
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Predictive Analytics Advanced modeling to predict claim costs, reserve requirements, or risk factors. |
Predictive analytics included under advanced analytics for claims/risk. | |
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Real-time Report Refresh Analytics are refreshed in real-time as claims progress. |
Real-time, dynamic report refresh referenced as a key feature. | |
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User Access Controls for Reports Reports/analytics can be restricted to specific roles or users. |
Role/user-based access controls for analytics described in product briefs. |
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Automated Payment Calculation Settlement amounts and deductions are computed automatically. |
System handles automated claim payment calculations. | |
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Multiple Payment Modes Support for ACH, checks, debit cards, and digital wallets. |
Supports diverse payment modes—ACH, check, debit card, digital wallets. | |
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Split/Multi-party Payments Ability to disburse claim proceeds to multiple parties in a single transaction. |
Supports splitting payments to multiple parties in one transaction. | |
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Payment Authorization Controls Integrated controls for multi-level approval before payment release. |
Payment approval/authorization controls referenced in payment processing modules. | |
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Automated Entry to General Ledger Disbursement transactions automatically post to financial ledgers. |
No information available | |
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Reissue/Stop Payment Workflow Facilitate payment reversals, reissues, and stops efficiently. |
Reissue/stop payment workflows supported within claims payment processes. | |
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Payment Status Tracking Visibility into payment transmission and clearing status. |
Payment status tracking is part of the payment and claims dashboard. | |
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Custom Payee Management Add, edit, or validate claim payees (claimants, providers, vendors). |
Payee management tools are referenced in claims disbursement modules. | |
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Bulk Payment Processing Capacity Number of claims settled in one batch. |
No information available |
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Role-based Access Control (RBAC) Granular control over which users or groups access specific claim data. |
Role-based access control (RBAC) referenced throughout security documentation. | |
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Audit Logs Comprehensive, time-stamped log of all user activities within the system. |
Comprehensive audit logging described as part of compliance toolkit. | |
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PHI/PII Encryption in Transit & At Rest Sensitive data (personal, health, financial) is encrypted throughout its lifecycle. |
PHI/PII encryption, both at rest and in transit, is stressed for compliance. | |
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Configurable Retention Policies Definition and automation of document/data retention according to regulation. |
Configurable document/data retention is part of compliance and admin toolkit. | |
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Regulatory Compliance Certifications Supports requirements such as PCI-DSS, GDPR, HIPAA, SOX, etc. |
Cognizant emphasizes GDPR, HIPAA, and other regulatory compliance certifications. | |
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Single Sign-On (SSO) Support Enables SSO for enterprise authentication and security. |
SSO integration supported for enterprise deployments. | |
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Multi-factor Authentication Enhances log-in security with additional authentication methods. |
Multi-factor authentication highlighted in security overview documents. | |
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Data Masking Sensitive data is masked for unauthorized or limited-access users. |
No information available | |
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Active Directory/LDAP Integration Integrates with enterprise identity and directory services. |
Enterprise directory (Active Directory/LDAP) integrations are referenced. | |
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Automated Compliance Reporting Generates audit and regulatory reports required by authorities. |
Automated compliance reporting referenced as part of regulatory toolkit. |
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Business Rule Engine Non-technical users can modify/define business rules for claims workflows. |
Business rule engine referenced as core configurability feature. | |
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Custom Fields & Forms Create and manage new data fields, screens, and input forms. |
Ability to create custom fields and forms referenced in customization materials. | |
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Workflow Designer Design and update claim process steps without programming. |
Workflow/process designers are a well-documented aspect of the solution. | |
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Branding/White Labeling Customize interface branding, colors, and logo per business unit. |
Branding, white labeling, and multi-organization configurations offered. | |
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Configurable Notifications Set up and change system notifications, escalation matrix, and triggers. |
Configurable notifications mentioned as part of workflow and UI configuration. | |
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Multi-language Support System UI and communications can operate in multiple languages. |
Multi-language UI and communications referenced for global insurance providers. | |
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Localization (Currency/Time Zone) Supports regional currencies, time zones, and date formats. |
Localization for currencies, time zones, etc., included as part of international support. | |
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Dynamic Form Logic Input forms can adjust dynamically based on user selection or claim type. |
Smart/dynamic form logic referenced in digital claims intake and workflows. | |
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Role-based UI Personalization User interface displays relevant information and tools based on user type. |
Role-based UI personalization highlighted for different user profiles. |
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Average Claim Processing Speed Typical backend processing time per claim. |
No information available | |
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Peak Concurrent Users Supported Maximum simultaneous system users without degradation. |
No information available | |
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Maximum Claims per Day Highest number of claims system can process in a day. |
No information available | |
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System Uptime/Availability Percent of operational availability. |
undefined High system uptime/availability indicated in technical datasheets. |
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Disaster Recovery RTO Recovery time objective after a system failure/disaster. |
No information available | |
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API Response Time Average latency of claim-related API calls. |
No information available | |
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Batch Processing Speed Capacity to handle claims/data batch jobs efficiently. |
No information available |
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Responsive Design System UI adapts for desktops, tablets, and smartphones. |
Responsive/adaptive UI for desktop and mobile referenced in product demos. | |
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Accessibility Compliance (e.g. WCAG) Supports users with disabilities in accordance with WCAG or similar standards. |
No information available | |
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Customizable User Dashboards Users can personalize data widgets, views, and claim summaries. |
Users can customize their dashboard views and widgets. | |
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In-app Help & Guidance Context help, guided workflows, and tooltips available inside the platform. |
In-app guidance and help functionality referenced in user materials. | |
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Inline Search Powerful search engine for rapidly locating claims, documents, or customers. |
Inline search for claims/customers/docs is standard in claims management UI. | |
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Integrated Task Management Users can track, assign, and resolve claim-related tasks. |
Task management (assign, track, resolve claim tasks) is referenced in workflow features. | |
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User Productivity Analytics Tracks and reports productivity metrics per adjuster/user. |
No information available | |
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Low-Code/No-Code Admin Tools Non-developers can modify workflows and reports without coding. |
Low-code/no-code admin tools referenced for workflow/report configuration. |
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