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The Claims Processor (TCP) |
Overview
The Claims Processor (TCP) is a paper-less claims straight-through-processing
platform. The system provides: |
| Automate claims processing to
achieve paper-less processingt |
| Single point claims processing
system with workflow |
| Rules based handling of claims
processing |
| Higher accuracy and audit controls |
| Unified case view |
| Reduced processing costs and
reduced time-service |
| Great Visibility and Reporting |
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High
Level Functional Overview |
Case Creation |
| Ability to create a new cases
through paper or electronic notification |
| Ability to view case associated
images through integration with imaging system |
| Auto display all policy details |
| Auto display of agent details |
| Auto display of plan, coverage
and Beneficiary details against each policy |
| Ability to capture Claimant and
Bank Details against each policy |
| Ability to process various claims
type, including: |
| Death |
| Living |
| Missing |
| Maturity |
| Annuity |
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Validation |
| Ability to define Claims as Admissible
and Non- Admissible Claims based on validation of
product and policy provisions |
| Auto validation of claimant,
beneficiary, owner |
| Validate payout options |
| Cross reference with U/W system
to validate any disputes |
| Initiate contestability based
on validations |
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Requirements Management |
| Determine, track, order, and
monitor requirements for processing claim |
| Order new requirements, such
as medical report, autopsy, third-party investigations,
etc |
| Auto follow-up on missing requirements |
| Associate in-coming requirements
(data and images) to the case file electronically |
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Administer |
| Calculate Claim Amount and Advance
Amount per coverage based on pre defined business
rules |
| Generate refund for excess premium |
| Ability to allocate case to case-examiner,
based on the business user defined rules |
| Ability to send the case for
approvals for exception processing |
| Refer cases for opinions (legal,
medical etc) |
| Ability to log events for audit
purposes |
| Ability to mark the following
recommendations on a case |
| Pay |
| Repudiate |
| Hold |
| Write-off |
| Ex-gratia |
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| Ability to refer a case for opinions
(Legal, Medical and Actuarial) |
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Payout |
Ability through the I-Hub to
integrate with internal and third-party systems,
including: |
| Underwriting |
| Policy Administration |
| Accounting |
| Imaging |
| Email |
| Re-insurance |
| Third-Party data providers,
including investigation, medical information,
etc. |
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Reporting |
The system offers both out of
the box and customized reports, along with third
party package interfaces for ad-hoc reporting. Standard
report categories include: |
| Workload reports |
| Time-service reports |
| Claims processed and
pending reports |
| Payout reports |
| Exception processing
reports |
| Contested claims report |
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PlanetSoft collaborates with clients to build innovative, workable, and cutomized solutions.
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PlanetSoft transforms the ways financial services and insurance companies process their new business.
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