Claim Processing Engine

The Claim Processing Engine, developed by Mastek Limited, is a software solution aimed at small to large insurance companies. According to the vendor, this solution is designed to streamline and automate the handling of insurance claims, providing insurance professionals, claims managers, underwriters, insurance brokers, and insurance agencies with a tool to efficiently manage and process claims.

Key Features

Intuitive User Interface: According to the vendor, the Claim Processing Engine offers an intuitive user interface that is designed to be easy to navigate and use, providing a user-friendly experience for insurance professionals.

Automated Claim Intake: The system is designed to automate the claim intake process, allowing insurance companies to efficiently capture and record claim information from various sources, such as customers, agents, or online portals, according to the vendor.

Claims Validation and Verification: According to the vendor, the software performs real-time validation and verification of claim data, aiming to ensure accuracy and completeness. It is said to check for missing or inconsistent information, reducing errors and improving data quality.

Automated Claim Adjudication: The system is designed to automate the claim adjudication process, applying predefined rules and algorithms to determine the eligibility and coverage of claims, according to the vendor. This is intended to help insurance companies make faster and more accurate claim decisions.

Integration with External Systems: According to the vendor, the Claim Processing Engine seamlessly integrates with external systems, such as policy administration systems, CRM systems, and payment gateways, aiming to enable smooth data exchange and streamline end-to-end claim processing.

Document Management and Imaging: The software is said to provide robust document management and imaging capabilities, allowing insurance companies to efficiently store, retrieve, and manage claim-related documents and images in a secure and organized manner, according to the vendor.

Workflow Automation: According to the vendor, the system automates claim workflows, routing claims to the appropriate individuals or departments based on predefined rules and business logic. This is intended to improve efficiency, reduce manual effort, and ensure timely claim processing.

Real-time Analytics and Reporting: The Claim Processing Engine is said to offer real-time analytics and reporting capabilities, providing insurance companies with insights into claim trends, performance metrics, and key performance indicators, according to the vendor. This is aimed at helping in making data-driven decisions and identifying areas for improvement.

Audit Trail and Compliance: According to the vendor, the software maintains a comprehensive audit trail, recording all activities and changes made during the claim processing lifecycle. This is intended to ensure transparency, accountability, and compliance with regulatory requirements.

Configurable Business Rules: The system allows insurance companies to configure and customize business rules and workflows based on their specific requirements, aiming to ensure flexibility and adaptability to changing business needs, according to the vendor.