Claims Management Software Evaluation: What CIOs and COOs Must Know Before Investing

Insurance is built on trust. And nowhere is that trust tested more directly than in claims. A delayed, inaccurate, or opaque claim settlement erodes customer confidence faster than any premium discount or marketing campaign can recover. For insurers, claims are not just a cost center. They are the strategic heartbeat of the business, influencing retention, compliance, and profitability.

Yet, the way claims are managed is changing. Traditional systems, burdened by manual workflows and fragmented data, cannot keep pace with rising customer expectations, regulatory oversight, and market competition. This is why CIOs and COOs are stepping into the decision-making spotlight. Choosing the right claims management software is no longer a back-office IT call. It is a boardroom-level strategy decision that defines operational agility and customer trust for the next decade.

What is Claims Management?

Claims management is the end-to-end process of capturing, validating, adjudicating, and settling claims across all lines of insurance. It includes document intake, fraud detection, compliance checks, customer communication, and final disbursement.

Its scope extends beyond handling payments. Modern claims management involves:

• Integrating with core systems like policy and billing.
• Leveraging digital channels for customer self-service.
• Ensuring audit readiness through embedded compliance.
• Creating data-driven insights for fraud prevention and reserve accuracy.

This shift from transactional processing to strategic orchestration makes the choice of software foundational.

The Importance of Claims Management in Insurance

Claims are the “moment of truth” for insurers. McKinsey’s Global Insurance Report 2025 highlights that speed and accuracy of settlements are now central to profitability, with commercial P&C carriers bringing their combined ratio down to 91% in 2023.

At the same time, even small lapses are costly: a 1% decline in claims accuracy can translate into millions of dollars in losses across large portfolios. Meanwhile, customer expectations are unforgiving. Digital leaders in claims achieve satisfaction scores up to 136 points higher than the industry average, according to J.D. Power benchmarks cited in 2024.

For insurers, this dual mandate, faster settlement with uncompromised accuracy, requires systems that balance automation, compliance, and human expertise.

Why CIOs and COOs Are Central to Technology Investment Decisions?

Technology investments in claims have ripple effects across the enterprise. CIOs bring the lens of system integration, data architecture, and vendor risk management. COOs weigh operational fit, cost-to-serve, and workforce productivity.

• The CIO’s role is to ensure the platform can sit at the center of a complex ecosystem, policy administration, billing, CRM, fraud detection, and regulatory reporting. They evaluate vendor risk, system security, and data architecture. In short, they decide whether the software strengthens or weakens the enterprise technology stack.
• The COO’s role is to measure the operational return. They look at how the system reduces cycle times, cuts cost-to-serve, and improves adjuster productivity. Their concern is whether claims can be processed faster and more accurately, at scale, without driving up overheads.

The questions they must answer together go beyond functionality:

• Can the platform handle rising claim volumes as product portfolios expand?
• Does it build compliance into every workflow rather than bolt it on later?
• Will it integrate cleanly with partners, repair networks, or digital health providers?
• Does it provide the data and automation needed to reduce loss ratios and control expense ratios?

When CIOs and COOs align, technology decisions shift from being tactical buys to enterprise-level strategies. The right claims system becomes more than a processing tool; it becomes an instrument of profitability, resilience, and customer retention.

How is the Claims Management Software Landscape Evolving in 2025 and Beyond?

Claims technology has moved from monolithic policy-adjacent tools to cloud-native, API-first platforms that sit at the center of the insurance stack. Insurers are modernizing core operations to improve profitability and resilience, while preparing for new risk classes and customer expectations. The result is a market defined by composability, ecosystem connectivity, and operational discipline.

1. Architecture goes composable (and cloud):

Boards expect faster product changes, leaner expense ratios, and better control of loss-adjustment costs. Composable architectures, microservices, event streams, packaged business capabilities, are replacing hard-wired suites. Cloud delivery is now the default for speed, reliability, and continuous upgrades. In the upcoming years, modernization and cloud are set to become the primary levers to elevate operational excellence across underwriting and claims.

2. Integration moves from point-to-point to data fabric:

Siloed integrations slow claims and inflate cost-to-serve. The integration pattern is changing APIs at the edge, data fabric for governed access across sources, and eventing for straight-through actions (FNOL triggers, repair scheduling, payments).

3. Security and resilience are board-level requirements:

IBM’s 2025 Cost of a Data Breach Report found that the average global cost of a breach fell to USD 4.44 million, down 9% from USD 4.88 million the year prior. The driver? Faster containment enabled by AI-powered defenses. Organizations were able to identify and contain a breach in 241 days, the fastest response in nine years. This shows that proactive, embedded defenses can materially reduce exposure.

For insurers, the implication is clear: next-generation claims platforms must come with provable security controls, encryption at rest and in transit, zero-trust access, SOC 2/ISO 27001 certifications, and the ability to integrate advanced threat detection. Security cannot be layered on afterward; it must be engineered into the claims stack as a core design principle.

4. Operations shift from workflow digitization to measurable outcomes:

Modern claims platforms are judged on cycle time, leakage, indemnity accuracy, and NPS/retention, not just e-forms. Analyst work highlights that carriers using advanced analytics and intelligent automation report material improvements in processing time and cost-to-serve, with marquee programs cutting complex-case timelines and complaint rates meaningfully.

5. Ecosystems are the new force multiplier:

Best-in-class claims platforms plug into repair networks, medical bill review, fraud services, geo/weather data, payments, and customer communications, through managed marketplaces and certified connectors. This reduces custom build, shortens upgrades, and keeps you current with partner innovation.

Senior-leader takeaway: This market isn’t just “moving to the cloud.” It is standardizing on composable platforms, governed data access, and ecosystem connectivity to deliver measurable gains in loss adjustment, expense, and customer loyalty. Treat claims technology as an enterprise control point, and buy for operating model fit, resilience, and roadmap strength, not just today’s features.

What Evaluation Criteria Matter Most When Selecting Claims Management Software?

1. Scalability

A modern claims platform must handle millions of transactions annually without performance degradation. As claim volumes rise with new product lines and catastrophic events, scalability determines whether operations hold up under stress or collapse into bottlenecks. Cloud-native platforms offer elastic scaling, provisioning resources in real time, unlike rigid on-premise systems that demand costly over-engineering. Scalability is not just a technical measure; it is an operational safeguard against volatility in claim frequency and severity.

2. Integration

Integration defines whether a platform fits seamlessly into the insurer’s broader digital ecosystem. Claims must connect cleanly with policy administration, billing, CRM, fraud detection, and third-party networks such as repair shops or digital health providers. Platforms with rich API libraries and data fabric designs eliminate the need for fragile point-to-point builds.

3. Compliance

Claims systems sit at the front line of regulatory scrutiny. HIPAA, GDPR, NAIC, and regional mandates require controls built into workflows, not bolted on later. CIOs and COOs should demand:

• Automated audit trails for every decision and transaction
• Retention policies and legal holds enforced by the system itself
• Vendor certifications such as ISO 27001 and SOC 2 for provable security and governance

Compliance capability is not optional. It shields insurers from fines, reduces supervisory drag, and protects reputation in the wake of data breaches or regulatory reviews.

4. User Experience

A claims platform must work as well for the adjuster as it does for the policyholder.

• For adjusters: intuitive dashboards, automated case routing, and visibility into workloads increase productivity and shorten cycle times.
• For customers: mobile-first self-service, real-time claim updates, and digital document submission reduce friction and build trust.

Why Correct Evaluation is Critical in Claims Management?

Choosing the wrong claims platform is not a neutral mistake, it carries real financial and reputational costs. Poorly integrated systems create disjointed workflows, drive up compliance exposure, frustrate adjusters, and alienate customers. What looks like a short-term saving often turns into multi-million-dollar technical debt and a brand credibility risk.

The right evaluation, by contrast, is an investment in resilience. It ensures the platform scales with rising claim volumes, embeds compliance by design, and empowers adjusters with tools that cut cycle times and enhance accuracy. Done well, claims technology becomes more than a back-office system, it secures the insurer’s ability to compete, comply, and retain trust in an industry where margins and reputations are tested daily.

Questions CIOs and COOs Should Ask Vendors while Evaluating Claims Management Software

When evaluating claims platforms, CIOs and COOs need to move past feature lists and press vendors on issues that define long-term value:

• Total Cost of Ownership: Beyond license fees, what are the costs of integration, upgrades, support, and hidden dependencies over five to seven years?
• Deployment and Scale: How quickly can the platform be implemented, and can it scale elastically in the cloud as claim volumes fluctuate?
• Support and Enablement: What structured programs exist for onboarding, continuous training, and change management to ensure adoption across adjusters and operations staff?
• Strategic Alignment: Does the platform align with the insurer’s digital transformation agenda, supporting advanced analytics, ecosystem integration, and data monetization opportunities?

The answers to these questions reveal whether a vendor is offering software or delivering a strategic operating platform that can carry the business forward.

What Challenges Should Insurers Anticipate When Implementing a New Claims System?

Technology alone does not guarantee transformation. Even the most advanced claims platform will fail if insurers overlook the operational realities that come with change. CIOs and COOs must plan for:

• Change Management: Ensuring adjusters, agents, and service staff adopt new workflows and trust automated decisioning. Resistance to change is often the biggest barrier to realizing ROI.
• Data Migration: Transitioning from legacy systems without errors, downtime, or data loss. Poor migration strategies can undermine compliance and erode customer confidence.
• Vendor Dependency: Striking the right balance between out-of-the-box functionality and the configurability needed for differentiation. Overreliance on proprietary tools can create long-term lock-in.
• Cybersecurity: Safeguarding sensitive claims and customer data in hybrid and multi-cloud environments. With breaches costing insurers very high amount, security must be engineered into the claims stack, not layered on afterward.

These challenges highlight why evaluation is not just about platform capability but about enterprise readiness to implement, secure, and scale it effectively.

How Does Newgen Help CIOs and COOs Navigate Claims Modernization Effectively?

The evaluation questions and challenges outlined above aren’t abstract. They are the real issues that stall transformation programs, drain IT budgets, and expose insurers to compliance and reputational risk. Insurers need partners who not only deliver technology but also bring the operational discipline and domain expertise to make change stick. This is where Newgen’s claims management software delivers.

• Enterprise Scalability: Newgen’s cloud-ready, low-code architecture allows insurers to handle surges in claims, from catastrophe events to portfolio expansion, without degrading performance. Elastic scaling ensures operations stay resilient under pressure.
• Seamless Integration: With an API-first design and certified connectors, Newgen integrates claims workflows with policy administration, billing, CRM, fraud systems, and third-party networks such as repair shops or digital health providers. This enables true straight-through processing and reduces reliance on fragile, point-to-point integrations.
• Unified Data and Documents: Built-in ECM and case management capabilities create a single source of truth for every claim. Documents, communications, and decisions are consolidated, cutting down on errors, delays, and compliance gaps.
• Embedded Compliance and Security: Regulatory controls are built into workflows, not layered on afterward. Newgen platforms are ISO 27001 and SOC 2 certified, with automated audit trails, retention policies, and legal hold functionality. This ensures HIPAA, GDPR, and NAIC compliance by design, while protecting sensitive claims data across hybrid and multi-cloud environments.
• User-centric Experience: From adjuster dashboards that simplify workloads to mobile-first self-service portals for policyholders, Newgen emphasizes usability. Real-time claim tracking and automated case routing shorten cycle times, reduce call center dependency, and improve satisfaction.
• Operational Resilience: Beyond technology, Newgen provides accelerators for data migration, adoption, and change management. This reduces transition risk and ensures insurers realize value quickly without disrupting existing operations.

For CIOs, this means system resilience, integration control, and reduced vendor risk. For COOs, it translates into lower cost-to-serve, faster settlement, and measurable productivity gains. Together, Newgen equips insurers to turn claims from a cost burden into a strategic growth lever, strengthening profitability, compliance, and customer trust in one platform.

Conclusion: From Claims Cost Center to Strategic Growth Lever

The evaluation of claims management software is not about ticking boxes on functionality. It is about transforming claims from a cost center into a strategic growth lever. CIOs and COOs who prioritize scalability, integration, compliance, and user experience will unlock operational efficiency, customer loyalty, and competitive advantage.

In a market where speed, accuracy, and trust define winners, the right claims management platform is not just software. It is the insurer’s promise, delivered.