Selecting the Right Claims Automation Software

Selecting the Right Claims Automation Software

A Newgen Guide for Insurers

Rethinking Claims Management in the Digital Era

Claims management has always been the ultimate test of an insurer’s operational excellence and customer commitment. It’s where trust is either strengthened or lost. However, in an increasingly digital world, the challenge lies in balancing speed with accuracy.

According to the National Association of Insurance Commissioners (NAIC), non-medical insurance fraud in the U.S. amounts to over $40 billion annually. This means claims teams can’t afford inefficiencies or errors. They need intelligent systems that ensure both faster settlements and stringent fraud control — without compromising customer experience.

This whitepaper serves as a practical guide for insurance leaders evaluating claims automation software to modernize their operations and deliver efficiency, compliance, and customer delight.

The Complex Reality of Claims Management

The claims process is inherently intricate, involving multiple stakeholders — customers, agents, underwriters, assessors, and regulators — all interacting across disconnected systems. Manual, paper-based processes only compound these challenges, leading to:

• Slow turnaround times
• Human errors and inconsistencies
• Compliance and audit risks
• Limited visibility into claim progress

The need of the hour is a cloud-based, intelligent, and configurable claims automation solution that streamlines workflows, enables real-time collaboration, and provides full process transparency.

Six Priorities for Effective Claims Automation

1. Digitize Every Document Across the Claims Lifecycle

Paper-based processes slow everything down. A modern claims platform must offer enterprise-grade content management capabilities for:

• Multi-channel document capture (email, portal, mobile, physical)
• Centralized, searchable digital repositories
• Auto-classification and checklist generation
• Real-time tracking and audit compliance

Digitization ensures speed, accuracy, and easy retrieval — the foundation of a paperless, efficient claims operation.

2. Eliminate Silos and Enable Seamless Journeys

Many insurers use multiple systems for similar processes across different product lines, creating technology silos and fragmented experiences.

An integrated platform allows:

• Unified access to claim information from one interface
• Real-time collaboration across teams and partners
• Elimination of redundant data entry and rework

A connected environment means faster resolutions and consistent customer experiences.

3. Automate End-to-End Workflows with Built-In Rules

Automation is at the heart of transformation. A configurable workflow engine can:

• Flag bottlenecks and reduce delays
• Route claims automatically based on complexity
• Enforce compliance with predefined rules and authority limits
• Enable straight-through processing (STP) for simple claims

By embedding business rules, insurers can increase productivity and reduce manual intervention in repetitive tasks.

4. Build Flexibility to Handle Complex and Future Scenarios

Claims are dynamic. The solution must accommodate exceptions and evolving business needs. It should allow:

• Dynamic routing of non-STP claims for human intervention
• Easy rule and process modifications without heavy IT involvement
• Scalability to handle claim surges during crises

This agility is vital for insurers to stay resilient amid constant regulatory and market shifts.

5. Ensure Business Continuity with Cloud and Remote Access

Post-pandemic, the ability to maintain uninterrupted operations is non-negotiable. A cloud-enabled claims platform ensures:

• Anytime-anywhere data access for remote teams
• High availability and disaster recovery
• Secure, compliant collaboration across geographies

Cloud-based solutions not only safeguard operations but also reduce infrastructure costs and enable faster scalability.

6. Leverage Emerging Technologies for Smarter Claims

The modern insurer’s advantage lies in intelligent automation. Claims software should integrate:

• Robotic Process Automation (RPA) for repetitive tasks
• AI and Machine Learning for fraud detection and predictive analytics
• Mobile and social channels for real-time claim initiation and updates

For example, customers can upload claim photos through a mobile app, receive instant acknowledgment, and track their claim status digitally — reducing cycle time and improving engagement.

Twelve Questions to Ask Before Choosing a Claims Automation Solution

1. Does it automate the entire claims process — from intimation to settlement?
   A good system should manage intake, adjudication, fraud checks, and settlement seamlessly, ensuring standardized processing and reduced human dependency.
2. Is there one unified interface for all claim types?
   A single view across health, life, and P&C claims reduces duplication and improves visibility.
3. Does it support complete document digitization?
   Built-in content services enable multi-channel ingestion, auto-indexing, and secure archival.
4. Can it intelligently route cases based on complexity and workload?
   A rules-driven engine should auto-classify “fast-track” vs. “manual” cases and distribute work intelligently.
5. Does it empower customers with self-service options?
   Real-time portals and mobile access let policyholders file and track claims anytime.
6. Can users easily access policy data and claim history?
   The solution should auto-fetch policy details and flag duplicate or fraudulent claims.
7. Does it ensure comprehensive assessment and transparency?
   Dashboards must provide a 360° view of each claim, tracking progress and compliance.
8. Can it provide real-time insights and monitoring?
   Built-in analytics and dashboards should track SLAs, identify fraud, and measure team efficiency.
9. Does it support timely customer communication?
   Auto-triggered emails, texts, and notifications should update stakeholders at every stage.
10. Can it foster collaboration across teams and partners?
    Multi-user access and parallel review capabilities reduce delays and duplication.
11. Is it scalable and cloud-ready?
    The system must ensure continuity, elasticity, and reduced IT maintenance costs.
12. Does it integrate seamlessly with your existing systems?
    Compatibility with PAS, CRM, ERP, and fraud detection systems ensures information flow and maximizes ROI.

The Newgen Advantage

Newgen’s cloud-based claims management software, built on the NewgenONE digital transformation platform, is designed to deliver agility, accuracy, and customer delight.

Key Capabilities

• End-to-end automation from claims initiation to settlement
• AI-powered decisioning and configurable business rules
• Integrated content and communication management
• Low-code flexibility for faster deployment and process updates
• Cloud-native scalability for cost efficiency and business continuity

Core Benefits

• 100 percent document digitization
• Straight-through processing for simple claims
• Fraud prevention through advanced analytics
• Seamless integration with core and third-party systems
• Enhanced customer and employee experience

Global insurers using NewgenONE report faster processing, higher transparency, and greater trust from their policyholders.

Future-Proof Your Claims Operations

The insurance industry is moving toward a future of AI-driven, fully digital claims ecosystems. Selecting the right claims automation software is not just a technology decision — it’s a commitment to operational excellence, fraud reduction, and customer satisfaction.

Newgen’s solution empowers insurers to transform claims management into a competitive advantage — faster, smarter, and more connected than ever before.