How to Evaluate the Right Claims Management System for Your Organization?

Author: Steven M Richard

With continuous changes to the software industry, Claims Management Systems (CMS) have evolved with technology. These systems are equipped with newer capabilities to provide enhanced services to customers. In such situations, evaluating and selecting the right CMS for your organization could be a difficult task. In order to assist with this process, we furnish a few simple steps through which you can evaluate and choose the right CMS for your organization.

Check the efficiency and responsiveness of the system:

Efficiency

  • Claim management systems are crucial to making the customers satisfied and to improve the overall performance of the company. A CMS should be able to manage the entire claim process - from the beginning to the final settlement. The software should help in organizing every file activity and maintain reports.

Responsiveness

  • In addition to performance, a CMS needs to allow the user to run reports instantly. The ability to quickly access information will expedite the claims, allowing employees to return to work, and employers to save valuable resources.
  • A transaction - accessing and saving a claim, creating letters, etc. should not take more than 10 seconds, and on an average it should be done only in a couple of seconds.
  • While evaluating the performance and response time of the CMS, ensure to check them in a real time environment with and user data. This will give a complete picture of the performance and the responsiveness of the system.

Technology used in the system

Today, many organizations prefer browser based systems that help them simplify deployment, support, and allow for remote access.

  • While evaluating the technology, check the type of database being used. It is important to choose the right database with a simple and efficient data model. This will help create reports and data mine independently.
  • A critical issue that goes unchecked by many organizations is with respect to the reporting database. The reporting database should be kept separate from the transactional database as it impacts the system performance.

Security, confidentiality and hosting model of the system

Security and confidentiality of the data

It is the responsibility of the organization to keep the claimants information secure. In order to keep the data safe, it has to be encrypted with multilevel access passwords. All users should be given unique ID’s and passwords with no plain text.

  • To reset the password and protect system security, do not allow viewing of the old password.
  • Data to the user and from the user should be encrypted using a SSL encryption. Along with this, user access permissions, levels of authority, hierarchy, etc. - are necessary to ensure security and confidentiality.

Hosting

  • If your organization possesses adequate bandwidth and infrastructure for supporting new applications you may want to consider hosting the system.
  • If not, hiring a reputable web host is you best alternative. Be sure to confirm the system is always accessible and is supported without any interruptions in the services. Additionally, in choosing a web host make sure that there is equipment redundancy and document backup to ensure data is replicated without any loss.

Functionality and features of the system

Functionality

  • For every CMS, there should be some basic functional modules such as claim/claimant maintenance, notepads, diaries, reporting, payment and reserves, etc.
  • Check the functionality that will help the examiners to focus on closing claims quickly. You can ask various questions regarding the functionality of the CMS, depending on your business requirements and workflow.

Features

  • Check the features of the system and all the data categories that your organization needs.
  • The system should enable users to build data fields as the organization grows and risks become more complex.
  • Check for the software integration. This gives the new capabilities in settling the claims quickly and efficiently.

Vendor assessment

Once the system meets all the required guidelines, it is necessary to assess the vendor. In order to assess a vendor, several factors should be considered.

Clients' needs

  • An efficient vendor should constantly work on improving the system, based on client needs. They should be to discuss new functionality and any challenges with implementing system enhancements. Ask any potential vendor how often they meet their clients for discussing such issues.

Other factors (past experience, etc.)

  • Consider vendors past experience. How efficient they are in research and development of new technologies? How effective are they are in knowledge transfer?
  • References would assist in choosing the right web host. This will provide approatiote insight to what a relationship with the vendor will be like in the future.

Pricing structure

  • Pricing structure should be flexible for each client. Depending on size and need, each contract can vary greatly. Terms of payment should also be flexible in order to allow companies of all sizes to find a system that works for them financially. A CMS with many users should cost less per user than that of one with fewer users.

Following these points can help evaluate the claims management system (CMS) quality parameters, and check how well it suits your business.