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Insurance claims management software:
an end-to-end overview
May 27, 2025
Claims management software helps insurance companies streamline claims processes, from registration to settlement, and ultimately boost the agency’s operational efficiency, improve decision-making, and provide policyholders with fair compensation for their losses.
An expert provider of insurance software development services, Itransition offers advisory and implementation support to insurance companies looking to adopt claims management software and automate claims handling, streamline claims resolution, and reduce related administrative costs.
Insurance claims management software market state
13.3%
the estimated CAGR of the global claims management market from 2024–2032
Fortune Business Insights
13.95
bn
expected value of the global claims management market in 2032
Fortune Business Insights
Core features of insurance claims management software
Insurance claims management systems include the following capabilities to enable end-to-end digitization of claims handling.
Claims intake & registration
Claims intake and registration functionality helps agents capture claims data provided by claimants to create a detailed case for further processing by adjusters.
- A customer portal for claim submission
- Intuitive forms for claims reporting
- Electronic FNOL reporting capabilities
- Instant data validation and verification against both internal and external databases
- Flagging of duplicate claims
- Case categorization, routing, and assignment
Claim investigation & adjudication
Claim investigation and adjudication features facilitate efficient decision-making on a particular claim and support a broad range of activities, from claim investigation to claim settlement.
- Structured storage and management of documents and images
- Real-time access to submitted data and policy details auto-retrieval
- Compensation calculators and FNOL total loss evaluators
- Rule-based adjudication and approval workflows
- Automated identification of recovery opportunities
- Activity logging for progress tracking
- Claims diaries and case notes
- Claims status tracking
- Third-party software integration for task scheduling, billing, and reinsurance
Collaboration capabilities
These features allow insurance agents to work together and exchange information and updates on the given case.
- Integration with communication platforms, such as Microsoft Teams, Slack, Zoom, as well as SMS, email, and telephony services
- Integration with customer relationship management software for customer data exchange between claims specialists and service reps
- Integration with task management solutions to establish priorities, delegate work, monitor progress, and set deadlines
- Collaborative file notes
- Automatic notifications and reminders
- Support for EDI protocols for the streamlined transfer of information from external stakeholders
Financial management
Financial management features help claims adjusters provide compensation to policyholders, ensuring quick and transparent payouts.
- Payment authorization and processing
- Co-pay and deductible tracking
- Financial reconciliation capabilities
- Payment gateway integration
- Automated reserve management
- Reserve and payment audit trail
- Invoice generation
Analytics & reporting
Data analytics functionality enables insurance carriers to gain actionable insights from data and use them to make evidence-based decisions.
- Operational efficiency monitoring and benchmarking
- Agent KPI tracking
- Fraud detection, including outlying claims identification and claims scoring
- Financial performance oversight
- Claimants behavior analysis
- Report templates
- Self-service analytics features
- Data visualization through customizable dashboards
- Automated compliance reports generation
Streamline claims management with an all-in-one solution
Insurance claims management software in practice
£1 million
of funding raised
SaaS claim management software development for a UK startup
Itransition developed and supported a web-based claims management solution for a UK startup. The delivered system consists of several portals and features for comprehensive claims management and has a robust workflow engine built to support high load, with the ability to process 400+ new quotes and 20+ purchases per minute.
Why implement insurance claims management software
Dedicated claim management software allows insurance carriers to properly organize and streamline a range of routine, resource-intensive operations related to claims handling, which leads to multiple improvements.
Improved agent productivity
Automate time-consuming data entry and processing and document management activities and provide agents with real-time access to critical information to speed up their decision-making.
Reduced costs
Cut costs by reducing employees’ administrative workload and allow them to focus on value-adding activities. Additionally, avoid penalties and loss of revenue by automating compliance regulations tracking and fraud detection.
Better customer experience
Improve customer satisfaction with faster claims resolutions and personalized communication due to policyholder information centralization.
Higher decision accuracy
Reduce human errors and data duplication with automated data capture, population, and validation to help insurers make accurate claims settlement decisions.
Enhanced collaboration
Provide a workspace where agents can keep track of claims they are handling, share data and communicate with colleagues, and schedule tasks and meetings.
Insurance claims management software examples
Salesforce provides a dedicated Claims Management feature as part of its Financial Services Cloud and complementary technology solutions to expand its capabilities with advanced analytics and automation capabilities and on-the-go data access.
- FNOL capture
- Claim details storage and access
- A customizable claim product model to create a blueprint for handling different claims
- Power attributes features to apply policy terms, such as limits and deductibles, to each claim
- Claims Adjuster Workbench, allowing claims adjusters to manage claim participants and the involved expenses, configure payment actions, and monitor financial operations
- Payment authorization workflows
- Management of claim loss and expense payments
- Reserve and approval management
- AI-powered claims patterns analysis, insurance claim summarization, fraud detection, and claims process automation
- Claimant communication capabilities via integration with communication channels
- Mobile access to policyholder data, claims information, and communication features
- Claim Party Management to match the involved parties with their records
- Prebuilt services and integration procedures for enabling data exchange between Salesforce and external systems
Guidewire ClaimCenter is part of the Guidewire Insurance Suite that facilitates end-to-end property and casualty (P&C) claims process management, from claim intake to claim processing and settlement.
- Questions and dynamic, wizard-based forms for simplified claims intake
- Policy search and retrieval enablement
- Rules-based claim segmentation and assignment to claims professionals
- Financial management capabilities, including financial calculations, cost type and cost category reserves, and a multicurrency feature
- Automated catastrophe detection
- Fraud detection
- An analytics tool, offering dashboards with claims KPIs, adjuster workloads tracking, and loss financials monitoring
- Subrogation tracking
- Tools for claims litigation tracking
- Granular claim statuses and updates
- Embedded analytics and predictions generation
ClaimsPro helps P&C insurers automate every stage of the claims process, communicate with claimants, insurers, and brokers, and provide quick and responsive services to policyholders in catastrophic events.
- Rules-driven workflow and automated claim assignment
- A central repository for case-related information to create a unified view of all parties involved in a claim
- Claims diaries and management capabilities
- Customizable dashboards and reports for tracking and visualizing claim trends, loss data, and correspondence activity in real time
- Catastrophic events management, policy identification, and assessment of losses
Riskonnect offers a unified platform for managing insurance operations that includes a claims management solution equipped with auto-assignment, analytics, and collaboration features.
- Intuitive forms for claims intake and the ability to submit supporting documents
- Automated generation of first reports of injury (FROI) and subsequent reports of injury (SROI), FROI/SROI-related triggers and notifications configuration, and automated creation of certain reporting events throughout the life of a claim
- Workflow automation and data-entry screens, rules, and forms customization
- Real-time data validation and adverse claims identification
- Detailed logging of every claim step and claim scoring capabilities
- Regulatory compliance facilitation
- Document management capabilities
- Indemnity benefit scheduling, reserving, and audit trail functionality
- Return-to-work process management features
- Predictive and prescriptive analytics, risk-control-cause-outcome relationship analysis, cost structure evaluation for insurable risk, and customizable reporting features and dashboards
BriteCore is a core cloud-based platform for property and casualty insurers that incorporates several modules for an all-inclusive insurance operations management, such as claims, policy, and billing solutions. The claims management module supports end-to-end claims handling, from FNOL intake to payment issuance.
- Claims intake, claimant contact data capture, automated coverage verification, and new loss notices recording and storage
- Claim mapping for understanding the location of claims
- Adjuster assignment to a claim
- Subrogation identification
- Catastrophe claims identification
- Granular reserves and payments tracking as well as aggregate and deductible monitoring
- Financial management, including check processing, subrogation billing, and partial payments calculation and scheduling
- Document management features with the ability to upload files and reports and attach external documents and images
- Note, diary, and reminder generation
- Web-based agent and policyholder self-service portals and mobile apps
- Standard and ad-hoc reports, dashboards, and jurisdiction-specific reports and forms
ClaimCore® is a specialized claims management solution provided by the company EIS that can be used by insurance companies from various sectors, including property and casualty, life and annuity, group and employee benefits, healthcare, and dental insurance.
- Omnichannel claims intake
- Rule-based claim routing
- Configurable workflows for claims lifecycle management, from assignment and adjudication to payment and resolution
- Payment calculation and tracking against coverage limits
- AI-powered solutions for fraud detection, risk assessment, and claims automation
- Claimant portal for claim status tracking and carrier communication
- Thousands of open APIs to integrate with third-party software
- Native integration with the PolicyCore® module for streamlining employee leave and absence management for group benefits carriers, the insureds, and HR teams
AI in insurance claims management
Insurance companies and Insurtech providers are increasingly implementing artificial intelligence into their software solutions to automate more complex claims-related tasks.
Advanced claims processing
AI algorithms can conduct real-time analysis of submitted structured and unstructured data, such as text, images, audio, and video, to evaluate damages and generate an assessment of their severity, possible remediation, and estimated settlement costs.
Fraud detection & risk scoring
Insurers can employ AI solutions for fraud detection to autonomously screen claims, detect suspicious details, and flag high-risk claims for further investigation.
Claims triage & segmentation
AI models determine claim complexity and payout value and automatically prioritize claims for processing based on their urgency, injury severity, damage extent, and financial risks associated with non-settlement.
Intelligent assistants for insurance agents
Powered by generative AI algorithms, these virtual assistants support agents by summarizing documentation, generating call transcripts, finding answers to questions, and drafting responses to customer claims.
Claims management software: common implementation challenges & solutions
Challenge | Solution | |
|---|---|---|
Connecting multiple data sources |
Claims specialists need to collect a lot of information from internal and external data sources to
accurately assess claims. Without seamless integration with the needed tools, they will have to manually
search for data and request additional details, which lengthens claim processing timelines.
| Choose software that provides robust integration capabilities, such as APIs or in-built connectors, to easily create an interoperable ecosystem. If your integration project is more complex and involves, for instance, connecting the insurance claims management software of your choice with legacy systems, tools lacking out-of-the-box connectivity and standard APIs, or solutions using different protocols, consider enlisting the help of an expert insurance software provider. |
Ensuring data security |
The claims system centralizes and stores large amounts of personally identifiable, financial, and
claim-specific information, making it an ideal target for cybercriminals.
| To protect data handled by the claims management software, implement rigorous security measures. Choose insurance tools that are compliant with relevant regulations, support data encryption at rest and in transit, and allow for setting up role-based access controls. Additionally, implement data backup and disaster recovery mechanisms and perform regular security audits. |
Limited process automation |
While traditional claims processing software automates some manual operations, there are still a great
number of processes taking up a lot of time of claims management specialists and lowering their efficiency.
| Equip claims management software with robotic process automation to streamline FNOL intake, claims management, and communication with policyholders. The bots can retrieve, store, and sort data from various channels and in multiple formats, send it to the corporate databases for further analysis, and integrate with workflow automation and rules engines to enable more efficient processes. |
Our insurance software services
Consulting
We assist you with selecting or implementing an insurance claims management system by providing end-to-end consulting support.
- Assessing insurance company needs
- Advising on the most suitable platform or custom solution
- Solution conceptualization and architecture design
- Choosing an optimal tech stack
- Creating a comprehensive implementation strategy
- Assisting with user onboarding and change management
Implementation
Our developers build custom claims management solutions or implement platform-based ones, making sure the platform delivers the required features and smoothly integrates with your IT ecosystem.
- Business needs analysis
- Current technical ecosystem evaluation
- Technical and non-technical requirements elicitation
- Solution design
- Configuring or customizing a platform-based solution/Front-end and back-end solution development
- Software integration with other business systems
- Quality assurance
- Deployment to the target environment
- User training and post-launch monitoring
Looking for a reliable partner for your claims management software project?
FAQs
Insurance claims management software helps insurers organize, track, and process claims more efficiently. It captures, records, and stores all claim details, automates agent assignment and case routing, assists with fraud detection, and supports rule-based adjudication and approval workflows to facilitate claims decision-making. Apart from that, insurance claim management software provides financial management capabilities, allowing specialists to estimate the right compensation amount and pay it.
Insurance claims management systems can make a difference for providers from different sectors, including property and casualty (P&C), life, and health insurance, allowing insurance carriers to quickly respond to policyholders’ claims and process them, build stronger customer relationships, and stay compliant with privacy regulations like GDPR and CCPA. Insurance claims management software can be used by all types of users, such as insurance companies, third-party administrators (TPAs), individual agents, brokers, and insured parties (claimants who submit their information and view their policy and claim details through dedicated portals and touchpoints).
Clearly understand the goals you want to achieve by implementing insurance claim management software, be it reducing claim cycle time, handling more claims, or preventing fraud, to know what features to prioritize. Before purchasing, review publically available customer feedback and test software demo versions if any using sample data to check the tool’s usability, performance, and the ability to perform the required tasks. Give preference to systems that offer intuitive user experiences, robust integration and customization capabilities, high scalability, and extensive security features tailored to your insurance sector’s specifics.
The cost of claims management software is determined by several factors, such as software pricing (if you opt for a platform solution) and hosting fees, customization scope, the number and complexity of the integrations, and existing IT infrastructure. Reach out to us to get a ballpark estimate of your project’s cost.
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