What is Connected Claims?

Introduction

The Appian Connected Claims Solution, built on the Appian Low-Code Platform, optimizes the claims life cycle with intelligent automation and unprecedented agility to rapidly unify disparate systems and data. This coupled with 360-degree view results in faster claims settlement, increased straight-through processing, reduced claims leakage, and a superior customer experience.

Connected Claims is comprised of 7 integrated modules that are relevant to all insurance lines of business (LOB), from property and casualty to life and specialty.

With Connected Claims, you can deliver a superior customer experience to each client throughout the claims process, reduce leakage, and settle claims quickly. Easily differentiate your claims management approach from your competition and expedite claims handling by delivering a 360-degree view of each insurance claim as it moves through the claims life cycle.

Empower your insurance personnel with the tools and information they need to speed up the claims process. Quickly mitigate issues around claims leakage and inefficiencies in claims handling due to disconnected systems. With Connected Claims, you'll increase your team's visibility into the entire claims process, equipping them to streamline processes, better identify potential fraud, and reduce time to close. Users of different roles can quickly access actionable dashboards that unify the Connected Claims modules and find the relevant records they need to process an active claim.

Connected Claims Site

The Connected Claims site consists of a single workspace that allows users to quickly navigate between the solution's 4 main pages: HOME, CUSTOMERS, TASKS, and CONFIGURATION and the 7 integrated insurance modules that are accessible from the solution's HOME page.

The site is strategically organized to provide users with a customized and focused experience. This means that access and visibility to the insurance modules are granted based on group membership. Connected Claims allows you to easily configure groups so members see only the modules and information they need to do their jobs. This allows users to quickly access the workflows, tasks, and information that they need quickly process a claim, conduct field inspections, manage fraud, and more.

For example, you might want to configure a Claims Agent Intake group and an admin group so only members of these groups can manage the claims intake workflow. In order to give members access to the information and actions that they need, both groups will need access to the Connected Claims FNOL and Customer Service modules. This access will allow them to view the Claims list and Customers list, report a new claim, and drill down into a specific claim to analyze claim data and take action on the claim. For more information about the various groups in Connected Claims and configuring groups, see the Groups Reference Page and Modifying Groups.

After logging into the Connected Claims site, users can:

• Access the Connected Claims Modules: Access the insurance modules they have visibility to and manage the workflows needed to process claims more efficiently.
• Read Insurance & Claim News: Stay current with the latest insurance and claims news that impacts their industry
• View Customer Data: View an active customer list and key performance indicators that provide an overall summary of your active customer data for a specific point in time. Drill down into a specific customer to view additional details. Quickly filter the list to view only the customers you want to see.
• Create and Update Customer Records: Enter details to create a new customer record or update an existing customer record.
• View Assigned Tasks: View a complete list of all of their assigned tasks, including status details, across all of the Connected Claims modules they have visibility to. Quickly filter the list to view only the tasks you want to see.
• Manage the Claims Journey: Configure new process workflows to manage the claims journey across all of your lines of business.
• Create Questionnaires and Surveys: Create and modify dynamic questionnaires and surveys to ask for the required information they need to process a claim. Select and consume existing questionnaires across multiple tasks in specific workflows. Externally publish questionnaires or surveys across multiple digital channels.
• Create Business Rules: Create and update new business rules to manage claims processing.
• Manage Claim Assignment: Create and manage rules to manage claim assignment.
• Manage the Workforce: View a complete list of your field service workers. Create and update field service worker records.
• Configure Inspector Types and Skills:

Connected Claims Configuration Page

After installing the Connected Claims solution, you can easily configure and customize it across all your lines of business (LOB) from the CONFIGURATION page.

Business users can:

• Manage the Claim Journey Setup: Create and manage the claim journey for different lines of business.
• Claim Journey Process Model Setup: Add process models for claim journey configuration.
• Manage Line of business: View, update, or add a new line of business.
• Manage Business Rules: Configure and update different business rules for claim processes.
• Payment and Reserve Authorization Rules: Create and configure business rules for reserves and payment authorization requests.
• Publish Expression Rules in Database: Publish and use expression rules in the Rules Engine.
• Communication Templates: Manage all communication templates.
• Questionnaires: Manage dynamic questionnaires and surveys.
• Claim Assignments: Configure rules to manage claim assignments.
• Inspector Skills: Manage field inspector skills for task assignments.
• Inspection Types: Manage field work types.
• Update Application Name: View or update the application name

Only business users with the appropriate group membership are able to access the CONFIGURATION page. This ensures that only a select few have access to modify sensitive processes and information.

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