Connected Claims Overview

What Connected Claims is

Claims management can be challenging for everyone involved, from submitting new claims to maintaining efficient workflows. For many claims, there are lots of moving parts and frequently multiple people involved. This makes it both essential and difficult to keep the entire process running smoothly, get vital information to the people that need it, and ensure that each part of the process addresses the user's and organization's specific needs.

Connected Claims helps address these challenges. Connected Claims is a suite of out-of-the-box applications that enable business users to efficiently manage the activities and data for each part of the claims process, as well as independently maintain and customize claims workflows to meet an organization's unique needs.

Connected Claims consists of two parts: Workspace and the Control Panel. Workspace is a central site for claims adjusters, claim examiners, and claim supervisors to carry out all of their core responsibilities, from claims intake to settlement.

The Control Panel is where business users configure and customize your organization's claims workflows and processes through simple and intuitive no-code design tools. The Control Panel is embedded in the Connected Claims application rather than hosted as a separate site.

How Connected Claims works

Connected Claims is built on the Appian process automation platform with a modular design. It employs both in-app and extensible design frameworks to ensure that it meets your needs. A set of no-code tools built into Connected Claims enables users of any skill set, even those that are not trained low-code developers, to customize workflows. Accompanying modules have pre-built features that are easily configurable and allow you to quickly expand your app functionality. These modern design approaches enable you to create robust, purpose-driven claims management apps without the lengthy development cycles.

The platform's underlying transactional database can be either PostgreSQL or MariaDB, which provides greater flexibility and compatibility with a wider range of enterprise environments.

In addition to Workspace and Control Panel capabilities, you can further extend Connected Claims capabilities by incorporating modules built specifically to accompany it, which include:

• AI Modules
  • AI Chat with Claims
  • AI Claim Comment Summary
  • AI Claim Document Summary
• LOB Supplements
  • LOB Automobile
  • LOB Home Owners
  • LOB Life
  • LOB Workers Compensation
• Productivity Modules
  • Create Claim API
  • Surveys and Questions
  • Upload Claim Document API

What does Connected Claims provide?

The Appian Connected Claims solution provides a wide range of features that enable your organization to collaborate, update, and execute their claims management processes. This table describes the solution's key features that differentiate it from other commercial solutions.

Connected Claims use case: Processing an automobile claim efficiently

To better understand these key features in action, let's examine a detailed use case:

SafeGuard Insurance faces increasing claim volumes and needs to process automobile claims more efficiently while maintaining high customer satisfaction. Sarah, a claims adjuster at SafeGuard, receives a new automobile claim from a policyholder who was involved in a multi-vehicle accident. The traditional claims process involves lengthy manual reviews and coordination between multiple departments, which delays settlements.

In this next section, let's explore the Connected Claims features that help Sarah and her colleagues accelerate the claims process through this example workflow.

Streamline claims intake and processing

The Connected Claims solution accelerates the initial claim intake and ensures accurate processing from the start. For example, when the policyholder submits their automobile claim through the First Notice of Loss (FNOL) process, the system automatically routes the claim to Sarah's queue based on the claim type and complexity.

As part of the initial assessment, Sarah uses the AI Coverages Analyzer feature. This intelligent system automatically analyzes the loss description against the policyholder's coverage details, instantly identifying that the claim falls under collision coverage and highlighting any potential coverage limitations. The advanced policy search capabilities allow Sarah to quickly access comprehensive policy information and validate coverage details without navigating multiple systems.

Enhance user experience and collaboration

Using the Workspace interface, Sarah has access to all claim-related information in a single, intuitive dashboard. She can efficiently review claim details, policy information, and related documentation without switching between multiple applications. Sarah uses the comment tagging feature to add internal notes about the claim investigation, tagging comments as "investigation" "coverage," or "settlement" to help other team members quickly find relevant information. When coordinating with the repair shop and medical providers, she leverages the related parties management system to create and link all involved parties, establishing clear relationships between the policyholder, witnesses, repair facilities, and medical providers.

Leverages the power of AI

Sarah utilizes the AI Chat with Claims module to quickly ask questions about similar past claims and get instant insights about typical settlement ranges for comparable automobile accidents. The AI provides data-driven recommendations based on historical claim patterns.

As the claim progresses and multiple comments are added by different team members, Sarah uses the AI Claim Comment Summary feature to generate a concise overview of all interactions and updates. When medical reports and repair estimates are uploaded, the AI Claim Document Summary automatically extracts key information, highlighting important details like injury severity, repair costs, and treatment recommendations.

Customizes workflows with no-code tools

The claims manager at SafeGuard has configured the automobile claims workflow using Control Panel configuration tools. The workflow includes conditional tasking that automatically assigns different tasks based on claim severity and damage amount. For Sarah's claim, tasks are automatically created for vehicle inspection, medical record review, and settlement negotiation based on the claim characteristics.

The multiple task assignment types ensure that high-priority tasks are assigned to senior adjusters while routine documentation tasks are distributed among the team based on current workload.

Extends with specialized modules

Since this is an automobile claim, SafeGuard leverages the LOB Automobile module, which provides specialized fields and workflows specific to vehicle claims, including VIN tracking, repair shop networks, and total loss calculations.

The claims team uses the Surveys and Questions module to send structured questionnaires to the policyholder and witnesses, gathering consistent information that feeds directly into the claim file. Additionally, the Create Claim API enables seamless integration with external systems for automated claim creation from third-party sources.

Provides transparency and insights

Connected Claims consolidates all relevant data, documents, tasks, communications, and progress for the automobile claim into a single, accessible, centralized view. This provides real-time visibility for the claims manager and all stakeholders, fostering cross-functional collaboration and accountability. Furthermore, Connected Claims offers reserve and recovery management capabilities that enable SafeGuard's claims managers to monitor financial exposure, track reserve adjustments, and manage recovery efforts effectively. This helps identify potential cost savings and optimize financial outcomes.

Integration and efficiency in Connected Claims

This walkthrough of key Connected Claims features demonstrates how SafeGuard Insurance significantly reduced its claim processing time while improving accuracy and customer satisfaction. The automobile claim that traditionally took weeks to resolve was processed efficiently in days, with better documentation and stakeholder communication throughout the process.

Get started with Connected Claims

Ready to get started using Connected Claims? See the following documentation for more information on installing and using Appian Connected Claims:

• Installing Connected Claims
  • Installing Connected Claims - MariaDB
  • Installing Connected Claims - PostgreSQL
• Using Workspace
• Using the Control Panel
• Migrating from Claims Studio to the Control Panel

Feedback