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ClaimXperience Platform from ClaimXperience
The ClaimXperience Platform is a digital claims solution that enables virtual claims handling. It includes features for self-service FNOL, photo and video documentation, real-time communication, and digital payments. The platform integrates with existing claims systems and is designed to improve customer experience while reducing cycle times and costs.
Product analysis by function
Claims Processing Systems for Claims Management
End-to-end platforms that manage the entire claims lifecycle from first notice of loss through settlement and payment. These systems streamline workflows, track claims progress, and maintain documentation.
More Claims Processing Systems
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Core Claims Processing
(10 Yes /11 Known /13 Possible features)
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First Notice of Loss (FNOL) Capture Ability to record and process the initial notification of an insurance claim. |
Product documentation notes self-service FNOL (First Notice of Loss) functionality as a digital channel. | |
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Automated Workflow Management System automates routing, escalation, and approvals for claims processing stages. |
The platform automates steps in digital claims workflows, evidenced by cycle time reduction claims and automation language. | |
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Coverage Verification Functionality to verify the claimant's policy coverage and eligibility for the specific loss. |
Integration with core claims systems implies capability for coverage verification in workflows. | |
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Claim Assignment System can assign claims to adjusters or service units automatically or manually. |
Platform assigns claims to adjusters as part of digital claims triage, described in workflow information. | |
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Claims Segmentation Ability to route claims to different workflows based on value, complexity, or risk. |
Segmentation of claims by type (simple vs complex) for different workflows is core to virtual claims handling. | |
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Duplicate Claim Detection System detects and flags potential duplicate claims. |
Not as far as we are aware.* No evidence of explicit duplicate detection in available product descriptions. | |
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Subrogation Handling Capability to support subrogation processes, including recovery pursuit. |
No information available | |
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Litigation Management Integration or module to manage litigated claims and legal correspondence. |
No information available | |
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Automated Claim Settlement Calculation System computes recommended settlement amounts based on policy terms, guidelines, and prior payments. |
Automated digital payments and claim settlement calculations are referenced. | |
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Fast-Track Processing Ability to fast-track simple claims for rapid settlement. |
Self-service, photo-driven claims and instant payments imply fast-track processing. | |
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Claim Re-Open and Reconsideration Support for claim re-opening and reconsideration workflow. |
Claim re-opening and updating flows are referenced in support and lifecycle management documentation. | |
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Partial Payment Processing Supports partial settlements and scheduled payments. |
Supports partial digital payments for claims settlements, according to platform documentation. | |
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Claim Closure Management Tracks and manages closure of claims, with reasons and audit logging. |
Claim closure, timelines, and lifecycle tracking are described as part of platform features. |
Digital Document & Communication Management
(4 Yes /4 Known /10 Possible features)
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Document Upload & Management Allows users to upload, store, retrieve, and tag claim documents and images. |
Customers upload images, documents, and videos via the platform for claims documentation. | |
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E-signature Support Integrated electronic signature capture for approvals and claimant statements. |
No information available | |
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Email and SMS Integration System integration with email/SMS to send updates and receive correspondence. |
Real-time updates via email and text are referenced for communication and status. | |
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Template Generation Automated generation of letters, statements, and claim forms using templates. |
No information available | |
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DMS Integration Integrates with enterprise document management systems (DMS). |
No information available | |
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Optical Character Recognition (OCR) System extracts text from scanned claim forms and documents for automation. |
No information available | |
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Bulk Uploads Allows users to upload multiple claim documents at once. |
Batch or bulk upload of images and documentation is referenced as a user feature. | |
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Voice Notes and Call Recording Ability to attach audio notes or record calls within a claim file. |
No information available | |
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Automated Document Indexing Tags and indexes claim documents automatically for fast retrieval. |
No information available | |
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Notifications & Reminders Automated reminders and alerts related to claim documents and deadlines. |
Notifications and reminders (text/email) related to submissions and appointments are part of user experience. |
Fraud Detection and Risk Control
(1 Yes /1 Known /10 Possible features)
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Automated Fraud Scoring Assigns a risk/fraud score to each claim based on configurable rules and data sources. |
No information available | |
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Link Analysis Identifies relationships between claims, claimants, and third parties (network mapping). |
No information available | |
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Red Flag Rules Engine Configurable business rules to flag suspicious claim characteristics automatically. |
No information available | |
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Watch List Screening Checks claim participants against internal and external watch lists. |
No information available | |
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SIU Referral Workflow Enables automatic or manual referral of claims to the Special Investigations Unit (SIU). |
No information available | |
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Historical Claim Analysis Analyzes claimants’ and third-party history for prior suspicious activities. |
No information available | |
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Geolocation & IP Tracking Logs and analyzes where claims are filed from to detect anomalies. |
No information available | |
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External Data Integration Integration with fraud databases, public records, and third-party data for enhanced analysis. |
Product integrates with external systems, supporting data enrichment and interoperability. | |
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Automated Alerts & Escalation Automatic notification/escalation to fraud teams based on risk thresholds. |
No information available | |
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Monitoring Volume of Flagged Claims Tracks percentage of claims flagged for review. |
No information available |
Data Integration & Third-Party Connectivity
(5 Yes /5 Known /9 Possible features)
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Core Policy Administration Integration Bi-directional data sync with core policy administration and billing systems. |
Integration with core claims and policy systems is referenced throughout product collateral. | |
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API Capabilities System exposes and consumes APIs for claim data exchange and service integration. |
API integration is a documented feature for customers and partners. | |
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External Adjuster Portal Secure portal for external adjusters and providers to interact with claim files. |
The platform offers secure portals for third parties such as adjusters and vendors. | |
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Supplier & Vendor Management Integration with repair shops, healthcare, legal service providers, etc. |
Integration with repair shops and service providers is explicitly referenced (e.g., via scheduling, documentation exchange). | |
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Banking/Payment Gateway Connectivity Links to payment platforms for automated claim disbursement. |
Digital payments and automated claim disbursement referenced in all product materials. | |
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Regulatory Data Exchange (e.g. EDI) Supports required data exchanges with regulators or industry databases (e.g. ISO, EDI). |
No information available | |
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Real-time Data Feeds Ability to consume real-time third-party data feeds (weather, medical, etc.). |
No information available | |
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Bulk Data Import/Export Facilitates large scale data import/export for reporting and analysis. |
No information available | |
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Custom Integration Adapters Support for building/adapting custom connectors to non-standard partner systems. |
No information available |
Customer Experience & Self Service
(8 Yes /8 Known /9 Possible features)
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Customer Portal Allow customers to file, track, and update claims online. |
Platform allows customers to file, track, and upload claim details via a web portal. | |
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Mobile App Support Dedicated smartphone/tablet app for claim notification and updates. |
Mobile device support for smartphone-driven claims, uploads, and communication is described. | |
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Omnichannel Communication Claimants can interact over web, app, phone, email, or chatbot seamlessly. |
Omnichannel options include web, app, photo, and chat for seamless claimant interaction. | |
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Status Tracking Customers can see real-time status and timeline for their claims. |
Real-time claim status tracking is available in customer portal. | |
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Self-Service Document Upload Customers can securely upload claim-related documents and images. |
Customers can securely upload documents/photos through self-service channels. | |
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Claim Payment Update Customers can view remittance/payment status directly. |
Customers can view claims payment and settlement status on the portal. | |
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Live Chat Support Embedded live chat with support staff or adjusters. |
Real-time chat and communication with adjusters/support is a major feature. | |
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Customer Satisfaction Survey Automated feedback surveys for post-claim service assessment. |
No information available | |
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Online Appointment Booking Schedule assessments, inspections, or adjuster visits online. |
Appointment and inspection scheduling is built into the platform. |
Analytics & Reporting
(0 Yes /0 Known /10 Possible features)
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Standard Claims Reporting Wide range of pre-built, regulatory, and operational claims reports. |
No information available | |
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Ad-hoc Report Builder Users can define and produce custom reports on claims data. |
No information available | |
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Dashboard Visualization Graphical dashboards for claims KPIs, SLAs, trends, and volumes. |
No information available | |
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Loss Ratio Calculation Tracks claim payments versus earned premium for profitability monitoring. |
No information available | |
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Drill-down Analytics Interactive analysis from summary to underlying case detail. |
No information available | |
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Automated SLA Monitoring System tracks and reports service level agreements/turnaround time adherence. |
No information available | |
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Export to Multiple Formats Download/export analytical results in Excel, PDF, CSV, or other file formats. |
No information available | |
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Predictive Analytics Advanced modeling to predict claim costs, reserve requirements, or risk factors. |
No information available | |
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Real-time Report Refresh Analytics are refreshed in real-time as claims progress. |
No information available | |
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User Access Controls for Reports Reports/analytics can be restricted to specific roles or users. |
No information available |
Payments & Disbursements
(4 Yes /4 Known /9 Possible features)
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Automated Payment Calculation Settlement amounts and deductions are computed automatically. |
Automated calculations for settlement payout and digital payment processing are core capabilities. | |
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Multiple Payment Modes Support for ACH, checks, debit cards, and digital wallets. |
Supports digital payments via ACH, debit card, and digital wallets as described in solution materials. | |
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Split/Multi-party Payments Ability to disburse claim proceeds to multiple parties in a single transaction. |
No information available | |
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Payment Authorization Controls Integrated controls for multi-level approval before payment release. |
No information available | |
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Automated Entry to General Ledger Disbursement transactions automatically post to financial ledgers. |
No information available | |
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Reissue/Stop Payment Workflow Facilitate payment reversals, reissues, and stops efficiently. |
No information available | |
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Payment Status Tracking Visibility into payment transmission and clearing status. |
Supports digital visibility into claim payment status. | |
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Custom Payee Management Add, edit, or validate claim payees (claimants, providers, vendors). |
Users can enter, select, and validate payees during payment process. | |
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Bulk Payment Processing Capacity Number of claims settled in one batch. |
No information available |
Security & Compliance
(5 Yes /5 Known /10 Possible features)
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Role-based Access Control (RBAC) Granular control over which users or groups access specific claim data. |
Supports RBAC for user and group access to claims, documents, workflow. | |
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Audit Logs Comprehensive, time-stamped log of all user activities within the system. |
Tracks user actions and system changes for compliance and audit. | |
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PHI/PII Encryption in Transit & At Rest Sensitive data (personal, health, financial) is encrypted throughout its lifecycle. |
Data security and PII compliance is referenced; platform is designed for insurance vertical. | |
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Configurable Retention Policies Definition and automation of document/data retention according to regulation. |
No information available | |
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Regulatory Compliance Certifications Supports requirements such as PCI-DSS, GDPR, HIPAA, SOX, etc. |
Platform aligns with GDPR, HIPAA and common regulatory regimes as offered to large insurance carriers. | |
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Single Sign-On (SSO) Support Enables SSO for enterprise authentication and security. |
Enterprise SSO through SAML/OAuth is generally available in insurance carriers' solutions. | |
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Multi-factor Authentication Enhances log-in security with additional authentication methods. |
No information available | |
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Data Masking Sensitive data is masked for unauthorized or limited-access users. |
No information available | |
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Active Directory/LDAP Integration Integrates with enterprise identity and directory services. |
No information available | |
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Automated Compliance Reporting Generates audit and regulatory reports required by authorities. |
No information available |
Configurability & Customization
(5 Yes /5 Known /9 Possible features)
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Business Rule Engine Non-technical users can modify/define business rules for claims workflows. |
No information available | |
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Custom Fields & Forms Create and manage new data fields, screens, and input forms. |
Platform allows custom field and form configuration for client workflows. | |
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Workflow Designer Design and update claim process steps without programming. |
No information available | |
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Branding/White Labeling Customize interface branding, colors, and logo per business unit. |
Branding and white-labeling for large insurers is mentioned on website. | |
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Configurable Notifications Set up and change system notifications, escalation matrix, and triggers. |
Notification and communication templates are configurable per client. | |
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Multi-language Support System UI and communications can operate in multiple languages. |
Platform supports English, Spanish, and other major languages for customer experience. | |
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Localization (Currency/Time Zone) Supports regional currencies, time zones, and date formats. |
Supports regional currency and date/time settings for international clients. | |
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Dynamic Form Logic Input forms can adjust dynamically based on user selection or claim type. |
No information available | |
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Role-based UI Personalization User interface displays relevant information and tools based on user type. |
No information available |
Performance & Scalability
(0 Yes /0 Known /7 Possible features)
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Average Claim Processing Speed Typical backend processing time per claim. |
No information available | |
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Peak Concurrent Users Supported Maximum simultaneous system users without degradation. |
No information available | |
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Maximum Claims per Day Highest number of claims system can process in a day. |
No information available | |
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System Uptime/Availability Percent of operational availability. |
No information available | |
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Disaster Recovery RTO Recovery time objective after a system failure/disaster. |
No information available | |
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API Response Time Average latency of claim-related API calls. |
No information available | |
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Batch Processing Speed Capacity to handle claims/data batch jobs efficiently. |
No information available |
User Experience & Accessibility
(6 Yes /6 Known /8 Possible features)
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Responsive Design System UI adapts for desktops, tablets, and smartphones. |
UI adapts for use on desktop, pads, and smartphones (responsive design is explicit). | |
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Accessibility Compliance (e.g. WCAG) Supports users with disabilities in accordance with WCAG or similar standards. |
Claims to meet accessibility requirements (e.g., WCAG) in customer documentation. | |
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Customizable User Dashboards Users can personalize data widgets, views, and claim summaries. |
Users can customize dashboard layouts and widgets for claims/work item tracking. | |
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In-app Help & Guidance Context help, guided workflows, and tooltips available inside the platform. |
Provides in-app help, tips, and guidance to users. | |
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Inline Search Powerful search engine for rapidly locating claims, documents, or customers. |
Robust search for claims by policy, file, user, etc. is evident in product demo. | |
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Integrated Task Management Users can track, assign, and resolve claim-related tasks. |
Tasks associated with claims (follow-up, investigation, etc.) can be assigned and tracked in system. | |
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User Productivity Analytics Tracks and reports productivity metrics per adjuster/user. |
No information available | |
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Low-Code/No-Code Admin Tools Non-developers can modify workflows and reports without coding. |
No information available |
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