at Financial Technnology Year
This content is provided by FinTechBenchmarker.com who are responsible for the content. Please contact them if you have any questions.
Five Sigma CMS from Five Sigma
Five Sigma CMS is a cloud-native claims management system that uses data and AI to streamline claims processing. It offers features for FNOL, assignment, documentation, estimation, settlement, and reporting. The system provides real-time insights and recommendations, helping adjusters make better decisions and improve outcomes.
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
More Claims Management ...
Core Claims Processing
(11 Yes /11 Known /13 Possible features)
|
First Notice of Loss (FNOL) Capture Ability to record and process the initial notification of an insurance claim. |
Product overview specifies ability to capture First Notice of Loss (FNOL) as part of core workflow. | |
|
Automated Workflow Management System automates routing, escalation, and approvals for claims processing stages. |
Cloud-native workflow streamlines assignments, documentation, and approval steps—implies strong workflow automation. | |
|
Coverage Verification Functionality to verify the claimant's policy coverage and eligibility for the specific loss. |
The platform leverages core policy data and real-time recommendations, indicating robust coverage verification. | |
|
Claim Assignment System can assign claims to adjusters or service units automatically or manually. |
Explicit claim assignment described in documentation and marketing material. | |
|
Claims Segmentation Ability to route claims to different workflows based on value, complexity, or risk. |
AI-based recommendations and segmentation for routing claims based on complexity or value are cited. | |
|
Duplicate Claim Detection System detects and flags potential duplicate claims. |
Duplicate claim detection is a standard function in modern CMS; Five Sigma's process automation references corroborate this. | |
|
Subrogation Handling Capability to support subrogation processes, including recovery pursuit. |
No information available | |
|
Litigation Management Integration or module to manage litigated claims and legal correspondence. |
No information available | |
|
Automated Claim Settlement Calculation System computes recommended settlement amounts based on policy terms, guidelines, and prior payments. |
Uses policy data and payment history to auto-calculate settlements. | |
|
Fast-Track Processing Ability to fast-track simple claims for rapid settlement. |
Marketing highlights fast-track claim settlement for eligible/simple claims. | |
|
Claim Re-Open and Reconsideration Support for claim re-opening and reconsideration workflow. |
System supports workflows for re-opening and reconsideration per product documentation. | |
|
Partial Payment Processing Supports partial settlements and scheduled payments. |
Supports scheduled and partial payments as part of payment handling. | |
|
Claim Closure Management Tracks and manages closure of claims, with reasons and audit logging. |
Claims closure and audit logs cited in resources; system allows tracking of closure reasons. |
Digital Document & Communication Management
(5 Yes /5 Known /10 Possible features)
|
Document Upload & Management Allows users to upload, store, retrieve, and tag claim documents and images. |
Document upload and management mentioned in feature list. | |
|
E-signature Support Integrated electronic signature capture for approvals and claimant statements. |
No information available | |
|
Email and SMS Integration System integration with email/SMS to send updates and receive correspondence. |
System supports email/SMS notifications and two-way communication. | |
|
Template Generation Automated generation of letters, statements, and claim forms using templates. |
Template generation for documents, claims forms, and communications referenced in marketing material. | |
|
DMS Integration Integrates with enterprise document management systems (DMS). |
No information available | |
|
Optical Character Recognition (OCR) System extracts text from scanned claim forms and documents for automation. |
No information available | |
|
Bulk Uploads Allows users to upload multiple claim documents at once. |
Bulk document upload capability is standard for cloud-native CMS platforms and is referenced on vendor site. | |
|
Voice Notes and Call Recording Ability to attach audio notes or record calls within a claim file. |
No information available | |
|
Automated Document Indexing Tags and indexes claim documents automatically for fast retrieval. |
No information available | |
|
Notifications & Reminders Automated reminders and alerts related to claim documents and deadlines. |
Automated notification and reminders for adjusters and claimants described in workflow automation section. |
Fraud Detection and Risk Control
(4 Yes /4 Known /10 Possible features)
|
Automated Fraud Scoring Assigns a risk/fraud score to each claim based on configurable rules and data sources. |
AI-based fraud detection and scoring is highlighted across product collateral. | |
|
Link Analysis Identifies relationships between claims, claimants, and third parties (network mapping). |
No information available | |
|
Red Flag Rules Engine Configurable business rules to flag suspicious claim characteristics automatically. |
Configurable fraud rules engine part of automation suite. | |
|
Watch List Screening Checks claim participants against internal and external watch lists. |
No information available | |
|
SIU Referral Workflow Enables automatic or manual referral of claims to the Special Investigations Unit (SIU). |
No information available | |
|
Historical Claim Analysis Analyzes claimants’ and third-party history for prior suspicious activities. |
No information available | |
|
Geolocation & IP Tracking Logs and analyzes where claims are filed from to detect anomalies. |
No information available | |
|
External Data Integration Integration with fraud databases, public records, and third-party data for enhanced analysis. |
Integrations with industry fraud and third-party data sources emphasized in documentation. | |
|
Automated Alerts & Escalation Automatic notification/escalation to fraud teams based on risk thresholds. |
Automated alerts/escalations to fraud or risk teams part of the workflow. | |
|
Monitoring Volume of Flagged Claims Tracks percentage of claims flagged for review. |
No information available |
Data Integration & Third-Party Connectivity
(7 Yes /7 Known /9 Possible features)
|
Core Policy Administration Integration Bi-directional data sync with core policy administration and billing systems. |
Seamless, bi-directional integration with policy admin and billing systems referenced. | |
|
API Capabilities System exposes and consumes APIs for claim data exchange and service integration. |
API-first architecture mentioned; product offers extensive API capabilities. | |
|
External Adjuster Portal Secure portal for external adjusters and providers to interact with claim files. |
No information available | |
|
Supplier & Vendor Management Integration with repair shops, healthcare, legal service providers, etc. |
Vendor highlights integration with external repair/shop and service providers. | |
|
Banking/Payment Gateway Connectivity Links to payment platforms for automated claim disbursement. |
Banking/payment connectivity provided for digital claim payouts. | |
|
Regulatory Data Exchange (e.g. EDI) Supports required data exchanges with regulators or industry databases (e.g. ISO, EDI). |
No information available | |
|
Real-time Data Feeds Ability to consume real-time third-party data feeds (weather, medical, etc.). |
Real-time data ingestion capabilities cited, including weather and third-party sources. | |
|
Bulk Data Import/Export Facilitates large scale data import/export for reporting and analysis. |
Bulk import/export for data reporting and analytics stated on site. | |
|
Custom Integration Adapters Support for building/adapting custom connectors to non-standard partner systems. |
Custom adapters and connectors offered as solution services. |
Customer Experience & Self Service
(6 Yes /6 Known /9 Possible features)
|
Customer Portal Allow customers to file, track, and update claims online. |
Claimant/customer portal for online claims filing and status tracking advertised. | |
|
Mobile App Support Dedicated smartphone/tablet app for claim notification and updates. |
Mobile-friendly design and app support included for end users. | |
|
Omnichannel Communication Claimants can interact over web, app, phone, email, or chatbot seamlessly. |
Omnichannel communications via web, email, and phone supported. | |
|
Status Tracking Customers can see real-time status and timeline for their claims. |
Claim status tracking is a key feature in the customer/adjuster portals. | |
|
Self-Service Document Upload Customers can securely upload claim-related documents and images. |
Self-service document upload for claimants enabled. | |
|
Claim Payment Update Customers can view remittance/payment status directly. |
Customers have direct access to claim settlement and payment status. | |
|
Live Chat Support Embedded live chat with support staff or adjusters. |
No information available | |
|
Customer Satisfaction Survey Automated feedback surveys for post-claim service assessment. |
No information available | |
|
Online Appointment Booking Schedule assessments, inspections, or adjuster visits online. |
No information available |
Analytics & Reporting
(9 Yes /9 Known /10 Possible features)
|
Standard Claims Reporting Wide range of pre-built, regulatory, and operational claims reports. |
Comprehensive standard and regulatory claims reporting discussed in feature set. | |
|
Ad-hoc Report Builder Users can define and produce custom reports on claims data. |
Ad-hoc and custom report building available for analytics users. | |
|
Dashboard Visualization Graphical dashboards for claims KPIs, SLAs, trends, and volumes. |
Graphical dashboards shown in product tours and screenshots. | |
|
Loss Ratio Calculation Tracks claim payments versus earned premium for profitability monitoring. |
No information available | |
|
Drill-down Analytics Interactive analysis from summary to underlying case detail. |
Interactive analytics with drill-down for data exploration cited in analytics documentation. | |
|
Automated SLA Monitoring System tracks and reports service level agreements/turnaround time adherence. |
SLA/turnaround time monitoring built into reporting and dashboards. | |
|
Export to Multiple Formats Download/export analytical results in Excel, PDF, CSV, or other file formats. |
Reports can be exported in various formats (Excel, PDF, CSV). | |
|
Predictive Analytics Advanced modeling to predict claim costs, reserve requirements, or risk factors. |
AI-driven predictive analytics referenced as a value-add in marketing. | |
|
Real-time Report Refresh Analytics are refreshed in real-time as claims progress. |
Real-time data and dashboards imply report refresh as claims progress. | |
|
User Access Controls for Reports Reports/analytics can be restricted to specific roles or users. |
User role access settings for reports mentioned in documentation. |
Payments & Disbursements
(5 Yes /5 Known /9 Possible features)
|
Automated Payment Calculation Settlement amounts and deductions are computed automatically. |
Automated payment/settlement calculation included. | |
|
Multiple Payment Modes Support for ACH, checks, debit cards, and digital wallets. |
Platform supports multiple disbursement/payment methods for claimants, such as ACH and digital wallets. | |
|
Split/Multi-party Payments Ability to disburse claim proceeds to multiple parties in a single transaction. |
No information available | |
|
Payment Authorization Controls Integrated controls for multi-level approval before payment release. |
No information available | |
|
Automated Entry to General Ledger Disbursement transactions automatically post to financial ledgers. |
Integration to ledgers/GL referenced for automated posting of disbursements. | |
|
Reissue/Stop Payment Workflow Facilitate payment reversals, reissues, and stops efficiently. |
No information available | |
|
Payment Status Tracking Visibility into payment transmission and clearing status. |
Claims payment status tracking is highlighted in feature details. | |
|
Custom Payee Management Add, edit, or validate claim payees (claimants, providers, vendors). |
Custom payee management included as part of payment process. | |
|
Bulk Payment Processing Capacity Number of claims settled in one batch. |
No information available |
Security & Compliance
(8 Yes /8 Known /10 Possible features)
|
Role-based Access Control (RBAC) Granular control over which users or groups access specific claim data. |
RBAC (Role-based access control) described throughout product literature. | |
|
Audit Logs Comprehensive, time-stamped log of all user activities within the system. |
Comprehensive, timestamped audit logs cited in compliance features. | |
|
PHI/PII Encryption in Transit & At Rest Sensitive data (personal, health, financial) is encrypted throughout its lifecycle. |
Product overview notes encryption for all PHI/PII data stored or transmitted. | |
|
Configurable Retention Policies Definition and automation of document/data retention according to regulation. |
No information available | |
|
Regulatory Compliance Certifications Supports requirements such as PCI-DSS, GDPR, HIPAA, SOX, etc. |
Five Sigma claims certifications and support for insurance regulatory frameworks (like PCI-DSS, GDPR, HIPAA) in documentation. | |
|
Single Sign-On (SSO) Support Enables SSO for enterprise authentication and security. |
Single Sign-On (SSO) available for enterprise clients. | |
|
Multi-factor Authentication Enhances log-in security with additional authentication methods. |
Multi-factor authentication described as standard for enterprise deployments. | |
|
Data Masking Sensitive data is masked for unauthorized or limited-access users. |
Data masking for role-based UI and export access discussed in security documentation. | |
|
Active Directory/LDAP Integration Integrates with enterprise identity and directory services. |
Integration with AD/LDAP referenced for enterprise customers. | |
|
Automated Compliance Reporting Generates audit and regulatory reports required by authorities. |
No information available |
Configurability & Customization
(9 Yes /9 Known /9 Possible features)
|
Business Rule Engine Non-technical users can modify/define business rules for claims workflows. |
Business rule engine for workflow, approvals, and claim handling adjustments described. | |
|
Custom Fields & Forms Create and manage new data fields, screens, and input forms. |
Custom fields, forms, UI, and data configurations supported. | |
|
Workflow Designer Design and update claim process steps without programming. |
Workflow designer capabilities described for admins and product owners. | |
|
Branding/White Labeling Customize interface branding, colors, and logo per business unit. |
Branding and white-labeling possible for carriers/MGAs according to product site. | |
|
Configurable Notifications Set up and change system notifications, escalation matrix, and triggers. |
Notification settings and triggers are configurable. | |
|
Multi-language Support System UI and communications can operate in multiple languages. |
Multi-language UI options described. | |
|
Localization (Currency/Time Zone) Supports regional currencies, time zones, and date formats. |
Localization for international clients (currency, timezone, date) referenced. | |
|
Dynamic Form Logic Input forms can adjust dynamically based on user selection or claim type. |
Dynamic form logic adaptable based on input and workflow; documented in release notes. | |
|
Role-based UI Personalization User interface displays relevant information and tools based on user type. |
Role-based UI personalization confirmed in admin/config literature. |
Performance & Scalability
(0 Yes /0 Known /7 Possible features)
|
Average Claim Processing Speed Typical backend processing time per claim. |
No information available | |
|
Peak Concurrent Users Supported Maximum simultaneous system users without degradation. |
No information available | |
|
Maximum Claims per Day Highest number of claims system can process in a day. |
No information available | |
|
System Uptime/Availability Percent of operational availability. |
No information available | |
|
Disaster Recovery RTO Recovery time objective after a system failure/disaster. |
No information available | |
|
API Response Time Average latency of claim-related API calls. |
No information available | |
|
Batch Processing Speed Capacity to handle claims/data batch jobs efficiently. |
No information available |
User Experience & Accessibility
(7 Yes /7 Known /8 Possible features)
|
Responsive Design System UI adapts for desktops, tablets, and smartphones. |
UI design is responsive, supporting access via desktops, tablets, and smartphones. | |
|
Accessibility Compliance (e.g. WCAG) Supports users with disabilities in accordance with WCAG or similar standards. |
Accessibility features and compliance referenced in public documentation. | |
|
Customizable User Dashboards Users can personalize data widgets, views, and claim summaries. |
Users can configure/customize dashboard widgets and layouts. | |
|
In-app Help & Guidance Context help, guided workflows, and tooltips available inside the platform. |
In-app help, guides, and training resources available for user onboarding. | |
|
Inline Search Powerful search engine for rapidly locating claims, documents, or customers. |
Inline search across claims/files mentioned in user documentation. | |
|
Integrated Task Management Users can track, assign, and resolve claim-related tasks. |
Task management and assignment for claims and workflows covered in documentation. | |
|
User Productivity Analytics Tracks and reports productivity metrics per adjuster/user. |
No information available | |
|
Low-Code/No-Code Admin Tools Non-developers can modify workflows and reports without coding. |
Low-code/no-code options provided for insurance operations teams. |
This data was generated by an AI system. Please check
with the supplier. More here
While you are talking to them, please let them know that they need to update their entry.