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Ventiv Claims from Ventiv Technology
Ventiv Claims is a comprehensive claims management solution that supports multiple lines of business. It offers features for FNOL, assignment, documentation, settlement, payment processing, and reporting. The system uses advanced analytics to identify trends and patterns, helping organizations reduce claims costs 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.
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Core Claims Processing
(13 Yes /13 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. |
Ventiv Claims documentation and product page state support for FNOL (First Notice of Loss) capture as a core feature of the solution. | |
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Automated Workflow Management System automates routing, escalation, and approvals for claims processing stages. |
Ventiv Claims advertises automated workflow management including routing, escalation, and approvals within the claims lifecycle. | |
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Coverage Verification Functionality to verify the claimant's policy coverage and eligibility for the specific loss. |
Coverage verification is a standard element as per Ventiv’s documentation on automated decision-making and eligibility checks. | |
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Claim Assignment System can assign claims to adjusters or service units automatically or manually. |
Product descriptions explicitly reference automated or manual claim assignment to adjusters or teams. | |
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Claims Segmentation Ability to route claims to different workflows based on value, complexity, or risk. |
Ventiv supports segmentation and workflow branching based on claim characteristics and complexity. | |
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Duplicate Claim Detection System detects and flags potential duplicate claims. |
The system can identify and flag duplicate claims using built-in logic, as per product features listing. | |
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Subrogation Handling Capability to support subrogation processes, including recovery pursuit. |
Subrogation handling is explicitly listed as part of the claims lifecycle tools in Ventiv Claims. | |
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Litigation Management Integration or module to manage litigated claims and legal correspondence. |
Litigation management and legal correspondence tracking are included modules as per Ventiv’s detailed claims process explanations. | |
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Automated Claim Settlement Calculation System computes recommended settlement amounts based on policy terms, guidelines, and prior payments. |
Ventiv Claims offers automated claim settlement logic which calculates recommended settlements based on rules and payment history. | |
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Fast-Track Processing Ability to fast-track simple claims for rapid settlement. |
Fast-track processing for simple claims is highlighted as a feature to support rapid settlements. | |
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Claim Re-Open and Reconsideration Support for claim re-opening and reconsideration workflow. |
Claim reopening and reconsideration workflows are available per Ventiv features and user guides. | |
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Partial Payment Processing Supports partial settlements and scheduled payments. |
Partial payment processing, including scheduled partial settlements, is standard in Ventiv Claims. | |
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Claim Closure Management Tracks and manages closure of claims, with reasons and audit logging. |
Claim closure management, including closure, audit, and reasons, are part of the claims processing suite. |
Digital Document & Communication Management
(9 Yes /9 Known /10 Possible features)
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Document Upload & Management Allows users to upload, store, retrieve, and tag claim documents and images. |
Document upload and management (including retrieval/tagging) is a core system function in Ventiv Claims. | |
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E-signature Support Integrated electronic signature capture for approvals and claimant statements. |
E-signature support is offered for digital approvals and claimant statements (referenced in Ventiv's documentation). | |
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Email and SMS Integration System integration with email/SMS to send updates and receive correspondence. |
Email/SMS notifications and integrations are mentioned as part of the communication toolkit. | |
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Template Generation Automated generation of letters, statements, and claim forms using templates. |
Template-based document and correspondence generation is supported according to product documentation. | |
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DMS Integration Integrates with enterprise document management systems (DMS). |
Ventiv Claims integrates with external Document Management Systems (DMS), as indicated in technical literature. | |
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Optical Character Recognition (OCR) System extracts text from scanned claim forms and documents for automation. |
Optical Character Recognition (OCR) is available to convert scanned forms into actionable data; this is highlighted for automation. | |
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Bulk Uploads Allows users to upload multiple claim documents at once. |
Bulk upload of documents is supported for high-volume operations. | |
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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. |
Automated indexing and tagging of files is documented for efficient retrieval. | |
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Notifications & Reminders Automated reminders and alerts related to claim documents and deadlines. |
Automated reminders and notifications are supported, covering deadlines and important events. |
Fraud Detection and Risk Control
(9 Yes /9 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. |
Ventiv Claims includes advanced fraud analytics, including configurable fraud scoring engines. | |
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Link Analysis Identifies relationships between claims, claimants, and third parties (network mapping). |
Link analysis tools for claims, claimants, and third-party relationships are mentioned in analytics modules. | |
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Red Flag Rules Engine Configurable business rules to flag suspicious claim characteristics automatically. |
Red flag rules engines can be configured to detect suspicious patterns in claims, according to product documentation. | |
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Watch List Screening Checks claim participants against internal and external watch lists. |
Watch list/integrated participant screening is supported for compliance and fraud. | |
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SIU Referral Workflow Enables automatic or manual referral of claims to the Special Investigations Unit (SIU). |
SIU referral workflow automation (manual/automatic) is standard in fraud management features. | |
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Historical Claim Analysis Analyzes claimants’ and third-party history for prior suspicious activities. |
Ventiv analyzes claim and claimant history for fraud, as supported by advanced analytics. | |
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Geolocation & IP Tracking Logs and analyzes where claims are filed from to detect anomalies. |
Geolocation/IP tracking for fraud/risk is listed among security and anti-fraud tools. | |
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External Data Integration Integration with fraud databases, public records, and third-party data for enhanced analysis. |
Ventiv Claims supports integration with external databases (public records, fraud databases) as part of the analytics suite. | |
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Automated Alerts & Escalation Automatic notification/escalation to fraud teams based on risk thresholds. |
Automated escalations and alerts are configured for risk/fraud triggers. | |
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Monitoring Volume of Flagged Claims Tracks percentage of claims flagged for review. |
No information available |
Data Integration & Third-Party Connectivity
(9 Yes /9 Known /9 Possible features)
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Core Policy Administration Integration Bi-directional data sync with core policy administration and billing systems. |
Policy admin/core system integrations are supported via APIs and built-in data connectors. | |
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API Capabilities System exposes and consumes APIs for claim data exchange and service integration. |
API exposure, including RESTful APIs for claims data integration, is cited in product technical specs. | |
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External Adjuster Portal Secure portal for external adjusters and providers to interact with claim files. |
External adjuster/provider portals are highlighted for collaboration and task management. | |
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Supplier & Vendor Management Integration with repair shops, healthcare, legal service providers, etc. |
Supplier/vendor management integrations are supported for healthcare, repairs, and legal services. | |
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Banking/Payment Gateway Connectivity Links to payment platforms for automated claim disbursement. |
Banking/payment gateway connectivity for automated disbursement is supported. | |
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Regulatory Data Exchange (e.g. EDI) Supports required data exchanges with regulators or industry databases (e.g. ISO, EDI). |
Regulatory data exchange (including EDI/ISO formats) is available for compliance. | |
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Real-time Data Feeds Ability to consume real-time third-party data feeds (weather, medical, etc.). |
Real-time data feeds (e.g., weather, medical) are supported via external data integrations. | |
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Bulk Data Import/Export Facilitates large scale data import/export for reporting and analysis. |
Bulk data import/export features available per documented reporting capabilities. | |
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Custom Integration Adapters Support for building/adapting custom connectors to non-standard partner systems. |
Custom adapters for integration with non-standard partner systems can be developed using Ventiv’s APIs. |
Customer Experience & Self Service
(9 Yes /9 Known /9 Possible features)
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Customer Portal Allow customers to file, track, and update claims online. |
A secure portal for customers to file, track, and manage claims online is a key offering from Ventiv. | |
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Mobile App Support Dedicated smartphone/tablet app for claim notification and updates. |
Mobile app support for claim notification and progress tracking referenced on the Ventiv website. | |
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Omnichannel Communication Claimants can interact over web, app, phone, email, or chatbot seamlessly. |
Ventiv Claims enables omnichannel communication, including web, app, email, and chat. | |
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Status Tracking Customers can see real-time status and timeline for their claims. |
Customers have real-time status and timeline visibility on their claims. | |
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Self-Service Document Upload Customers can securely upload claim-related documents and images. |
Self-service, secure document upload and image support for customers is available. | |
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Claim Payment Update Customers can view remittance/payment status directly. |
Remittance/payment status visibility provided to customers via portal/app. | |
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Live Chat Support Embedded live chat with support staff or adjusters. |
Live chat with staff or adjusters is supported in the communications suite. | |
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Customer Satisfaction Survey Automated feedback surveys for post-claim service assessment. |
Customer satisfaction survey automation is highlighted within post-claim processes. | |
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Online Appointment Booking Schedule assessments, inspections, or adjuster visits online. |
Online appointment booking for assessments/adjuster visits is referenced as part of digital self-service tools. |
Analytics & Reporting
(10 Yes /10 Known /10 Possible features)
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Standard Claims Reporting Wide range of pre-built, regulatory, and operational claims reports. |
Ventiv features a standard catalog of pre-built and regulatory claims reports. | |
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Ad-hoc Report Builder Users can define and produce custom reports on claims data. |
Ad-hoc/custom report builder for claims data is highlighted as part of analytics. | |
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Dashboard Visualization Graphical dashboards for claims KPIs, SLAs, trends, and volumes. |
Configurable, graphical dashboards for KPIs, SLAs, and workflow monitoring are supported. | |
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Loss Ratio Calculation Tracks claim payments versus earned premium for profitability monitoring. |
Loss ratio and profitability tracking is supported by analytics. | |
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Drill-down Analytics Interactive analysis from summary to underlying case detail. |
Drill-down analytics from summary to detail is available within dashboard/analytics. | |
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Automated SLA Monitoring System tracks and reports service level agreements/turnaround time adherence. |
SLA monitoring and reporting is supported by the reporting engine. | |
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Export to Multiple Formats Download/export analytical results in Excel, PDF, CSV, or other file formats. |
Export to Excel, PDF, CSV, and other formats is documented for reporting tools. | |
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Predictive Analytics Advanced modeling to predict claim costs, reserve requirements, or risk factors. |
Advanced (predictive) analytics is a notable selling point for Ventiv Claims. | |
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Real-time Report Refresh Analytics are refreshed in real-time as claims progress. |
Real-time report refresh and live dashboard information cited in technical architecture. | |
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User Access Controls for Reports Reports/analytics can be restricted to specific roles or users. |
User access controls for reporting and analytics are part of built-in security features. |
Payments & Disbursements
(8 Yes /8 Known /9 Possible features)
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Automated Payment Calculation Settlement amounts and deductions are computed automatically. |
Automated payment/settlement amount calculations are included within the payments module. | |
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Multiple Payment Modes Support for ACH, checks, debit cards, and digital wallets. |
Multiple payment modes (ACH, check, digital wallets) are supported and promoted as part of Ventiv's payment capabilities. | |
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Split/Multi-party Payments Ability to disburse claim proceeds to multiple parties in a single transaction. |
Split or multi-party payments are referenced in payment processing documentation. | |
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Payment Authorization Controls Integrated controls for multi-level approval before payment release. |
Payment authorization and multi-level approval controls are integrated in the disbursements workflow. | |
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Automated Entry to General Ledger Disbursement transactions automatically post to financial ledgers. |
Automated entries to general ledger are supported for financial reconciliation. | |
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Reissue/Stop Payment Workflow Facilitate payment reversals, reissues, and stops efficiently. |
Payment reissue/stop workflows are part of claims payments management. | |
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Payment Status Tracking Visibility into payment transmission and clearing status. |
Payment status tracking from disbursement to clearing is available through the UI. | |
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Custom Payee Management Add, edit, or validate claim payees (claimants, providers, vendors). |
Custom payee management (vendors, claimants, providers) is included in the claims solution. | |
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Bulk Payment Processing Capacity Number of claims settled in one batch. |
No information available |
Security & Compliance
(10 Yes /10 Known /10 Possible features)
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Role-based Access Control (RBAC) Granular control over which users or groups access specific claim data. |
Role-based access control (RBAC) is a standard feature for user and group-level security. | |
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Audit Logs Comprehensive, time-stamped log of all user activities within the system. |
Audit logging and traceability are documented security and compliance features. | |
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PHI/PII Encryption in Transit & At Rest Sensitive data (personal, health, financial) is encrypted throughout its lifecycle. |
PHI/PII encryption at rest and in transit is cited for compliance with security regulations. | |
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Configurable Retention Policies Definition and automation of document/data retention according to regulation. |
Configurable retention policies for documents/data are included for regulatory compliance. | |
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Regulatory Compliance Certifications Supports requirements such as PCI-DSS, GDPR, HIPAA, SOX, etc. |
Supports major regulatory compliance frameworks (GDPR, HIPAA, PCI-DSS) as stated in Ventiv compliance documentation. | |
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Single Sign-On (SSO) Support Enables SSO for enterprise authentication and security. |
Single sign-on (SSO) and enterprise authentication integrations are supported. | |
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Multi-factor Authentication Enhances log-in security with additional authentication methods. |
Multi-factor authentication can be enabled for user login security. | |
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Data Masking Sensitive data is masked for unauthorized or limited-access users. |
Data masking available to restrict sensitive field visibility to authorized users. | |
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Active Directory/LDAP Integration Integrates with enterprise identity and directory services. |
Active Directory/LDAP integration is a standard option for enterprise clients. | |
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Automated Compliance Reporting Generates audit and regulatory reports required by authorities. |
Automated compliance reporting is part of built-in audit tools and regulatory feature sets. |
Configurability & Customization
(9 Yes /9 Known /9 Possible features)
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Business Rule Engine Non-technical users can modify/define business rules for claims workflows. |
Business rules engine is built-in, supporting configuration by non-technical users. | |
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Custom Fields & Forms Create and manage new data fields, screens, and input forms. |
Custom fields and forms allow tailored data capture in claims workflows. | |
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Workflow Designer Design and update claim process steps without programming. |
Workflow designer for process customization without code is part of the admin toolkit. | |
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Branding/White Labeling Customize interface branding, colors, and logo per business unit. |
Branding/white labeling (UI, logo, colors) supported for clients/partners. | |
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Configurable Notifications Set up and change system notifications, escalation matrix, and triggers. |
Notification settings and escalation rules are configurable by administrators. | |
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Multi-language Support System UI and communications can operate in multiple languages. |
Product UI and communications support multiple languages, as outlined for multinational customers. | |
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Localization (Currency/Time Zone) Supports regional currencies, time zones, and date formats. |
System supports localization for currency, time zone, and date formatting. | |
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Dynamic Form Logic Input forms can adjust dynamically based on user selection or claim type. |
Dynamic form logic adjusts screens based on input selection or claim type. | |
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Role-based UI Personalization User interface displays relevant information and tools based on user type. |
UI components are customized by user role/persona for personalized workspaces. |
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
(8 Yes /8 Known /8 Possible features)
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Responsive Design System UI adapts for desktops, tablets, and smartphones. |
The interface is designed to be responsive/adaptable for different devices, as advertised by Ventiv. | |
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Accessibility Compliance (e.g. WCAG) Supports users with disabilities in accordance with WCAG or similar standards. |
Supports accessibility standards (e.g., WCAG), as stated for public sector and enterprise clients. | |
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Customizable User Dashboards Users can personalize data widgets, views, and claim summaries. |
User dashboards are customizable for common claims, reports, and data elements. | |
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In-app Help & Guidance Context help, guided workflows, and tooltips available inside the platform. |
In-app help, context guidance, and tooltips are available for end users. | |
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Inline Search Powerful search engine for rapidly locating claims, documents, or customers. |
Inline/document search is supported across the claims and document management. | |
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Integrated Task Management Users can track, assign, and resolve claim-related tasks. |
Integrated task management for assignment and tracking is included. | |
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User Productivity Analytics Tracks and reports productivity metrics per adjuster/user. |
User productivity analytics and reporting available for adjusters and teams. | |
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Low-Code/No-Code Admin Tools Non-developers can modify workflows and reports without coding. |
Low-code/no-code admin tools are part of the business process management offering. |
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