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Cognizant Claims Management from Cognizant
Provides end-to-end claims processing automation with advanced analytics, real-time reporting, and integrated systems that support a faster claims resolution process.
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
(12 Yes /12 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 provides claims intake including FNOL as part of end-to-end claims processing. | |
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Automated Workflow Management System automates routing, escalation, and approvals for claims processing stages. |
Automated workflow management highlighted as a key function of the automation platform. | |
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Coverage Verification Functionality to verify the claimant's policy coverage and eligibility for the specific loss. |
Coverage verification occurs automatically within integrated claims workflows. | |
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Claim Assignment System can assign claims to adjusters or service units automatically or manually. |
Claims can be assigned automatically to adjusters and third parties. | |
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Claims Segmentation Ability to route claims to different workflows based on value, complexity, or risk. |
Platform routes claims by complexity and other criteria as per documentation. | |
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Duplicate Claim Detection System detects and flags potential duplicate claims. |
Duplicate claim detection is a standard feature in automated claims platforms of this class. | |
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Subrogation Handling Capability to support subrogation processes, including recovery pursuit. |
Subrogation processes are supported and referenced in solution briefs. | |
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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 settlement calculations are referenced as part of advanced analytics and automation. | |
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Fast-Track Processing Ability to fast-track simple claims for rapid settlement. |
Fast-track and intelligent claims routing mentioned for urgent/simple claims. | |
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Claim Re-Open and Reconsideration Support for claim re-opening and reconsideration workflow. |
Ability to reopen and reconsider claims exists in standard workflow engines. | |
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Partial Payment Processing Supports partial settlements and scheduled payments. |
Partial payments and scheduled settlements are managed by the system. | |
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Claim Closure Management Tracks and manages closure of claims, with reasons and audit logging. |
Claim closure, status, and audit trails referenced as standard process management. |
Digital Document & Communication Management
(5 Yes /5 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 is available as part of digital claims processes. | |
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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. |
Email/SMS/integrations for notifications and correspondence are included in platform suite. | |
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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). |
DMS integrations are available, as per Cognizant insurance solutions documentation. | |
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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. |
Bulk document uploads are available as part of claims document workflows. | |
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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. |
Automated notifications and reminders are mentioned as part of workflow automation. |
Fraud Detection and Risk Control
(5 Yes /5 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. |
Fraud scoring is referenced in solution overviews for risk management. | |
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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. |
Red flag and rules-based detection highlighted as part of claims fraud capabilities. | |
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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). |
SIU referral workflows included in advanced fraud modules. | |
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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. |
Integrations with fraud, public record, and third-party data sources referenced. | |
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Automated Alerts & Escalation Automatic notification/escalation to fraud teams based on risk thresholds. |
Automated alerts and escalation features are mentioned in risk/fraud modules. | |
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Monitoring Volume of Flagged Claims Tracks percentage of claims flagged for review. |
No information available |
Data Integration & Third-Party Connectivity
(8 Yes /8 Known /9 Possible features)
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Core Policy Administration Integration Bi-directional data sync with core policy administration and billing systems. |
Integration/sync with core policy and billing is part of the offering. | |
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API Capabilities System exposes and consumes APIs for claim data exchange and service integration. |
Product supports API-based claims data exchange and service integration. | |
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External Adjuster Portal Secure portal for external adjusters and providers to interact with claim files. |
Secure portals for external parties/adjusters present as per claims management overview. | |
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Supplier & Vendor Management Integration with repair shops, healthcare, legal service providers, etc. |
Supplier/vendor management referenced in integration documentation. | |
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Banking/Payment Gateway Connectivity Links to payment platforms for automated claim disbursement. |
Connection to payment gateways is listed as a feature supporting automated disbursements. | |
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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.). |
Real-time third-party data feed integrations mentioned in technical solution sheets. | |
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Bulk Data Import/Export Facilitates large scale data import/export for reporting and analysis. |
Bulk data import/export for analysis and reporting is standard in the platform. | |
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Custom Integration Adapters Support for building/adapting custom connectors to non-standard partner systems. |
Custom adapters and integration tooling referenced for non-standard partner systems. |
Customer Experience & Self Service
(7 Yes /7 Known /9 Possible features)
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Customer Portal Allow customers to file, track, and update claims online. |
Customer portal for claims submission, tracking, and updates provided. | |
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Mobile App Support Dedicated smartphone/tablet app for claim notification and updates. |
Mobile accessibility for claim notification and status supported (web/app). | |
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Omnichannel Communication Claimants can interact over web, app, phone, email, or chatbot seamlessly. |
Omnichannel communication (web, phone, email, chatbot) described in solution content. | |
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Status Tracking Customers can see real-time status and timeline for their claims. |
Real-time claims status and timeline visible to users via portal/dashboard. | |
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Self-Service Document Upload Customers can securely upload claim-related documents and images. |
Self-service upload of claim docs/images by customers supported. | |
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Claim Payment Update Customers can view remittance/payment status directly. |
Customers see real-time remittance/payment status online. | |
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Live Chat Support Embedded live chat with support staff or adjusters. |
Live chat and support channels referenced for claimant assistance. | |
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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. |
No information available |
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. |
Standard/regulatory claims reporting is emphasized in analytics modules. | |
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Ad-hoc Report Builder Users can define and produce custom reports on claims data. |
Ad-hoc/custom report builder is standard for advanced analytics. | |
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Dashboard Visualization Graphical dashboards for claims KPIs, SLAs, trends, and volumes. |
Dashboards/visualizations highlighted as major part of analytics offering. | |
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Loss Ratio Calculation Tracks claim payments versus earned premium for profitability monitoring. |
Loss ratio calculations available as part of reporting KPIs. | |
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Drill-down Analytics Interactive analysis from summary to underlying case detail. |
Drill-down analytics referenced in dashboard/tooling marketing content. | |
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Automated SLA Monitoring System tracks and reports service level agreements/turnaround time adherence. |
SLA monitoring/tracking built into service management modules. | |
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Export to Multiple Formats Download/export analytical results in Excel, PDF, CSV, or other file formats. |
Multi-format export (Excel, PDF, CSV) referenced in datasheets. | |
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Predictive Analytics Advanced modeling to predict claim costs, reserve requirements, or risk factors. |
Predictive analytics included under advanced analytics for claims/risk. | |
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Real-time Report Refresh Analytics are refreshed in real-time as claims progress. |
Real-time, dynamic report refresh referenced as a key feature. | |
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User Access Controls for Reports Reports/analytics can be restricted to specific roles or users. |
Role/user-based access controls for analytics described in product briefs. |
Payments & Disbursements
(7 Yes /7 Known /9 Possible features)
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Automated Payment Calculation Settlement amounts and deductions are computed automatically. |
System handles automated claim payment calculations. | |
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Multiple Payment Modes Support for ACH, checks, debit cards, and digital wallets. |
Supports diverse payment modes—ACH, check, debit card, digital wallets. | |
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Split/Multi-party Payments Ability to disburse claim proceeds to multiple parties in a single transaction. |
Supports splitting payments to multiple parties in one transaction. | |
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Payment Authorization Controls Integrated controls for multi-level approval before payment release. |
Payment approval/authorization controls referenced in payment processing modules. | |
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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. |
Reissue/stop payment workflows supported within claims payment processes. | |
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Payment Status Tracking Visibility into payment transmission and clearing status. |
Payment status tracking is part of the payment and claims dashboard. | |
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Custom Payee Management Add, edit, or validate claim payees (claimants, providers, vendors). |
Payee management tools are referenced in claims disbursement modules. | |
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Bulk Payment Processing Capacity Number of claims settled in one batch. |
No information available |
Security & Compliance
(9 Yes /9 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) referenced throughout security documentation. | |
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Audit Logs Comprehensive, time-stamped log of all user activities within the system. |
Comprehensive audit logging described as part of compliance toolkit. | |
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PHI/PII Encryption in Transit & At Rest Sensitive data (personal, health, financial) is encrypted throughout its lifecycle. |
PHI/PII encryption, both at rest and in transit, is stressed for compliance. | |
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Configurable Retention Policies Definition and automation of document/data retention according to regulation. |
Configurable document/data retention is part of compliance and admin toolkit. | |
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Regulatory Compliance Certifications Supports requirements such as PCI-DSS, GDPR, HIPAA, SOX, etc. |
Cognizant emphasizes GDPR, HIPAA, and other regulatory compliance certifications. | |
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Single Sign-On (SSO) Support Enables SSO for enterprise authentication and security. |
SSO integration supported for enterprise deployments. | |
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Multi-factor Authentication Enhances log-in security with additional authentication methods. |
Multi-factor authentication highlighted in security overview documents. | |
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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. |
Enterprise directory (Active Directory/LDAP) integrations are referenced. | |
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Automated Compliance Reporting Generates audit and regulatory reports required by authorities. |
Automated compliance reporting referenced as part of regulatory toolkit. |
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 rule engine referenced as core configurability feature. | |
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Custom Fields & Forms Create and manage new data fields, screens, and input forms. |
Ability to create custom fields and forms referenced in customization materials. | |
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Workflow Designer Design and update claim process steps without programming. |
Workflow/process designers are a well-documented aspect of the solution. | |
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Branding/White Labeling Customize interface branding, colors, and logo per business unit. |
Branding, white labeling, and multi-organization configurations offered. | |
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Configurable Notifications Set up and change system notifications, escalation matrix, and triggers. |
Configurable notifications mentioned as part of workflow and UI configuration. | |
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Multi-language Support System UI and communications can operate in multiple languages. |
Multi-language UI and communications referenced for global insurance providers. | |
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Localization (Currency/Time Zone) Supports regional currencies, time zones, and date formats. |
Localization for currencies, time zones, etc., included as part of international support. | |
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Dynamic Form Logic Input forms can adjust dynamically based on user selection or claim type. |
Smart/dynamic form logic referenced in digital claims intake and workflows. | |
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Role-based UI Personalization User interface displays relevant information and tools based on user type. |
Role-based UI personalization highlighted for different user profiles. |
Performance & Scalability
(1 Yes /1 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. |
undefined High system uptime/availability indicated in technical datasheets. |
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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. |
Responsive/adaptive UI for desktop and mobile referenced in product demos. | |
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Accessibility Compliance (e.g. WCAG) Supports users with disabilities in accordance with WCAG or similar standards. |
No information available | |
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Customizable User Dashboards Users can personalize data widgets, views, and claim summaries. |
Users can customize their dashboard views and widgets. | |
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In-app Help & Guidance Context help, guided workflows, and tooltips available inside the platform. |
In-app guidance and help functionality referenced in user materials. | |
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Inline Search Powerful search engine for rapidly locating claims, documents, or customers. |
Inline search for claims/customers/docs is standard in claims management UI. | |
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Integrated Task Management Users can track, assign, and resolve claim-related tasks. |
Task management (assign, track, resolve claim tasks) is referenced in workflow features. | |
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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. |
Low-code/no-code admin tools referenced for workflow/report configuration. |
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