CLAIMS AND BENEFITS MANAGEMENT - ConVista

CLAIMS AND BENEFITS MANAGEMENT
CLAIMS AND BENEFITS
MANAGEMENT
Actively controlling the moment of truth

CLAIMS AND BENEFITS MANAGEMENT
ACTIVELY CONTROLLING THE MOMENT OF TRUTH
CLAIMS
MANAGEMENT
Face the challenge!
Customer-orientation,
process effi ciency and
fl exibility
In today‘s insurance market, process costs of
claims and benefi ts management can be the key fi gures
of advantage in competition.
A holistic approach of architectural and organizational
processes is needed to make the business more
effi cient and cost-effective.
COMMON CHALLENGES FOR INSURANCE COMPANIES
Increasing challenges of the insurance market due to economic conditions
EURO debt crisis
Complex regulatory compliance demands
Elimination of paper based claims processing
Improvement of overall performance of claim management processes (time & quality)
Optimization & control of reserves, claims costs and related lost revenue
Growing demand for mobile solutions & apps
Wider use of social media by general public
Competition from banks/super markets
Changing client expectations/trends
Take advantage of your opportunity!
Respond to the challenges and maximize your potential.
Improved customer satisfaction
Reduced processing costs
Streamlined processes,
customer-specifi c
support and
integrated IT systems
Support your customers and their specifi c needs: with
cash performance, replacement in kind, or with local
service partners. Flexible processing methods allow a
more customer-specifi c support during the claims process
and offers added value.
Create streamlined and fl exible internal processes. The
automation of processing steps and the provision of all
claim-relevant data, as well as an optimized utilization
of claims offi cers will help shorten claims processing
times.
© ConVista Consulting AG 2012 2

CLAIMS AND BENEFITS MANAGEMENT
ACTIVELY CONTROLLING THE MOMENT OF TRUTH
CLAIMS
MANAGEMENT
Small measures, big results:
Reducing the processing time by fi ve minutes per
claim at a volume of 100,000 claims per year will result
in resource savings of more than 1000 working days.
Integrated IT systems, from policy management to
payment transaction systems, will allow a more seamless
claims processing. If it is also possible to integrate
additional applications from external partners, then
harmonization has certainly been achieved.
Reducing claims costs
Analytical methods can be adopted to eliminate overpayment
and claims fraud. Comprehensive reporting
will ensure transparency and will support controlling
and the identifi cation of cost drivers. Intelligent test
routines and plausibility checks guarantee the consistent
and contract compliant processing of similar
claims.
The SAP for Insurance landscape
Phone Fax E-Mail
Customer Communication
Channels
Post IVR Web SMS
Customer Relationship Management
Marketing
Sales
Customer Information Management
Service
Business Partner
Core applications in the area of insurance
Portfolio Management Collections and Disbursements
Claims Management Commission Management
Reinsurance
Asset Management
Enterprise Resource Planning
Human Capital Management
- Talent Management
- Human Resources Management
- Human Resources Development
Purchase and Procurement
Cost Controlling
Insurance Analytics
Enterprise Performance Mmgt. Governance, Risk & Compliance
Information Management Information Discovery & Delivery
Financial Accounting
Internal Services
- Travel Management
- Estate Management
SAP NetWeaver
© ConVista Consulting AG 2012 3

CLAIMS AND BENEFITS MANAGEMENT
ACTIVELY CONTROLLING THE MOMENT OF TRUTH
CLAIMS
MANAGEMENT
The ConVista service offering
In addition to designing and implementing claims
management processes, ConVista provides services to
ensure the seamless integration of your policy management,
payment transactions as well as frontends, mobile
apps, external service providers and other systems, e.g.
for customer relationship management, procurement or
fraud detection. While focusing on claims management
processes, we never lose the big picture.
ConVista combines process expertise with fi rst-rate
technology know-how. ConVista consultants are specialized
in the implementation, maintenance and development
of the SAP component Claims Management and
the integrated packaged solution msg.PIA.
SAP FS-CM is the core component for claims management.
It was developed as a fl exible and highly adaptable
software, which focuses on a holistic approach to
claims processes for car insurance, building and contents,
liability, accident, medical and life insurance.
SAP Claims Management was designed as a standalone
system, but can be seamlessly integrated into a SAP
or non-SAP system environment by the means of
standardized interfaces.
ConVista has been able to prove their expertise many
times over in successful international implementation
projects, where the wealth of experience and know-how
of their consultants were the decisive factors.
ConVista provides system and process analysis, process
redesign, software specifi cations, as well as software
implementation and development and go-live-support.
For example every month, around 10,000 claims are
reported via interfaces designed by ConVista and processed
in FS-CM. SAP Claims Management will support
your efforts to increase the effi ciency of your business
processes. SAP FS-CM and your claims administrators
are ‘actively’ supported when processing complex
claims or performance cases. SAP FS-CM will help process
claims from the initial claims report to allocating
the claim to an administrator and the actual claims processing
leading to a more effi cient claims process and a
signifi cant reduction in cost.
YOUR BENEFITS
Streamlined processes, higher level of automation and shorter project run times
Customer-specifi c, tailored solutions and made-to-measure services internationally
Concept and implementation of complete claims and performance management processes
Integration support for policy and in/out payment processes, and for the implementation of external service
providers and fraud detection mechanisms
Worldwide company presence with many years of experience in processes and implementations across all
insurance sectors
Optimization and control of reserves, payments and debts
© ConVista Consulting AG 2012 4

CLAIMS AND BENEFITS MANAGEMENT
ACTIVELY CONTROLLING THE MOMENT OF TRUTH
CLAIMS
MANAGEMENT
FS-CM integration into a heterogeneous application environment
Other Applications
Ext-BP
Segment
Expansion
Life
Insurance
Property
Insurance
Care
Insurance
Health
Insurance
Customer Relationship Management
Compensation
Association‘s Accident
Insurance
ConVista
Solutions
FS-CD
FS-PM
FS-RI
Enterprise
Search
SRM
HR
Basic functions of the Claims Management
Claim and Accident Report
Integration of
external services
Payment or Reimbursement
Compensation Calculation
Reserves Management
Dispute Management
Key features of the Claims and Service Area
Key features of the Claims Management
Recourse and Regress
Electronic Claims File
Verifi cation of Coverage
Role-based Performer
Administrator Assignment
Correspondence Control
Business Partner (FS-BP)
Claim Migration
Geodata Integration
Company-wide Search
of Claims
Claim Reporting
CRM
FI
BI
Document
Management
Portal
Archiving
Enterprise
Services
Business Data
Toolset
BRF Plus Activity Customer Relationship Management
Structured Facts
Capture
© ConVista Consulting AG 2012 5

CLAIMS AND BENEFITS MANAGEMENT
ACTIVELY CONTROLLING THE MOMENT OF TRUTH
CLAIMS
MANAGEMENT
Expertise to the power of 3!
Excellent process knowledge
Expertise in processes, technology and methodology
forms the foundation of our work. Based
on the know-how of our consultants and software
engineers, we have been developing process
models, software and implementation processes for
many years with the sole intention of making our
customers’ claims processes more effective to enable
them to increase their business performance.
That is why we consolidate all our knowledge and
experience in our reference model.
OUR REFERENCE MODEL
The ConVista reference model visualizes a structured and standardized architecture with all key objects and processes
needed for claims processing.
The object and process-oriented visualization allows the fast capture of all relevant contexts in claims
processing much better than any other text-based documentation.
The integration of object and process models forms the basis for the conception of stable application
environments.
Our reference model is based on many years of experience in the area of claims processing and is being
continuously improved by our specialists.
It supports our structured approach, speeding up and facilitating the creation of business blueprints and
solution proposals.
Reference model claims management
© ConVista Consulting AG 2012 6

CLAIMS AND BENEFITS MANAGEMENT
ACTIVELY CONTROLLING THE MOMENT OF TRUTH
CLAIMS
MANAGEMENT
First class methodology know-how
Our structured process model C-ENS guarantees continuous and streamlined
claims projects. C-ENS business engineering is an established procedure for the
confi guration of processes and focuses on the management system model.
Excellent technology expertise
We combine our process and methodology expertise with fi rst class technology
know-how. As a special expertise partner of SAP, our consultants specialized
in the implementation, maintenance and further development of the claims
and benefi ts system SAP Claims Management.
ConVista Academy
Some of the wide range of courses offered by the ConVista Academy are
available for both employees and clients – these include for example:
SAP FS-CM LoB functionalities
In this course you will receive a broad overview on claims management. It will
focus on the fl exibility of the system with regard to the Line of Business specifi c
processes for life, P&C and health insurance, accompanied by detailed exercises.
The main focus of the course can also be adjusted to your branch’s individual
demands.
General introduction to insurance business
This introductory course is designed to give participants an overview of the
insurance industry and the structure of an insurance company. It covers the
structure of the insurance market, the variety of products available and their
particularities, as well as insurance company’s business processes and their
dependencies.
© ConVista Consulting AG 2012 7

YOUR CONTACTS
Pullaiah Suryadevara
Associate Partner
E-Mail Pullaiah.Suryadevara@ConVista.com
Phone +49 221 888 26 532
Christian Novak
Process Manager
E-Mail Christian.Novak@ConVista.com
Telefon +43 676 676 96 72
www.ConVista.com