Medical Claims Processing and Workflow Software
Achieve consistency and fair outcomes by putting your best adjusters' expert guidance at key points in your claims handling processes. Imagine each of your adjusters having access to a personal expert on all of your claims. You can achieve a "best-of-the-best" claims handling consistency on every claim—helping you achieve superior claims results.
ClaimIQ™, a flexible, modular solution, helps you handle claims better across these critical areas of claims handling—coverage evaluation, investigation, liability evaluation,
recovery evaluation, settlement evaluation and negotiation & settlement.
Your Claims. Your Way.
A Flexible, Modular Solution Suite to Fit Your Unique Situation.
With ClaimIQ's leading-edge modular design, you're connected to all aspects of a claim. Each module of ClaimIQ looks, feels, and operates like the other, sharing data and workflow seamlessly, while offering you a wide variety of configurability in the features and functions you need to support your individual best practices:
- Implement the modules you want individually or as an integrated suite
- Simplicity is built into the solution through a standard web browser
- Thin client design—no high demands for storage or processing power on the user's desktop
- Host at your site or at Mitchell's secure operations center
- Integrate with your existing or future core claims systems though standard messaging protocols
The first step in effectively handling any claim is clearly understanding and evaluating the coverage that applies to the occurrence. ClaimIQ empowers adjusters to accurately accelerate their coverage determinations by providing a framework of consistent, jurisdictionally appropriate coverage review points such as:
For the personal lines insurer:
- Was the insured driving their vehicle in course and scope of employment?
For the General Liability insurer:
- Who are the maintenance sub-contractors?
- What do the hold harmless, indemnification and additional insured clauses
of the contracts say?
- Do we have tender opportunities?
For the Workers' Compensation Carrier
- Is the injured worker an employee or independent contractor?
When your adjusters are working with ClaimIQ™, they'll be using your best investigative skills—automatically—with online, multi-level investigative guides that help them:
- Consistently execute key claim investigative activities via a clear, easy to understand set of logical steps.
- Document investigative results within a clear, concise "top to bottom" and "bottom to top" logical framework.
- Simplify additional claim investigative information—including notes, documents, diagrams, recorded statements, photos and other media—in just one place for easy access.
For some claims, once coverage is confirmed, the claim moves immediately into optimum handling and resolution mode. For liability claims, however, liability determination is the next step. ClaimIQ provides extensive capabilities in this critical claim step, enabling your adjusters to:
- Review applicable tort duties owed and/or breached.
- Cross-reference investigation facts.
- Access comprehensive tort law information.
- Quickly access information such as rules of the road, vehicle codes, historical weather specific to where, how and when the claim incident occurred.
- Compare various parties' versions of the claim incident in a side-by-side format where any disputes and discrepancies are automatically highlighted.
The same capabilities that make ClaimIQ such a powerful partner in coverage and liability evaluations add even more value in identifying and pursuing recovery opportunities.
ClaimIQ provides a consistent and clear claim evaluation frame-work that empowers effective and productive claim settlement results. Key points of liability are clearly and accurately documented and special and general damages are appropriately detailed and accounted for enabling negotiations to proceed smoothly in a timely and logical manner.
With ClaimIQ, you can:
- Identify injuries in clear, natural language.
- Appropriately review medical specials via integration with Mitchell DecisionPoint® (non-workers' compensation bodily injury claims) or Mitchell™(for workers' compensation injury claims).
- Evaluate general damages, wage loss and permanency.
- Assess applicable no-fault and/or tort threshold breach factors.
ClaimIQ™ helps accelerate and simplify the claim settlement process. Key negotiation points are clearly and logically documented and a clear negotiation and settlement strategy outlined enabling settlement discussions to proceed smoothly in a reasoned and straight-forward order. With ClaimIQ™, you can:
- Establish separate evaluation ranges for liability and damage determinations.
- Automatically reference and organize all aspects of the claim file (investigative facts, liability arguments, damage evaluations) into a single, logical Negotiation T-Chart.
- Review other parties' negotiation tactics and settlement track record experience prior to initiating negotiations.
- Clearly track negotiation progress around points of agreement, any points of concession and areas still in need of resolution.
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