What to Look for in a Claims Management System
A Buyer’s Guide for Carriers, TPAs, Public Entities, Risk Pools, and Self-Insureds
As insurance organizations evolve, so do their expectations for technology. Legacy claims management software systems often fail to meet today’s need for automation, visibility, and speed. Whether you’re a carrier looking to modernize, a TPA serving multiple clients, a public entity managing complex claims, a risk pool tracking collective exposure, or a self-insured organization focused on cost control—the right claims management system can make all the difference.
This buyer’s guide is designed to help you identify what to look for in modern claims management software and avoid common pitfalls during the selection process.
The Evolving Landscape of Claims Management
The claims process has become more than just paying losses. It now includes data analysis, customer experience, vendor coordination, litigation management, and compliance oversight. And with the rise of low-code/no-code insurance platforms, organizations now have powerful options to customize systems without traditional development cycles.
Tailored Needs from Claims Management Software by Organization Type
Carriers
- Scalability for multiple lines of business
- Integration with policy admin, billing, and reinsurance systems
- Compliance automation for state and federal requirements
Third-Party Administrators (TPAs)
- Multi-client configuration with unique rules/workflows
- White-label capabilities and flexible client reporting
- Efficient intake and triage tools
Public Entities
- Governmental reporting capabilities
- Long-tail exposure tracking
- Internal communication & audit trails for transparency
Risk Pools
- Collective risk tracking and allocation tools
- Member-specific dashboards and performance metrics
- Integrated subrogation and recovery tools
Self-Insured Organizations
- Recurring claims management (e.g., workers’ comp, health)
- Vendor and legal spend control
- Automation of FNOL and follow-up tasks
5 Must-Have Features in Modern Claims Management Software
- End-to-End Workflow Automation
Eliminate manual tasks from FNOL to closure. Customize workflows using low-code/no-code tools. - Real-Time Analytics and Dashboards
Monitor key metrics like claim cycle time, reserve accuracy, and litigation rates. - Third-Party Data Integrations
Seamless connections to data providers like LexisNexis, ISO, DMV records, and weather data enhance decision-making. - Self-Service Portals
Empower claimants, adjusters, attorneys, and vendors with role-based access to status updates, documents, and communications. - Configurability Without Code
Modern low-code platforms for insurance let you make updates quickly—no IT backlog or coding required.
Red Flags to Avoid
- Systems with hard-coded workflows and outdated User Interfaces
- Long implementation cycles (12+ months)
- Hidden fees for basic integrations or additional users
- Lack of configurability for different user types or clients
Success Story: A TPA Greatly Improves Efficiency by Leveraging Low-Code/No-Code
A business user successfully deployed 12 AI models—without a developer—to automate tasks previously being done manually and is now successfully reading invoices and indexing them to claim files, entering payments based on invoices, processing documents, and summarizing notes, leading to measurable efficiency gains.
The Bottom Line: Flexibility and Speed Are Now Mandatory
The future of claims management lies in platforms that are:
- Agile
- Scalable
- Configurable by business users
- Built on low-code/no-code frameworks
Whether you’re upgrading from spreadsheets or replacing legacy systems, choose a claims management software solution that evolves with your needs and empowers every stakeholder.
**The TPA Use Case previously mentioned is a current Spear client leveraging SpearClaims™**
Contact Us to see the possibilities you can achieve.
Free Download: 20 Questions to Ask Before Choosing a Claims Management System
Use this checklist to guide internal discussions and vendor demos:
- Does the system support our specific lines of business and claim types (e.g., liability, workers’ comp, property)?
- Can business users configure workflows, rules, and forms without relying on developers?
- How quickly can we launch a new client, program, or line of business using this platform?
- What third-party data integrations (e.g., ISO, CMS, VIN, address validation) are prebuilt or available via API?
- Can the system provide client/member-specific dashboards and reporting views out of the box?
- Is there a mobile-optimized or responsive experience for adjusters, claimants, and supervisors?
- What kind of embedded reporting and analytics tools are included (dashboards, KPIs, export options)?
- Can the platform track litigation milestones, legal expenses, and associated parties easily?
- Will we retain full ownership and unrestricted access to our data?
- Are audit trails and internal notes preserved automatically for every user action?
- Does the system support secure, role-based access and permissioning for all user types?
- Can we customize letters, emails, and communication templates without IT involvement?
- Will business users be empowered to make real-time changes to workflows and business rules without needing vendor assistance?
- How are system updates, feature enhancements, and bug fixes managed—and are they disruptive?
- Does the solution include tools for vendor tracking, payment management, and invoice reconciliation?
- Is native document generation (e.g., letters, reports, forms) available and customizable?
- Can the system integrate easily with our current policy, billing, or general ledger systems via API or connectors?
- What service-level agreements (SLAs) are offered for uptime, performance, and support response times?
- What is the typical implementation timeline—from contract to go-live—for an organization of our size?
- Are end-user training, administrator onboarding, and post-launch support included in the package?
Discover a smarter way to manage claims.
Schedule a Demo to see first-hand how SpearClaims™ will enable your organization to accelerate and simplify claims processing. Built by industry experts on a modern low-code/no-code platform, SpearClaims™ is a future-ready claims management software solution delivering the power of next-generation AI capabilities – all the “must-haves” with none of the red flags.
To discover how Spear’s solutions are accessible to insurers of all sizes, Request Pricing.