Claims Management Software That Automates Every Step from FNOL to Settlement
Claimatrix is AI claims management software for insurers and TPAs. Automate intake, pre-authorization, routing and adjudication from first notice of loss (FNOL) to settlement, with human review where it matters.
FNOL workflow steps
- 1
FNOL intake
Claims are captured from the app, portal, email, call centre or agent.
- 2
Document collection and classification
Photos, bills, forms and reports are identified and grouped by claim.
- 3
Data extraction
Dates, amounts, parties, diagnosis or repair items are read into structured fields.
- 4
Policy and coverage check
Details are matched against policy terms, limits and waiting periods.
- 5
Fraud and duplicate checks
Duplicate bills and inconsistent details are flagged for review.
- 6
Routing and assignment
Claims go to the right queue or adjuster based on type, value and region.
- 7
Pre-authorization
For planned treatment, eligibility and limits are confirmed before the service.
- 8
Adjudication and approval
Simple claims are approved within rules; exceptions go to an adjuster.
- 9
Settlement and payment
Approved amounts are sent to payment systems with a clear record.
- 10
Closure and feedback
The claim is closed, the customer is updated and outcomes feed back into the rules.
Claimatrix features
| Feature | What it does | Who uses it |
|---|---|---|
| Intake | Captures FNOL from app, portal, email or call | Customers, call centres, agents |
| Pre-authorization | Checks eligibility and limits before treatment | TPAs, hospital desks |
| Routing | Assigns claims by type, value and region | Claims managers |
| Adjudication | Applies policy rules and flags exceptions | Claims adjusters |
| Fraud flags | Surfaces duplicate bills and anomalies | Investigation units |
| Audit trail | Logs each decision and document | Compliance teams |
Health insurance claims
Health claims depend on timing. Cashless pre-authorization needs eligibility and limits confirmed before treatment, while reimbursement claims depend on bills, discharge summaries and prescriptions arriving complete. Claimatrix verifies these documents as they arrive, flags missing items to the hospital or member early, and hands TPA teams a claim with its checks already done.
Clinical decisions stay with qualified reviewers. Claimatrix handles document checks, rule matching and routing, so reviewers see only the cases that need judgement.
Frequently asked questions
What is claims management software?
Claims management software manages a claim from first notice of loss (FNOL) to settlement: intake, documents, verification, approval, payment and closure. Claimatrix automates most of these steps and keeps a person in the loop for exceptions.
Who uses Claimatrix?
Insurers and third-party administrators (TPAs) use Claimatrix. Claims managers, adjusters, pre-authorization desks and compliance teams work in the same workflow.
Does Claimatrix support health insurance claims?
Yes. Claimatrix supports pre-authorization, bill verification and discharge document handling for health claims, with rules for cashless and reimbursement cases.
How does fraud detection work?
Claimatrix flags duplicate bills, inconsistent dates and amounts, and other anomalies across documents in a claim. Flagged claims are routed to investigators rather than rejected automatically.
Can Claimatrix integrate with our policy and payment systems?
Claimatrix connects to policy administration, claims and payment systems through APIs. The integration scope is agreed during implementation.
Where should we start?
Most carriers start with one claim type, such as motor or minor property claims, measure cycle time and straight-through processing, and then expand to more complex claim types.