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G00269737

Critical Capabilities for Property and Casualty
Insurance Claims Management Modules
Published: 27 July 2015

Analyst(s): Jeff Haner

Claims management module vendors continue to emphasize advanced
capabilities beyond core claims management. However, insurance CIOs
should take care to validate production experience behind vendor marketing
collateral.

Key Findings

Support for international expansion is becoming a higher priority for vendors. A higher
percentage of new deals are occurring outside North America, and all vendors are investing in
or enhancing multilanguage and multicurrency functionality.

As the market matures and core claims processing capabilities become common, vendors are
stressing advanced capabilities, such as catastrophe management or supply chain
management, in order to differentiate their offerings. Actual production experience with
advanced capabilities varies widely.

All but one of the vendors are building out hosting capabilities and placing a greater emphasis
on these in their marketing. Nearly 20% of new customer wins globally were for hosted
deployments.

Every vendor offers basic multilanguage and multicurrency functionality, but the ability to fully
support multiple regions is very uneven — especially in terms of local system integration
partners and local requirements such as tax and regulatory frameworks. Some vendors are still
seeking their first customer outside of their home region.

Recommendations

Prioritize advanced capabilities beyond core claims processing in your vendor selection, and
ensure that the vendor's roadmap aligns well with your long-term business needs.

Verify actual production experience with advanced capabilities with client references to make
better-informed negotiation, planning and risk management decisions. In many cases, these
advanced capabilities have been developed and marketed, but not yet deployed in production
by customers.

Verify track records with sales and service to insurers headquartered in the regions and
countries in which you operate. Some vendors are supporting global insurers that operate in
regions outside of North America, but these vendors have not demonstrated an ability to sell to
and support insurers headquartered in these other regions.

What You Need to Know
The market for property and casualty (P&C) claims management modules continues to mature.
There is a high degree of consistency among core claims management functionality, including
configuration and workflow, and growing emphasis on advanced capabilities such as supply chain
management or advanced fraud analytics for differentiation in the market. Support for international
growth is improving. All vendors are enhancing or building support for international operations as a
greater percentage of new deals are being made outside North America. With the exception of one
vendor, all vendors are placing a greater emphasis on support for hosted deployments.
Due to the maturity of vendor offerings for core claims management, this report does not address
critical capabilities such as claim life cycle management, component-based architecture, and
performance and scalability, where there is little differentiation across the market. Instead, this
report focuses on advanced capabilities such as fraud management, supply chain management and
catastrophe management, where there are more distinct differences in the vendor offerings.

Analysis
Critical Capabilities Use-Case Graphics

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Gartner, Inc. | G00269737

Figure 1. | G00269737 Page 3 of 26 . Vendors' Product Scores for the Process Definition Use Case Source: Gartner (July 2015) Gartner. Inc.

Inc. Vendors' Product Scores for the New Claim Submission and Tracking Use Case Source: Gartner (July 2015) Page 4 of 26 Gartner.Figure 2. | G00269737 .

Vendors' Product Scores for the Catastrophe Management Use Case Source: Gartner (July 2015) Gartner.Figure 3. | G00269737 Page 5 of 26 . Inc.

| G00269737 . Inc.Figure 4. Vendors' Product Scores for the Fraud Identification and Investigation Use Case Source: Gartner (July 2015) Page 6 of 26 Gartner.

Vendors' Product Scores for the Hosted Deployment Use Case Source: Gartner (July 2015) Gartner.Figure 5. | G00269737 Page 7 of 26 . Inc.

| G00269737 .Figure 6. Inc. Vendors' Product Scores for the Multiregional Support Use Case Source: Gartner (July 2015) Page 8 of 26 Gartner.

Denmark. Accenture Duck Creek supports hosted deployments and offers a range of licensing options — two customers are currently being hosted. | G00269737 Page 9 of 26 . and seven countries across Asia/Pacific. Accenture Duck Creek's customers are using the system to support operations outside their home countries. Support for catastrophe management is excellent. such as social network analysis.. which include 14 countries in Europe. Ireland. Australia and New Zealand. but editing capabilities within process views require custom code or integration with third-party tools. and supports automated referral to special investigations unit (SIU) and case management for fraud investigations. The system offers supply chain management that enables the user to import and manage a supplier network. The systems can be configured to provide visualization tools. Gartner. with production experience primarily with portals and apps for direct consumers versus agents or brokers. with the remaining customers in Europe (in the U. but these capabilities have not been used in production. assign work and track supplier performance. Accenture Duck Creek also released a mobile app for postcatastrophe use by adjusters that is in production with customers. More advanced processed flow views are supported. The system offers a portal for collaboration with suppliers. With 17 data centers across various regions and a system that supports multiple currencies and multiple languages. with a drag-and-drop and menu-driven interface that enables users to complete configuration tasks ranging from simple tasks to more complex integration with other systems. Through its reporting tools. and integrated with third-party solutions for advanced fraud analytics. mapping and catastrophe risk management. Inc. such as vehicle identification numbers (VINs). and support unique assignments and workflows. Accenture Duck Creek has positioned itself with the infrastructure and system capabilities to serve customers around the globe. prefill. The system includes comprehensive business process management functionality that supports complex and unique workflows.S. with the ability to automatically assign catastrophe and unique noncatastrophic event codes.Vendors Accenture (Accenture Duck Creek Claims) Accenture Duck Creek Claims offers configuration tools that are user-friendly.K. Accenture Duck Creek Claims offers both portals and mobile apps. The system has prebuilt integration with a number of common third-party data sources. such as weather data. although this has not been used in production. Accenture Duck Creek has also built an interface for ServicePower. The system uses a combination of business rules and analysis of historical data to identify potential fraud. geocoding. Prebuilt integration is available for external sources for address verification. bureaus and credit reports. Office of Foreign Assets Control (OFAC) and ISO ClaimSearch. Prebuilt integrations are available for services such as the U. the system offers catastrophe management dashboards and the ability to map claims data with other layers. three countries in Latin America. Portugal and Turkey) and in Japan. Roughly two-thirds of its customer base is headquartered in North America.

The system lacks out-of-the-box capabilities for visualization and mapping of claims data. other data sources. More advanced processed flow views and editing capabilities require custom integration with third-party tools. work assignment and supplier scoring. Bulk assignment and linking of claims to a noncatastrophe event is not supported in the base product. No prebuilt integration is available for other non-CSC fraud analytics packages. assignment and unique workflows. Prebuilt integration is available for third parties such as OFAC and ISO ClaimSearch.S. CSC offers good catastrophe management capabilities in terms of support for automated identification. fully integrated fraud suite component to provide comprehensive fraud management capabilities. Although prebuilt integration is available for third-party catastrophe risk management tools. The configuration tools are limited. however. The company has 15 data centers available for hosting in regions around the world. More complex Page 10 of 26 Gartner. geocoding and mapping. and Canada. CSC does not offer separate agent or policyholder portals for Riskmaster Accelerator — access to the system is provided either directly through the application's UI or through integration with thirdparty or custom portals. All customers in production are currently in the U. it does not offer prebuilt integration for other data sources such as VIN numbers or to support prefill capabilities. CSC supports alternative delivery models. The system uses both business rules and analytics to identify potential fraud. through the optional. Although CSC offers prebuilt integration for agency upload/download. fully integrated Vendor Solutions Suite. Sharing of computing resources within hosted deployments is limited to hardware. | G00269737 . would require custom integration. such as address verification. and the system supports multiple currencies. The system includes a business rule editor and supports the configuration of unique workflows and system-generated tasks and activities. but CSC is working to position Riskmaster Accelerator for international expansion. and it hosts approximately 50 noninsurer entities such as self-insureds and TPAs. Inc. Support for multiple languages is now available. CSC has partnered with Microsoft to offer a native mobile app for Windows mobile devices.CSC (Riskmaster Accelerator) CSC's Riskmaster Accelerator provides configuration tools embedded within the administration options of the system with straightforward access that enables non-IT developer users to complete common changes such as updates to screens or fields. Guidewire (ClaimCenter) Guidewire ClaimCenter's configuration tools offer business users access to a range of frequent configuration changes within an administration module embedded in the system. in their support for more complex changes. Riskmaster Accelerator has an optional. Riskmaster Accelerator supports core supply chain management requirements. such as management of a network. such as unique screen design and support for complex assignments. which also includes a vendor portal. and supports automated assignment to SIU and case management for investigations. The system does not offer prebuilt integration with external supplier networks. An adjuster app with catastrophe management capabilities has been released for Windows mobile devices.

and the system has been deployed in every region across the globe except the Middle East and Africa (see Note 1). This includes automated identification of catastrophe and noncatastrophic event claims. including the ability to import and manage a supplier network. which host four of its customers. including mobile. It has recently productized a mobile-enabled claims portal. Innovation Group (Insurer Claims) Innovation Group offers the claims management module Insurer Claims. may be challenging for less technical users to navigate. ClaimCenter includes prebuilt integration for common external data sources such as agency upload/download and VINs. Case management tools are provided for investigation. The company does not directly provide hosting services. geocoding.configuration changes are enabled via Guidewire Studio. Inc. and collaboration among the parties involved with the claim. The system offers very comprehensive configuration tools. All configuration is supported within a single system that. and has prebuilt integration with ISO ClaimSearch. Guidewire does not offer native mobile applications — the company's portals are built on a unified HTML5 platform that delivers content to multiple form factors. The company offers solution guides for integration with Detica NetReveal for predictive fraud scoring. although powerful. mapping and catastrophe risk management. ClaimCenter includes comprehensive supplier functionality. The system offers prebuilt integration to third-party sources for address verification. assign work and track supplier performance. ClaimCenter supports outbound communication to policyholders ahead of a major event. coverage verification. ClaimCenter also offers strong support for catastrophe management. Guidewire has also introduced a supplier portal to provide visibility into supplier operations and facilitate collaboration between insurers and suppliers. | G00269737 Page 11 of 26 . Guidewire provides only limited support for alternative delivery. and the ability for users to view and modify process flows. Guidewire offers strong fraud management capabilities through the use of business rules and historical data to identify fraud and refer claims to SIU. The system's excellent business process management support includes a business rule editor. support for complex workflows and automated tasks. and also is integrated with the other Guidewire modules to support catastrophe management for various functions such as underwriting and billing throughout Guidewire InsuranceSuite. but instead relies on its partners. Mapping and data visualization capabilities of Guidewire Live have also been applied as tools for fraud identification. Dashboard and visualization tools that combine claim and third-party data are integrated within the system. ClaimCenter supports multiple currencies and multiple languages. The company has deployed ClaimCenter successfully to meet requirements for a large customer base around the globe. and support for unique catastrophe assignment rules and workflows. Guidewire offers mobile and portal capabilities. The system also offers Gartner. which has been deployed in production by customers. a separate native configuration tool. Guidewire offers excellent support for international expansion. which provides functionality for first notice of loss (FNOL). status inquiries.

Insurer Claims has comprehensive fraud management capabilities. and it is integrated with Innovation Group's Insurer Analytics for real-time fraud analytics. support for complex workflows and automated assignments. and China. Supplier management capabilities are very good. and Innovation Group has not yet productized mobile apps. and the U. It offers prebuilt integration for VIN and prefill. It is now building out enhanced mobile capabilities. Innovation Group offers the unique option of preloading the supplier network used in its BPO operations. There is no prebuilt integration for other.S. The company maintains four data centers in the U. Visualization tools are not fully integrated and directly assessable within the system at the task level. Asia/Pacific and Japan. but does not have prebuilt integration with third parties for agency upload/ download. however.S. Innovation Group has extensive experience supporting large numbers of insurers in its BPO operations..strong business process management support. and is hosting approximately 20% of its Insurer Claims customers. claim status and self-service) that are in production. and the ability to view and edit process flows. Innovation Group lacks regional partners outside of Deloitte in the U. Innovation Group also has not yet productized mobile offerings for catastrophe management. and has prebuilt integration with OFAC and ISO ClaimSearch. The system includes case management functionality for investigation. Prebuilt integration is not available for non-Innovation Group advanced fraud analytics solutions. Innovation Group provides portals for captive and independent distributors and direct consumers (including FNOL. Insuresoft is in the process of rolling out full. The system supports outbound communications to policyholders. assignments and supply partner scoring. The system has standard business rule scoring and analysis of historical data for fraud. workflow and forms configuration. and support for unique assignment rules and workflows. | G00269737 . including a rule editor. and IBM and Deloitte in Europe. the Middle East and Africa. Work on UI configuration is not planned to be completed until the end of 2015. and has no customers in production in Central and South America. but its mobile-enabled portals have not yet been deployed to production. The system is positioned for international operations with support for multiple currencies and multiple languages. Insurer analytics does not include social network analysis or visualization tools for fraud. Inc. Business process management capabilities include a business rule editor and the ability to manage manual and system-generated Page 12 of 26 Gartner. Innovation Group offers excellent support for catastrophe management. with support for supplier network management. and offers prebuilt integration with SpatialKey to provide dashboards and mapping with real-time data for more informed claims decisions. nonInnovation Group supplier networks. Insuresoft (Diamond Claims) Insuresoft offers Diamond Claims as part of its Diamond Suite for P&C insurers. graphical user interface (GUI)-based configuration through its Composer configuration tool and has completed work on rules. with automated identification of catastrophe and noncatastrophic event claims.K.

The system offers support for unique workflows. The system does not offer prebuilt mapping or data visualization for catastrophe management. Supply chain management is limited. Automatic assignment of catastrophe codes is not supported. The system can be integrated with other third-party solutions for advanced fraud analytics. Inc. and it does not include a mobile adjusting app. The system has prebuilt integration with OFAC. although these are not yet in production. and can be configured to store fraud scores returned by third parties.tasks. Business rules can be configured by customers to provide a means to flag potentially fraudulent claims. which have been more readily accepted by the Tier 3 insurers that make up its primary target market (see Note 2). but it does offer limited support for multiple languages (English and Spanish). Diamond Claims does not support multiple currencies. no computing resources are shared. ISO ClaimSearch and ISO ClaimDirector. It is testing mobile native apps. unique workflows and next-step processing. Diamond Claims includes a portal for both agents and policyholders that is in production. Diamond Claims offers the user simple tools for fraud management. Each hosted customer is a separate instance. Four of Diamond Claims' customers are hosted. but it does not offer a process flow view or editor. and Keylane has been successful in keeping the majority of its customers on current versions of the system. The system offers support for action sequences. Unique workflows are also not supported — instead. It does not offer a supply chain partner portal. | G00269737 Page 13 of 26 . and integration is prebuilt for geocoding and mapping. Insuresoft's portal has been mobile-enabled. Keylane (QIS Claims Management) Keylane offers the claims management module QIS Claims Management. The focus of Insuresoft has historically been on the North American market. the system uses a standard set of assignment rules for overflow claims. but it does provide the ability for SIU to make a clone of the claim file for use in investigations. The system offers very comprehensive configuration tools. The system does not offer full case management functionality. Business process management capabilities include a business rule editor and the ability to manage manual and system-generated tasks. Insuresoft has had success with several customers with hosted deployments. The system provides prebuilt catastrophe management reports and enables manual assignment of catastrophe codes to claims. Integration is prebuilt with Pitney Bowes for address verification. Diamond Claims offers the ability to assign work to third parties (such as repair shops) through basic email notification or through custom integration. The system includes prebuilt integration for agency upload/download and data sources for VIN or prefill. but this integration is not prebuilt. The company partners with Marias Technology to offer hosting through its data center in Ohio. with Insuresoft reporting that most customers address this outside the system. It also includes a Gartner.

day-to-day changes. Keylane can provide sandbox environments for prospects and hosted deployments for customers through its data center in the Netherlands. Keylane's smaller size and limited partnerships will likely constrain growth outside of Europe. QIS Claims Management supports fraud management through business-rule-based identification of potential fraud. Page 14 of 26 Gartner. Switzerland and France. but this would require custom report development. The system can also be integrated with third-party solutions to support review and editing within a process flow view. Automatic and bulk assignment of catastrophe codes is supported for existing claims in the base system. and this process flow view can be configured to support editing. The system includes prebuilt integration for agency upload/download and data sources for VIN or prefill. It includes a business rule editor and supports unique workflows. Majesco offers a direct-to-consumer portal and mobile Web applications that have been deployed in production by customers. QIS Claims Management also does not include a supply chain partner portal.process flow view of business processes. and by one customer in the Caribbean. and a full configuration studio that equips technical users and IT developers to perform complex configuration and integration. Unique workflows. The system offers limited catastrophe management functionality. Majesco (Majesco Claims) Majesco offers the claims management module Majesco Claims. catastrophe collaboration portals. The company also offers mobile native applications that have not been deployed in production. catastrophe reporting. The system includes two sets of configuration tools — one set designed to enable business users to perform simple. and catastrophe analytics and visualization tools are not offered in the base system. Prebuilt interfaces are available for third-party fraud analytics packages. Catastrophe reporting is available through the QIS Data Mart. QIS Claims Management is positioned for international operations with support for multiple currencies and multiple languages. Keylane is hosting one QIS Claims Management customer in production. although this integration is not prebuilt. The system offers core functionality for managing a supplier network and assigning work. The system has prebuilt integration for agency upload/download. Inc. The system contains reusable components that can be integrated in a native mobile app. Management of licenses and prerequisites and supply partner analysis/scoring is limited in the base system. QIS Claims Management enables manual assignment of catastrophe codes to new claims. but this would require custom development. Keylane includes a portal and mobile Web applications for both agents and policyholders that are in production. configuration of action sequences and system-generated tasks. and is being used by European customers in the Netherlands. | G00269737 . with external data sources for VIN and prefill. The system supports automated referral to SIU and case management functionality for investigations.

and automatic and bulk assignment of catastrophe codes. and prebuilt integrations with OFAC and ISO ClaimSearch. catastrophe analytics and visualization tools. The system includes mapping. It can also be configured to support case management functionality for investigations. includes prebuilt reports for catastrophe management. with 90% of configuration accomplished through a GUI-based configuration toolset. SAP offers separate portals for multichannel support. Supply partner analysis/scoring is not offered in the base system. Inc. These are mobile-enabled and in production. The system has prebuilt integrations for address verification and geocoding. Fraud management within Majesco Claims is supported through business-rule-based identification of potential fraud. | G00269737 Page 15 of 26 . and Majesco Claims does not have prebuilt integration to external supply networks. Catastrophe management is supported by Majesco Claims through custom workflows. with 13 of its 20 customers in production being hosted within its data center in the U. SAP Claims Management. neither the catastrophe analytics nor the mobile app have been deployed to production. The system supports multiple currencies through configuration and supports multiple languages. Majesco's historical focus has been on the P&C insurance market in North America. The company can support hosting of separate instances in which no computing resources (including hardware) are shared or hosting in which application containers and databases remain separate.The system offers core functionality for managing a supplier network and assigning work. Custom integration work is necessary for the use of third-party fraud analytics packages. and also includes a mobile adjusting app. although these capabilities have not been deployed to production. but this has not yet been deployed to production. Gartner. The system also offers excellent business process management capabilities. offers comprehensive configuration tools. However. but hardware and virtual infrastructure are shared. and it is targeting Europe and Latin America for expansion. The system supports automated referral to SIU and capture of information during fraud investigation. with support for complex workflows and the ability to view and edit workflows visually in a process-flow UI. the company plans to expand into other regions. and these have been deployed to production for direct consumers. SAP Claims Management also offers end users a wide array of configuration and personalization options for their day-to-day workspace. Prebuilt integration is available for agency upload/download. The system provides access suitable for business users for business rules and Q&A configuration. but SAP does not have production experience with integration for VIN or prefill. Majesco has significant experience supporting alternative delivery options. SAP (SAP Claims Management) SAP's claims management module. but it is investing in the product to make it appropriate for global use.S. SAP also has developed mobile applications for distributors and direct consumers. manual assignment. The system does not include a supply chain partner portal. In the long term. Majesco Claims is integrated with Cognos for reporting. and is also preintegrated with Majesco Analytics.

Claims management Page 16 of 26 Gartner. and includes flexible portal functionality that enables the user to quickly set up portals for collaboration with supply chain partners. these supply chain management portals and capabilities have not yet been deployed to production by customers. with additional data centers planned in Asia. SAP Claims Management supports the Hana in-memory database and contains basic fraud management capabilities. these capabilities have not been deployed to production. Although the claims management market is mature. buyer preferences are shifting. However. Comprehensive fraud management. SAP offers a mobile app for use by adjusters responding to an event. The system also supports mapping of claim and policy details with layers of other data (such as weather data). such as business-rule based fraud identification and analysis of historical data. but it is supporting customers in production in North America.The system provides core supply chain management functionality for managing a supplier network and assigning work. | G00269737 .S. automated referrals. SAP Claims Management also supports supply partner analysis/scoring and prebuilt integration to external supplier networks. All SAP Claims Management customers in production have deployed the system on-premises. and it has new customers currently implementing in all other regions. to meet their strategic objectives and remain competitive in the long term. Context The P&C claims management module market is relatively mature. Inc. The system offers prebuilt integration with third-party data sources for address verification. The system supports unique workflows and offers portals that can enable collaboration among different internal and external parties. However. Gartner is seeing via client inquiry that insurance buyers are looking beyond core claims modernization to other capabilities and technologies. and SAP has established a large partner network that gives it a presence in every region across the globe. and two in Europe. every vendor is offering its claims module with complementary modules for policy and billing that enable their customers to choose a single vendor to provide a full suite of core modules for their modernization needs. SAP offers excellent catastrophe management capabilities. With one exception. The company has experienced slower growth in North America. Prebuilt integration with other third-party fraud analytics solutions is not available. with support for automated catastrophe and other event code assignments. SAP offers hosting through two data centers in the U. Europe. and ship the systems with prebuilt content and workflows that minimize configuration required during implementation. mapping and catastrophe risk management. geocoding. such as the concept of digital business and the Internet of Things. The system also offers prebuilt integration with OFAC and ISO ClaimSearch. and the Middle East and Africa. Every system reviewed in this report includes configuration tools that enable the user to modify the system independent of the vendor. The system supports multiple currencies and multiple languages. including fraud analytics. One customer currently implementing the system will be hosted by SAP in Australia. The vendors have gained experience from multiple deployments. and case management functionality is available under a separate license with SAP Fraud Management for Insurance.

Claims management modules have been mostly heavily adopted within the North American market. Although adoption in other regions has lagged in the past in favor of in-house solutions or local incumbents. The number of new customers in North America fell from 27 in 2013 to 23 in 2014. and the degree to which they were incorporating scoring. For example. We assessed how well the systems supported challenging scenarios like catastrophes with automated identification. catastrophe management. while the number of new customers outside of North America grew dramatically from 7 in 2013 to 22 in 2014. minor changes and support for advanced workflows remain key differentiators. Given the emphasis on the customer experience. and advanced fraud analytics. where accessibility by business users for frequent. Gartner. and all vendors are enhancing or investing in support for international expansion. IT and business leaders feel more urgency to complete claims management module implementations quickly to that they can invest in more impactful technologies. supply chain management.modules are increasingly viewed as systems of record that provide little in the way of competitive differentiation — especially as they are being widely adopted across the industry. we assessed the degree to which vendors offered multichannel support via customer portals and mobile device support. where they have become the near-universal choice for legacy modernization and claims transformation. analytics and case management to combat fraud. Nearly all vendors are expanding their hosting services. custom workflows. Instead. We also assessed how vendors were using partners to address various capabilities. and increasing interest from outside of North America — vendors continue to invest in advanced functionality and capabilities outside of core claims processing to address buyer needs and better differentiate their products. | G00269737 Page 17 of 26 . we did not focus on these capabilities. is scalable and provides full support for claim life cycle management. As Gartner surveyed these trends. that fall outside the scope of core claims management or require skills and expertise beyond the scope of most vendor organizations. as this is becoming a more attractive (and sometimes necessary) option for many insurance CIOs. because every vendor in this research offers a system that has a component-based architecture. We assessed the degree to which vendors were enabling automation and collaboration within their supply chains. in client inquiry Gartner. and much less patience for customization beyond what is absolutely necessary to adopt these systems. and data visualization and mapping for better decision making. we focused our assessments on the capabilities and use cases where we saw the most differentiation among the vendors. and all are introducing or improving support for mobile devices. such as advanced fraud analytics or international operations. and we assessed the vendors' abilities to support international operations. They are placing greater emphasis on building out or partnering for capabilities such as advanced workflow and business process management. Inc. We evaluated the vendors' abilities to host their solutions. has seen a spike in interest from insurance IT leaders in other regions that is reflected in the new customer wins reported by these vendors. All vendors offer portals for consumers and agents or distributors. we addressed capabilities such as configuration. There is a significant appetite for revising business processes to match functionality provided by the vendors. In response to these shifting attitudes and priorities among buyers — growing acceptance of core claims management as a commodity function.

as well as tools to support investigation such as case management. they address core claims management only. | G00269737 . track status and assist in managing the claims process. Prebuilt interfaces for best-of-breed fraud analytics tools (such as predictive modeling and fraud analytics. adapting system attributes and parameters. as stand-alone modules. Customers and agents are able to access portals with self-service functions from any device and initiate claims.Product/Service Class Definition Gartner has defined "claims management modules" as solutions to manage the life cycle of an insurance claim. Fraud Management This is the ability to support various techniques for identifying fraud — both within the claims module and through integration with specialized packages — and the management of investigations. Critical Capabilities Definition Configuration This is the capability for insurers to adapt the module to their needs without support from vendors. which support more advanced data mining for early fraud scoring and social network analysis for better fraud ring detection) are increasingly expected by buyers. These modules are often sold as independent software applications supporting claims management functions only. changing the sequence and layout of user screens. business rules and processes. Claims management modules should offer basic workflow and business-rule-based fraud identification capabilities. which have been commonly deployed in the past. the Internet or mobile channels. Fraud assessment should take place in real time in addition to separate analysis over the life of a claim. Gartner distinguishes claims management modules from policy administration systems. billing and other administrative functions — in a single. track their performance. to form a suite of modular core solutions. and provide for collaboration among the suppliers and other stakeholders (such as claimants and adjusters) in the claims management process. Multichannel Support This is the capability to support different claim service channels — such as call centers. Inc. facilitate referrals. More advanced Page 18 of 26 Gartner. Policy administration systems support end-to-end insurance operations — including claims. monolithic system. Supply Chain Management This is the capability to maintain a network of suppliers (such as repair shops). and integrating with external systems. This includes modifying workflows. Claims management modules differ from claims functionality provided by broader policy administration systems because. such as policy and billing. They may also be integrated with other stand-alone modules.

These deployments may be more traditional hosting with managed application services or more sophisticated offerings that are truly SaaS. event and postevent stages.. Internationality This is the ability to support operations in multiple geographic regions. Alternative Delivery This is the ability to support deployment models beyond a traditional on-premises implementation. Link claims to defined catastrophes. Use Cases Process Definition Modify out-of-the box process flow. The system should support automated linking of claims to catastrophes and provide insight via analytics that enable the visualization of key data. and provide configuration tools that enable it to be localized for each region's unique regulatory environment and common business practices. and in some cases. Gartner. policyholder.vendors have production experience with prebuilt integrations with best-of-breed fraud analytic tools. event and postevent stages. New Claim Submission and Tracking Submit and track the status of a claim across multiple channels from the perspective of various stakeholders (e. are offering additional data visualization and geospatial analysis for identifying fraud.g. Provide support for the investigation. and provide insight via analytics and reports. Fraud Identification and Investigation Use a mix of techniques (such as business rules or predictive analytics) to identify a potentially fraudulent claim and refer it to SIU. Inc. The system must support multiple currencies and languages. claims adjuster and supply chain partner). In nearly all cases. the ability to deploy quickly is paramount. | G00269737 Page 19 of 26 . Catastrophe Management Support alternative claim processes during pre-event. Catastrophe Management This is the ability to minimize the impact of catastrophic events through alternative processes during pre-event. layout of user screens and supporting business rules to meet the requirements of a client-specific version of a process.

For inclusion in the Magic Quadrant. even if there are multiple deployments for different lines of business within a single company. 2. with its claims management module QIS Claims Management. Multiregional Support Deploy the system across multiple regions that do not share a common language or a common currency. Inclusion Criteria This Critical Capabilities report uses the same inclusion criteria as the "Magic Quadrant for Property and Casualty Insurance Claims Management Modules. Gartner selected seven critical capabilities and defined six use cases (see Table 1). At least 10 customers that have deployed the claims solution to production as of 31 December 2014. Dropped No vendors were dropped from this report.Hosted Deployment Implement the system as quickly as possible using a vendor-hosted deployment. Inc. At least one new customer in 2014 (excluding upgrades or expansion within existing customers). Use prebuilt content and functionality to speed implementation. | G00269737 . Vendors Added and Dropped Added Keylane. each solution must have: 1. and those vendors that have fewer than 10 customers in production as of December 2014. they lack claims financials). not coupled with a policy system or available only as part of a comprehensive policy administration suite). was added to this report. Not included in this report are vendors that supply only front-office functionality for claims (that is." This report includes only claims management modules that are offered stand-alone (for example. solutions sold exclusively to workers' compensation product lines with no capability to support commercial and personal-line functions. For this report. Each organization is counted once. Page 20 of 26 Gartner.

Weighting for Critical Capabilities in Use Cases Configuration 60% 50% 20% 30% 10% 25% Multichannel Support 10% 15% 10% 5% 0% 5% Supply Chain Management 10% 15% 10% 5% 0% 5% Fraud Management 5% 5% 5% 55% 0% 5% Catastrophe Management 10% 10% 45% 5% 0% 5% Alternative Delivery 0% 0% 10% 0% 90% 10% Internationality 5% 5% 0% 0% 0% 45% 100% 100% 100% 100% 100% 100% Total As of July 2015 Source: Gartner (July 2015) This methodology requires analysts to identify the critical capabilities for a class of products/ services. | G00269737 Page 21 of 26 . Critical Capabilities Rating Each of the products/services has been evaluated on the critical capabilities on a scale of 1 to 5. Each capability is then weighed in terms of its relative importance for specific product/ service use cases.Multiregional Support Hosted Deployment Catastrophe Management Fraud Identification and Investigation Critical Capabilities New Claim Submission and Tracking Process Definition Table 1. a score of 1 = poor (most or all defined requirements are not achieved). Inc. while 5 = outstanding (significantly exceeds requirements). Gartner.

5 3.7 3.5 3.2 4.8 3.8 Internationality 3. | G00269737 .3 2.8 2. The scores.8 Catastrophe Management 3.8 2.8 2.9 3.6 3.1 3.6 As of July 2015 Source: Gartner (July 2015) Table 3 shows the product/service scores for each use case.3 2.2 3.2 2.2 3. Page 22 of 26 Gartner.0 3.8 Supply Chain Management 2.1 2.6 3.5 2.4 3.0 2.8 3. Inc.0 2.4 2.2 2.0 2. Product/Service Rating on Critical Capabilities Configuration 3.3 1.9 3.5 2.8 3.8 3.6 Alternative Delivery 3.3 2.5 3.1 2.3 2.8 Fraud Management 2.4 Multichannel Support 3.CSC (Riskmaster Accelerator) Guidewire (ClaimCenter) Innovation Group (Insurer Claims) Insuresoft (Diamond Claims) Keylane (QIS Claims Management) Majesco (Majesco Claims) SAP (SAP Claims Management) Critical Capabilities Accenture (Accenture Duck Creek Claims) Table 2.4 4.3 3.8 2.1 3.0 3.6 2.2 3. which are generated by multiplying the use case weightings by the product/service ratings. summarize how well the critical capabilities are met for each use case.8 2.0 3.2 2.3 2.2 2.2 3.

"How Products and Services Are Evaluated in Gartner Critical Capabilities" "Magic Quadrant for Property and Casualty Insurance Claims Management Modules" Gartner.53 3.58 2.13 2.58 3.66 3.84 3.90 3.22 2.51 2.60 3. | G00269737 Page 23 of 26 .CSC (Riskmaster Accelerator) Guidewire (ClaimCenter) Innovation Group (Insurer Claims) Insuresoft (Diamond Claims) Keylane (QIS Claims Management) Majesco (Majesco Claims) SAP (SAP Claims Management) Use Cases Accenture (Accenture Duck Creek Claims) Table 3.37 3.86 Multiregional Support 3.45 2.33 Fraud Identification and Investigation 3.39 2.50 2.25 2.51 3.23 2.82 3.27 Catastrophe Management 3. multiply the ratings in Table 2 by the weightings shown in Table 1.43 2.17 2.33 New Claim Submission and Tracking 3.87 3.28 2.91 3.08 3. Inc.58 3.36 3.59 2.82 3. Product Score in Use Cases Process Definition 3.40 As of July 2015 Source: Gartner (July 2015) To determine an overall score for each product/service in the use cases.90 3.57 Hosted Deployment 3.75 2.23 2.57 2.92 3.47 2.71 3.55 2.93 3.35 2.78 3.08 2. Gartner Recommended Reading Some documents may not be available as part of your current Gartner subscription.83 2.34 3.

Gartner recommends that users consider the set of critical capabilities as some of the most important criteria for acquisition decisions. Each capability is then weighted in terms of its relative importance for specific product or service use cases. when considering products/services in this market? Use cases should match common client deployment scenarios. | G00269737 . products/services are rated in terms of how well they achieve each of the critical capabilities. the analyst first identifies the leading uses for the products/services in this market. Next. Inc. Each capability is assigned a level of importance in fulfilling that particular need. A score that summarizes how well they meet the critical capabilities for each use case is then calculated for each product/service. and Canada) ■ Latin America ■ Europe ■ Middle East and Africa ■ China. depending on the use case being evaluated. In defining the product/service category for evaluation.Note 1 Definition of Regions Gartner asked vendors to respond with data on customers in production and sales for the following six regions: ■ North America (U. "Critical capabilities" are attributes that differentiate products/services in a class in terms of their quality and performance. Page 24 of 26 Gartner.S. Asia/Pacific region and Japan ■ Australia and New Zealand Note 2 Definition of Tiers ■ Tier 1: More than $5 billion (or equivalent) in direct written premium (DWP) ■ Tier 2: $1 billion to $5 billion in DWP ■ Tier 3: Less than $1 billion in DWP Critical Capabilities Methodology This methodology requires analysts to identify the critical capabilities for a class of products or services. These capabilities are generalized groups of features commonly required by this class of products/services. The analyst then identifies the critical capabilities. These distinct client scenarios define the Use Cases. some sets of features are more important than others. What needs are end-users looking to fulfill.

Ratings and summary scores range from 1. therefore.0 to 5. Inc. Gartner. Clients should use a critical capabilities analysis as one of several sources of input about a product before making a product/service decision. The critical capabilities Gartner has selected do not represent all capabilities for any product. may not represent those most important for a specific use situation or business objective.0: 1 = Poor or Absent: most or all defined requirements for a capability are not achieved 2 = Fair: some requirements are not achieved 3 = Good: meets requirements 4 = Excellent: meets or exceeds some requirements 5 = Outstanding: significantly exceeds requirements To determine an overall score for each product in the use cases. These ratings are displayed side-by-side for all vendors.Each vendor’s product or service is evaluated in terms of how well it delivers each capability. the product ratings are multiplied by the weightings to come up with the product score in use cases. on a five-point scale. | G00269737 Page 25 of 26 . allowing easy comparisons between the different sets of features.

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