ClaimsVISION
By P&C Insurance Systems, Inc
Typical Implementation Process for ClaimsVISION Software
Project Planning: Establish project scope, goals, key deliverables, timeline, and responsibilities with both the client and PCIS implementation team.
Business Process Analysis: Assess and document current claims workflows and requirements; determine needed configuration and any process improvements.
System Configuration: PCIS configures ClaimsVISION based on client specifications—this includes user roles, custom business rules, forms, templates, and integration points.
Data Migration: Migrate relevant historical and active claims data from legacy systems into ClaimsVISION, validating for accuracy and completeness.
Integration: Set up integration with policy, finance, and third-party data systems using standard APIs and secure methods.
User Training: Provide comprehensive user training sessions for claim adjusters, supervisors, admin staff, and IT support.
User Acceptance Testing (UAT): End-to-end testing with live workflows to catch and resolve issues before going live.
Go-Live: Official rollout of the platform for production use; monitoring and support available post-launch.
ClaimsVISION offers extensive customization to fit a wide range of business needs in the insurance and claims management sector. Here are the key data points highlighting how the platform can be tailored:
The claims workflow and business logic are driven by a powerful, configurable rules engine. Users can customize intelligent business processes and automation rules without programming expertise, tailoring the software to match unique organizational practices.
ClaimsVISION features user-configurable workflows and an unlimited organizational hierarchy. This enables businesses to mirror complex internal structures, approval paths, and process steps in the software for claims, risk, and policy management.
Entry forms, dynamic fields, data pre-population, and navigation shortcuts can be customized per client requirements. Custom fields and layout adjustments improve data capture for diverse claim types and user roles.
Granular security permissions allow organizations to define access at the user, departmental, or role level. This makes it possible to restrict or grant functionality and data access based on business needs.
Automated task routing, alerting, document creation, and information distribution can be fully customized to support different operational models, including public sector, commercial carriers, and self-insured organizations.
Built-in automation ensures federal and state compliance reporting (like OSHA, MMSEA) can be tailored for each client. Custom rules can support organization-specific workflows, forms, and action plans.
ClaimsVISION provides robust, flexible B2B integration capabilities with APIs, allowing seamless connection to policy systems, finance, third-party vendors, and legacy systems, customized per client technical environment.
Over 100 pre-built reports are available, and users can create their own dashboards, KPIs, and ad hoc data queries with drag-and-drop tools, supporting organization-specific management and regulatory reporting needs.
The document management module allows custom automation for form creation, attachment, and communication, with workflows dictated by user-defined business rules.
ClaimsVISION, offered by PCIS, provides comprehensive training and support options for new users to ensure an effective onboarding and ongoing experience.
Types of Training: ClaimsVISION delivers a mix of training formats, including:
Live online training sessions
In-person sessions (when requested)
Webinars and recorded tutorials
Training documentation and user manuals
Ongoing Learning: Training is not limited to the initial onboarding. Users have access to regular webinars and refresher courses to keep skills up-to-date.
Dedicated Account Representative: Each client is assigned a dedicated account representative to provide personalized guidance and address specific needs.
Support Channels: Users have access to support through multiple channels:
Phone and email support
An online helpdesk and knowledge base
Contextual help within the software (tooltips, wizards)
Video tutorials
Support Hours: Standard support is available Monday to Friday, typically from 8am to 8pm (EST), with after-hours emergency support options.
Additional Resources: Online user conference sessions and advisory council meetings for deeper engagement and peer learning opportunities.
Comprehensive help documentation and step-by-step guides are built directly into the ClaimsVISION platform.
Onboarding Support: The same team that manages implementation continues with ongoing support, ensuring continuity and in-depth product knowledge throughout the customer relationship.
ClaimsVISION implements several key security measures to protect sensitive data and ensure regulatory compliance in claims management:
Data Encryption: The platform employs robust encryption protocols to secure data both at rest and during transmission. This ensures that even if data is intercepted, it remains unreadable to unauthorized parties.
Strict Access Controls: ClaimsVISION uses granular permissions and authentication mechanisms. Only authorized users can access sensitive information, reducing the risk of internal or external breaches. Role-based access control (RBAC) helps ensure users see only the data relevant to their responsibilities.
Regular Security Audits: The system undergoes periodic security audits and vulnerability assessments to identify and address weaknesses before they can be exploited by cybercriminals. These reviews cover the entire IT infrastructure and software environment.
Intrusion Detection and Monitoring: Advanced monitoring tools and intrusion detection systems track user activity, detect suspicious behavior, and enable a swift response to threats or anomalies within the platform.
Regulatory Compliance: ClaimsVISION is designed to help insurance providers adhere to data privacy and security regulations relevant to the industry, such as HIPAA for health data or similar standards based on client needs. Ensuring compliance with these regulations reduces legal risks and supports customer trust.
Secure Cloud Infrastructure: Given the cloud-based nature of ClaimsVISION, the platform leverages up-to-date cloud security standards, such as encrypted storage, secure API connections, and continuous updates to defend against evolving cyber threats.
Renewal Notice: Clients are generally provided with renewal terms well in advance of contract expiration, allowing them to review pricing, terms, and decide on continuation.
Negotiated Renewal: Renewal is not always automatic―it may require negotiation or agreement on new terms, especially if there have been changes in service scope, pricing, or other material aspects.
Duration: Typical contract periods for software platforms like ClaimsVISION are annual or multi-year, with renewal options specified in the original agreement.
Express Renewal Clause: The right to renew must usually be expressly stated in the contract. In some cases, a period of negotiation or confirmation is needed before renewal takes effect.
Cancellation Clause: Most insurance technology contracts, including those for ClaimsVISION, include a cancellation clause that allows either party to end the agreement under certain specified circumstances.
Grounds might include breach of contract, non-payment, material misrepresentation, or failure to comply with important obligations.
In the event of contract termination initiated by the client, there may be penalties or requirements such as advance notice (e.g., 30 days).
Pro-Rata Refunds: If cancellation occurs and premium/service fees have been paid in advance, the client may receive a pro-rata refund for the unused term, depending on contract language.
Notice Period: Industry standard is to require written notice before cancellation, usually 30 days, though this may vary by agreement.
ClaimsVISION software complies with key industry and regulatory standards to ensure secure, accurate, and legally compliant claims management for insurance providers. The platform is recognized for its robust compliance automation and support for complex reporting and data handling requirements across multiple jurisdictions.
Federal and State Regulatory Compliance: ClaimsVISION automates compliance with essential U.S. federal and state-level reporting, including statutory requirements for First Report of Injury/Second Report of Injury (FROI/SROI), Medicare (CMS) reporting, and other mandatory claims and payment disclosures.
SOC 2 Certification: Independent review sites list ClaimsVISION as meeting SOC 2 standards, signifying a third-party audit of its controls for data security, confidentiality, and availability. SOC 2 is especially valued by insurance and financial organizations for protecting personal and sensitive data.
ISO 27001 Information Security Certification: ClaimsVISION is recognized as having achieved ISO 27001 certification, an internationally accepted information security management standard, further validating its data protection and risk management controls.
Cyber Essentials Certification: ClaimsVISION holds the Cyber Essentials certification, which focuses on core cybersecurity and data protection measures to guard against the most common cyber threats.
Automated Compliance Workflows: The platform provides highly automated tools for compliance monitoring, reporting, and audit trails, which enhance efficiency and minimize compliance errors.
