Custom Workers’ Compensation Insurance Software

Robotic process automation and machine learning can be used to automatically extract and validate data on employers’ financial performance, workforce, specifics of employee workflows, past claims history, etc. from digital and paper insurance applications.

Insurers can create and manage custom actuarial models for loss prediction and risk evaluation. The solution enables criteria-based scoring of employer risks. It can also provide AI-powered risk assessment based on the employer’s web footprint and social media sentiment.

The software calculates personalized insurance premiums based on the requested coverage terms and an employer’s risk score. It can provide AI-powered prescriptions on optimal premiums based on the analysis of demand, price elasticity, potential risks, and competitors’ prices.

Custom solutions enable automated policy generation, updating, renewal, and termination. They provide centralized and scalable policy storage. Insurers can create custom templates for region-specific policies and sign the policies using a digital signature.

The software automatically generates one-time and recurring invoices and enables real-time payment processing via payment gateways. Custom solutions can support all necessary payment currencies (including crypto) and payment methods: bank transfer, card, check, etc.

RPA and AI can be used to process workers’ compensation claims and claim-supporting documents (incident reports, photos of involved assets, medical bills, etc.) in near real time. The software automatically prioritizes claims for processing based on the claim date, urgency, damage severity, and more.

The software uses custom rules to detect fraudulent claims and calculate due compensation amounts for valid claims. It can also be powered with AI for automated claim validation against the insurance coverage terms and relevant data from third parties (e.g., employers, healthcare providers, telematics providers).

Insurers can create custom payment plans for each claim case. The software enforces payments in the form of partial wage replacement, reimbursement of medical expenses, payments to workers’ dependents (for workplace-incurred fatality cases), etc., according to the pre-set schedule.

Claims (FROI/SROI), required policy statistics, and financial performance details are automatically reported in line with the regional standards and guidelines, e.g., by OSHA, NCCI, WCIS, OWCP, IFRS 17 for the US. The software can also trigger scheduled or ad hoc report submission to regulators via EDI.

The software calculates all required insurance metrics (sales, underwriting, claim settlement, etc.) and can deliver them in real time. AI-supported solutions may also forecast the demand, revenue, and expenses — or prescribe optimal employee task plans and claim reserves.

Custom software is protected with role-based access control, multi-factor authentication, and end-to-end data encryption. Insurers can also request it to be compliant with the necessary standards and regulations: SOX, SOC 1 and SOC2, NYDFS, GDPR, HIPAA, and more.

Insurer’s teams can leverage AI-powered virtual assistants to automatically handle basic customer and partner communication tasks, such as requests for missed information, notifications on the claim processing status, payment reminders, etc.

Workers can file claims based on customizable templates, upload claim-relevant documents for various loss events (work-related injury, occupational disease, etc.), and track the claim resolution status in real time. Custom software can also offer a criteria-based selection of healthcare providers from the pre-approved list.

Employers can automatically generate insurance applications and claims. They can also create and manage the list of loss-handling partners (healthcare providers). Custom software would provide a full history of received insurer invoices and enable automated payment for insurance services.

Healthcare providers can upload data on claim reasoning (medical diagnostics results, treatment prescriptions, etc.) and instantly share it with insurers.