access
 • State Compliant Electronic Data Interchange (EDI)
 • Total security and redundancy

System Functionality

Functionality
QISS’ Claims Management System is one of the most complete, robust systems on the market today. Our system handles all lines on insurance. Whether it’s Worker’s Compensation, with all of its state reporting requirements, Property & Casualty, Auto Liability, or General Liability; Claims from all lines are managed by our system. When the claim type for a new claim is entered into our system, the subsequent screens are customized to capture the necessary information unique to that claim type.

Diary/Notes
Our diary/notes feature is one of the most utilized features of the Claims Management System. We use the diary feature as our primary way to communicate with each other concerning claims. Our notes feature allows for the entry and storage of more detailed information associated with a claim.

Service Tracking
We use our system to enter and track services performed for a specific claim. Rate sets can be defined on a client-specific basis, allowing for the automatic filling of the rate field. We have the choice of defining as many types of services as our clients would like. All this allows for detailed itemization of services, including (but not limited to) adjuster hours, clerical time, mileage, photos, etc… Even if the client wants us to bill at a flat rate, we often use this feature to track how much time is being spent on individual claims. All of this information is recorded and can then be used for analysis.

Reserve Management
Reserves are tracked and adjusted through the system. Reserves can be set, increased, or decreased manually. There is an option of setting reserves to automatically increase as bills are submitted against the claim, or to be approved by an adjuster. Each transaction, whether a bill, reserve adjustment, or subrogation, is recorded and a log is produced that can be referenced to produce a ‘snapshot’ of that claim at any given time and date. All reserve information can be reproduced in detailed loss runs by the user.

Compensation Schedules
Compensation schedules can be initiated out of the system to automatically produce compensation checks. The system handles waiting periods, third party payments, and caps on total compensation paid.

Bank Account Management and Check Cutting
Checks can be cut directly out of our system. Multiple payments to one entity can be ‘rolled-up’ into one check, rather than cutting separate checks. Auto reconciliation of bank accounts is provided. QISS will load our or the client company logo into our system so your checks can be cut on blank check stock…. a cost saving.

Recoveries/Subrogation
Recoveries, subrogation, and salvages, are all itemized in the system under the reserve management section. Any recoveries made reduce the total incurred figure.

Document Storage
QISS allows us to upload any digital document associated with a claim into the claims management system. It then can store PDF’s, photos, Word documents, and audio files into the system. There are no storage restrictions so we can store an unlimited number of documents. Our document storage system also features the popular ‘drag and drop’ feature from Microsoft, allowing users to use their mouse to drag any icon from their desktop to the document storage field where it will then automatically queue for upload. Documents uploaded into the system are then set to ‘lock’ after a default period of 24 hours (defined by us) to prevent accidental destruction or deletion of data.

Claim Importing
Currently under development, the QISS system will soon include a bill importer. The bill importer will essentially be a web page that our clients can go to in order to submit a prospective claim. After the prospective claim is submitted, the adjusting company or TPA can inspect the proposed claim, add any additional information necessary, or reject the claim if it is determined to be an invalid claim. This new feature will streamline the claim entry process and saving claims personnel time and money.

Medical/Legal
Any medical or legal information related to the claim can be stored under the separate medical and legal tabs on the claims screen. Information pertaining to doctors, lawyers, judges, etc., can be entered and applied to multiple claims.

Report Generation
QISS’ claims management system has extensive reporting capabilities built into our system. Over 100 pre-defined reports exist in our system that can further be modified by the user by simply changing the parameters of the reports.
For option-based reporting, modified reports can be generated based on the parameters chosen by the user. This allows users to customize reports simply and quickly in a variety of ways. Customized reports can then be labeled and saved in the user’s reports table. Bar and pie graphs can be created and added to reports. All reports can then be exported to Microsoft Word, Excel, or pdf files. These reports can then be e-mailed to our clients. If our client's choose, a ‘view-only’ id can be provided to the client, enabling them to run their own ad-hoc reports whenever needed. Custom reports can be built as necessary at customer’s request.

Form Letters
Form letters of all types are stored in our system. When a particular form letter is referenced, all of the information related to the claim is auto-filled into the appropriate fields. The letters can then be printed and mailed, or saved as a PDF or Word document and e-mailed

Refer to www.eqiss.com for details on security and other information