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OneShield Market Solutions
Claims handling built for speed and predictability
Claims handled with the speed and predictability of a managed service: streamlined automation, detailed reporting, and a Claims module built on the same platform as your policy and billing data.
From FNOL through file closure, we tailor workflows, business rules, codes, forms, and documents to match your process, backed by the Claims Document AI Assistant for faster review of large, complex files.
From FNOL through file closure, we tailor workflows, business rules, codes, forms, and documents to match your process, backed by the Claims Document AI Assistant for faster review of large, complex files.
Functionality that elevates customer service and streamlines resolution
First Notice of Loss
FNOL intake from agency and customer portals, email, or manual entry: every notice is recorded and stored automatically for the next step.
Scripting
Support FNOL intake with reflexive questioning and custom question sets, including decision branching, to prompt every mandatory question.
Workflows
A powerful business rules engine creates user-based alerts, triggers workflows, assigns claims handlers, and supports escalation.
Workers' Comp
Handle claims efficiently with FROI/SROI EDI reporting and integration with external vendors: car rental, repair services, and more.
Customization
Manage claim adjudication, medical case handling, litigation, salvage and subrogation, special investigations, and reserve/sub-reserve categories.
Visibility
Permission-based, 360-degree views of claimants and related parties, with a fully integrated journal and task management.
Core Capabilities Inside Claims
Intake
Every notice captured, no matter where it starts
FNOL intake from agency and customer portals, email, or manual entry, with scripted questioning and duplicate detection.
Key capabilities:
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FNOL intake from agency and customer portals, email, or manual entry
Scripted intake with reflexive questioning and decision branching
Duplicate claims checking at intake
Claim characteristic scoring for alerts and handler assignment
Workflows
Claims routed to the right handler automatically
Rules-based routing by coverage, jurisdiction, workload, and authority level, with automatic escalation and out-of-office rerouting built in.
Key capabilities:
Automatic or manual routing: rules-based, skill-based, round robin, or load balancing
Assignment by workload, coverage type, location, LOB, jurisdiction, and authority level
Out-of-office diary rerouting and bulk reassignment
Manager “switch user” access to other staff inboxes
Financial authority thresholds with automatic referral above authority
Financials
Reserves, coverage, and payments on one ledger
Automatic, worksheet, or manual reserves with coverage verification, aggregate tracking, and full payment processing built in.
Key capabilities:
Reserves set automatically, by worksheet, or manually by exposure type
AI-powered coverage verification at coverage, limit, location, and class code levels
Aggregate and deductible tracking
Check, EFT, ACH, wire, credit card, and credit note payment methods
Legal tracking module for internal-only case tracking
Recovery & Legal
Subrogation and litigation tracked inside the claim file
A fully integrated subrogation module manages offers and recoveries, with legal tracking and litigation tools built in.
Key capabilities:
Subrogation Tracking Module manages offers, assignments, and recovered funds
Distinguishes loss recovery from subrogation recovery
Litigation module tracks trials, settlement offers, and counteroffers
Separate journal and appointment calendar restricted to authorized users
Artificial Intelligence
A claims assistant built for large, complex files
The Claims Document AI Assistant summarizes documents, builds timelines, and answers questions across large, complex claim files.
Key capabilities:
Automated document summarization with highlighted critical details
Generates chronological timelines of claim-related events
Intelligent querying across selected documents in a file
Query modes range from direct answers to interpretive summaries
Reduces manual review time on large, complex files
Comprehensive Pricing Strategy
No large upfront implementation fees
Annual service hours allotment
Monthly upgrades and enhancements
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