Adjusters working claims in email and spreadsheets with no central claim record or workflow?
Fraud going undetected because there's no pattern detection across claims history?
Insurance Claims Management Software Development
Custom claims management software for insurers and MGAs who need FNOL intake, adjuster workflow, adjudication, and payments in one system -- not claims worked in email and spreadsheets with no central record.
Built to connect to your policy management system so coverage is verified automatically, and to your payment systems so claim settlements go out without manual processing. Fraud pattern detection included.
FNOL intake via web portal, mobile, and phone integration
Claims workflow -- assignment, SLA tracking, status updates, document management
Adjudication and reserve management with approval workflow
Fraud detection -- anomaly flags, SIU referral, pattern analysis across claim history
Insurance claims management software handles the full claim lifecycle -- FNOL intake, claims workflow and task assignment, document management, adjudication and reserve setting, payment processing, and fraud detection. RaftLabs builds custom claims systems for insurers and MGAs, integrated with policy management and payment systems, with delivery in 12-14 weeks at a fixed cost.
100+Products shipped
·24+Industries served
·FixedCost delivery
·12-14Week delivery cycles
A claim worked in email is a claim you cannot audit
When adjusters manage claims in email threads and personal spreadsheets, you have no consistent record of what happened, who did what, or when decisions were made. Coverage interpretation varies by adjuster. Reserve changes are undocumented. SLAs are tracked manually -- or not at all. When a claimant disputes a decision, the claim file has to be assembled from email archives and someone's memory.
The fraud problem is worse. Fraud patterns -- the same address on multiple claims, the same repair shop across unrelated claimants, a claimant with a history of claims just inside policy limits -- are invisible when claims live in email. No one person has the view of the full claim population that would surface a pattern.
Custom claims management software creates a single claim record that follows the claim from FNOL to settlement. Every action is logged. Every reserve change is documented with a reason. SLA deadlines are tracked automatically. Documents are attached to the claim record, not emailed around. Fraud indicators are checked against the full claim history -- not just the current adjuster's memory.
What we build
FNOL intake
First Notice of Loss captured through a customer-facing web portal, a mobile app, or a phone intake form completed by a contact centre agent. Structured intake form collecting incident date, location, description, policy number, and claimant contact details. Dynamic form logic -- a motor claim asks different questions than a property claim. Photo and document upload at FNOL so the claimant submits supporting evidence immediately. Claim reference generated and confirmation sent to the claimant. Triage rules applied at FNOL to route the claim to the right team or adjuster based on claim type, estimated loss, and coverage. FNOL data carried forward to the full claim record -- no re-keying required.
Claims workflow and task management
Claims queue showing open claims by team, adjuster, status, and days open. Automatic claim assignment based on adjuster workload, claim type, and specialism. Task list per claim -- coverage verification, contact claimant, instruct assessor, obtain repair estimate, set reserve, issue payment -- with due dates and SLA countdown. SLA rules configured by claim type and severity -- a catastrophe claim has different response time requirements than a routine property claim. Automated reminders to the adjuster and supervisor when tasks are overdue. Status updates visible to the claimant via a self-service portal so they are not calling to ask where their claim stands.
Document management
Document store attached to each claim record. Photo uploads from the claimant's mobile device geo-tagged and time-stamped at capture. Assessor reports, repair estimates, and specialist reports uploaded directly to the claim. E-signature workflow for settlement agreements and proof of loss statements -- sent to the claimant by email, signed digitally, and stored against the claim. Document version tracking so the latest assessor report is clearly identified. Access controls so external assessors can upload documents to the claim without seeing sensitive policy data. Document checklist per claim type shows which documents are required and which have been received.
Adjudication and reserve management
Coverage verification tool pulling policy details from the policy management system -- coverage limits, deductibles, exclusions, and endorsements -- displayed alongside the claim facts. Reserve setting with initial reserve entered at first adjuster contact and updated as new information arrives. Reserve change requires a documented reason and goes through an approval workflow for changes above a configurable threshold. Settlement calculation showing coverage limit, deductible applied, depreciation if applicable, and net settlement amount. Approval workflow for settlements above a threshold -- junior adjuster submits, senior adjuster or manager approves. Settlement decision documented with reason and authority reference for the claim file.
Claims payment processing
Payment initiation from the claim record -- no need to re-enter settlement details in a separate system. Direct EFT to the claimant's bank account for fast settlement. Cheque generation for claimants without bank account details on file. Payment to third parties -- repair shops, medical providers, legal representatives -- with payee verification before payment is released. Payment status tracked against the claim record -- initiated, cleared, returned. Remittance advice sent to the claimant with the settlement breakdown. Payments integrated with your finance system for accounting and reserve release. Payment audit trail showing who authorised, when, and to which account.
Fraud detection
Anomaly scoring applied at FNOL and updated as claim details are added. Rules-based flags for common fraud indicators -- incident date shortly after policy inception, multiple claims from the same address within 12 months, claimant address matching a known staging address, claim amount clustering just below a common investigation threshold. Network analysis linking the current claim to other claims by claimant, address, phone number, repair shop, and legal representative. SIU (Special Investigations Unit) referral workflow -- adjuster flags a claim, referral goes to the SIU queue with the supporting evidence, and SIU investigation tracked separately from the main claim. Fraud flag audit trail showing every indicator triggered and the adjuster's response.
Frequently asked questions
We build claims management systems for personal lines -- motor, home, contents, travel, and health -- and commercial lines including property, liability, and specialty. The claim workflow, document requirements, and reserve management differ by line of business, so we design the system around the specific lines you write. MGAs that write on behalf of multiple capacity providers need claims workflows that match each carrier's requirements, which we handle through configurable claim type templates. We have also built claims systems for warranty providers and embedded insurance products. If you write an unusual line or have a specific distribution model, tell us during discovery and we will scope accordingly.
The claims system connects to your policy management system via API to pull policy details at the point of FNOL -- coverage limits, deductibles, exclusions, endorsements, and premium status. This means the adjuster sees the coverage picture without switching systems, and coverage verification is a check rather than a manual lookup. If you do not have an API-enabled policy management system, we can build a batch integration that pulls policy data on a daily schedule, or a lightweight policy data store within the claims system that is updated via file import. The integration approach depends on what your policy system can expose. We scope this specifically during discovery.
Fraud detection in our claims systems works in two layers. The first is rules-based flagging -- configurable indicators that trigger automatically when a claim matches a known fraud pattern. These rules are built in consultation with your claims and SIU teams during scoping, and they are configurable so your team can add or adjust rules without a software release. The second layer is network analysis -- linking claims across the full population by shared claimant identity, address, phone number, vehicle, repair shop, or legal representative to surface connections that a single adjuster would not see. Flagged claims go to an SIU referral workflow with the supporting evidence packaged for investigation. We do not make fraud determinations -- the system surfaces indicators and the SIU makes decisions.
A focused claims management system covering FNOL intake, adjuster workflow, document management, reserve management, and payment processing typically ships in 14-18 weeks at a fixed cost. Adding fraud detection with network analysis, complex policy system integration, and a customer self-service portal typically moves the timeline to 18-24 weeks. Projects covering multiple lines of business with significantly different claim workflows, or integration with complex legacy policy systems, may run longer. We scope every project before pricing it. You receive a fixed cost and delivery schedule covering an agreed scope before development begins.
Talk to us about your claims management software project.
Tell us which lines of business you write, how your current claims process works, and where the manual steps and visibility gaps are. We will scope the right system and give you a fixed cost.
