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G00269737

Critical Capabilities for Property and Casualty


Insurance Claims Management Modules
Published: 27 July 2015

Analyst(s): Jeff Haner

Claims management module vendors continue to emphasize advanced


capabilities beyond core claims management. However, insurance CIOs
should take care to validate production experience behind vendor marketing
collateral.

Key Findings

Support for international expansion is becoming a higher priority for vendors. A higher
percentage of new deals are occurring outside North America, and all vendors are investing in
or enhancing multilanguage and multicurrency functionality.

As the market matures and core claims processing capabilities become common, vendors are
stressing advanced capabilities, such as catastrophe management or supply chain
management, in order to differentiate their offerings. Actual production experience with
advanced capabilities varies widely.

All but one of the vendors are building out hosting capabilities and placing a greater emphasis
on these in their marketing. Nearly 20% of new customer wins globally were for hosted
deployments.

Every vendor offers basic multilanguage and multicurrency functionality, but the ability to fully
support multiple regions is very uneven especially in terms of local system integration
partners and local requirements such as tax and regulatory frameworks. Some vendors are still
seeking their first customer outside of their home region.

Recommendations

Prioritize advanced capabilities beyond core claims processing in your vendor selection, and
ensure that the vendor's roadmap aligns well with your long-term business needs.

Verify actual production experience with advanced capabilities with client references to make
better-informed negotiation, planning and risk management decisions. In many cases, these
advanced capabilities have been developed and marketed, but not yet deployed in production
by customers.

Verify track records with sales and service to insurers headquartered in the regions and
countries in which you operate. Some vendors are supporting global insurers that operate in
regions outside of North America, but these vendors have not demonstrated an ability to sell to
and support insurers headquartered in these other regions.

What You Need to Know


The market for property and casualty (P&C) claims management modules continues to mature.
There is a high degree of consistency among core claims management functionality, including
configuration and workflow, and growing emphasis on advanced capabilities such as supply chain
management or advanced fraud analytics for differentiation in the market. Support for international
growth is improving. All vendors are enhancing or building support for international operations as a
greater percentage of new deals are being made outside North America. With the exception of one
vendor, all vendors are placing a greater emphasis on support for hosted deployments.
Due to the maturity of vendor offerings for core claims management, this report does not address
critical capabilities such as claim life cycle management, component-based architecture, and
performance and scalability, where there is little differentiation across the market. Instead, this
report focuses on advanced capabilities such as fraud management, supply chain management and
catastrophe management, where there are more distinct differences in the vendor offerings.

Analysis
Critical Capabilities Use-Case Graphics

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Figure 1. Vendors' Product Scores for the Process Definition Use Case

Source: Gartner (July 2015)

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Figure 2. Vendors' Product Scores for the New Claim Submission and Tracking Use Case

Source: Gartner (July 2015)

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Figure 3. Vendors' Product Scores for the Catastrophe Management Use Case

Source: Gartner (July 2015)

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Figure 4. Vendors' Product Scores for the Fraud Identification and Investigation Use Case

Source: Gartner (July 2015)

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Figure 5. Vendors' Product Scores for the Hosted Deployment Use Case

Source: Gartner (July 2015)

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Figure 6. Vendors' Product Scores for the Multiregional Support Use Case

Source: Gartner (July 2015)

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Vendors
Accenture (Accenture Duck Creek Claims)
Accenture Duck Creek Claims offers configuration tools that are user-friendly, with a drag-and-drop
and menu-driven interface that enables users to complete configuration tasks ranging from simple
tasks to more complex integration with other systems. The system includes comprehensive
business process management functionality that supports complex and unique workflows. More
advanced processed flow views are supported, but editing capabilities within process views require
custom code or integration with third-party tools.
Accenture Duck Creek Claims offers both portals and mobile apps, with production experience
primarily with portals and apps for direct consumers versus agents or brokers. The system has
prebuilt integration with a number of common third-party data sources, such as vehicle
identification numbers (VINs), prefill, bureaus and credit reports.
The system offers supply chain management that enables the user to import and manage a supplier
network, assign work and track supplier performance. The system offers a portal for collaboration
with suppliers, although this has not been used in production. Accenture Duck Creek has also built
an interface for ServicePower.
The system uses a combination of business rules and analysis of historical data to identify potential
fraud, and supports automated referral to special investigations unit (SIU) and case management for
fraud investigations. Prebuilt integrations are available for services such as the U.S. Office of
Foreign Assets Control (OFAC) and ISO ClaimSearch. The systems can be configured to provide
visualization tools, and integrated with third-party solutions for advanced fraud analytics, such as
social network analysis, but these capabilities have not been used in production.
Support for catastrophe management is excellent, with the ability to automatically assign
catastrophe and unique noncatastrophic event codes, and support unique assignments and
workflows. Prebuilt integration is available for external sources for address verification, geocoding,
mapping and catastrophe risk management. Through its reporting tools, the system offers
catastrophe management dashboards and the ability to map claims data with other layers, such as
weather data. Accenture Duck Creek also released a mobile app for postcatastrophe use by
adjusters that is in production with customers.
Accenture Duck Creek supports hosted deployments and offers a range of licensing options two
customers are currently being hosted. With 17 data centers across various regions and a system
that supports multiple currencies and multiple languages, Accenture Duck Creek has positioned
itself with the infrastructure and system capabilities to serve customers around the globe.
Roughly two-thirds of its customer base is headquartered in North America, with the remaining
customers in Europe (in the U.K., Ireland, Denmark, Portugal and Turkey) and in Japan. Accenture
Duck Creek's customers are using the system to support operations outside their home countries,
which include 14 countries in Europe, three countries in Latin America, and seven countries across
Asia/Pacific, Australia and New Zealand.

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CSC (Riskmaster Accelerator)


CSC's Riskmaster Accelerator provides configuration tools embedded within the administration
options of the system with straightforward access that enables non-IT developer users to complete
common changes such as updates to screens or fields. The configuration tools are limited, however,
in their support for more complex changes, such as unique screen design and support for complex
assignments. The system includes a business rule editor and supports the configuration of unique
workflows and system-generated tasks and activities. More advanced processed flow views and
editing capabilities require custom integration with third-party tools.
CSC does not offer separate agent or policyholder portals for Riskmaster Accelerator access to
the system is provided either directly through the application's UI or through integration with thirdparty or custom portals. CSC has partnered with Microsoft to offer a native mobile app for Windows
mobile devices. Although CSC offers prebuilt integration for agency upload/download, it does not
offer prebuilt integration for other data sources such as VIN numbers or to support prefill
capabilities.
The system does not offer prebuilt integration with external supplier networks. Riskmaster
Accelerator supports core supply chain management requirements, such as management of a
network, work assignment and supplier scoring, through the optional, fully integrated Vendor
Solutions Suite, which also includes a vendor portal.
Riskmaster Accelerator has an optional, fully integrated fraud suite component to provide
comprehensive fraud management capabilities. The system uses both business rules and analytics
to identify potential fraud, and supports automated assignment to SIU and case management for
investigations. Prebuilt integration is available for third parties such as OFAC and ISO ClaimSearch.
No prebuilt integration is available for other non-CSC fraud analytics packages.
CSC offers good catastrophe management capabilities in terms of support for automated
identification, assignment and unique workflows. Bulk assignment and linking of claims to a
noncatastrophe event is not supported in the base product. An adjuster app with catastrophe
management capabilities has been released for Windows mobile devices. Although prebuilt
integration is available for third-party catastrophe risk management tools, other data sources, such
as address verification, geocoding and mapping, would require custom integration. The system
lacks out-of-the-box capabilities for visualization and mapping of claims data.
CSC supports alternative delivery models, and it hosts approximately 50 noninsurer entities such as
self-insureds and TPAs. The company has 15 data centers available for hosting in regions around
the world. Sharing of computing resources within hosted deployments is limited to hardware.
All customers in production are currently in the U.S. and Canada, but CSC is working to position
Riskmaster Accelerator for international expansion. Support for multiple languages is now available,
and the system supports multiple currencies.

Guidewire (ClaimCenter)
Guidewire ClaimCenter's configuration tools offer business users access to a range of frequent
configuration changes within an administration module embedded in the system. More complex
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configuration changes are enabled via Guidewire Studio, a separate native configuration tool. The
system's excellent business process management support includes a business rule editor, support
for complex workflows and automated tasks, and the ability for users to view and modify process
flows. The company has deployed ClaimCenter successfully to meet requirements for a large
customer base around the globe.
Guidewire offers mobile and portal capabilities. It has recently productized a mobile-enabled claims
portal, which provides functionality for first notice of loss (FNOL), coverage verification, status
inquiries, and collaboration among the parties involved with the claim. Guidewire does not offer
native mobile applications the company's portals are built on a unified HTML5 platform that
delivers content to multiple form factors, including mobile. ClaimCenter includes prebuilt integration
for common external data sources such as agency upload/download and VINs.
ClaimCenter includes comprehensive supplier functionality, including the ability to import and
manage a supplier network, assign work and track supplier performance. Guidewire has also
introduced a supplier portal to provide visibility into supplier operations and facilitate collaboration
between insurers and suppliers.
Guidewire offers strong fraud management capabilities through the use of business rules and
historical data to identify fraud and refer claims to SIU. Case management tools are provided for
investigation. The company offers solution guides for integration with Detica NetReveal for
predictive fraud scoring, and has prebuilt integration with ISO ClaimSearch. Mapping and data
visualization capabilities of Guidewire Live have also been applied as tools for fraud identification.
ClaimCenter also offers strong support for catastrophe management, which has been deployed in
production by customers. This includes automated identification of catastrophe and
noncatastrophic event claims, and support for unique catastrophe assignment rules and workflows.
The system offers prebuilt integration to third-party sources for address verification, geocoding,
mapping and catastrophe risk management. Dashboard and visualization tools that combine claim
and third-party data are integrated within the system. ClaimCenter supports outbound
communication to policyholders ahead of a major event, and also is integrated with the other
Guidewire modules to support catastrophe management for various functions such as underwriting
and billing throughout Guidewire InsuranceSuite.
Guidewire provides only limited support for alternative delivery. The company does not directly
provide hosting services, but instead relies on its partners, which host four of its customers.
Guidewire offers excellent support for international expansion. ClaimCenter supports multiple
currencies and multiple languages, and the system has been deployed in every region across the
globe except the Middle East and Africa (see Note 1).

Innovation Group (Insurer Claims)


Innovation Group offers the claims management module Insurer Claims. The system offers very
comprehensive configuration tools. All configuration is supported within a single system that,
although powerful, may be challenging for less technical users to navigate. The system also offers

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strong business process management support, including a rule editor, support for complex
workflows and automated assignments, and the ability to view and edit process flows.
Innovation Group provides portals for captive and independent distributors and direct consumers
(including FNOL, claim status and self-service) that are in production. It is now building out
enhanced mobile capabilities, but its mobile-enabled portals have not yet been deployed to
production, and Innovation Group has not yet productized mobile apps. It offers prebuilt integration
for VIN and prefill, but does not have prebuilt integration with third parties for agency upload/
download.
Supplier management capabilities are very good, with support for supplier network management,
assignments and supply partner scoring. Innovation Group offers the unique option of preloading
the supplier network used in its BPO operations. There is no prebuilt integration for other, nonInnovation Group supplier networks.
Insurer Claims has comprehensive fraud management capabilities. The system has standard
business rule scoring and analysis of historical data for fraud, and it is integrated with Innovation
Group's Insurer Analytics for real-time fraud analytics. The system includes case management
functionality for investigation, and has prebuilt integration with OFAC and ISO ClaimSearch. Insurer
analytics does not include social network analysis or visualization tools for fraud. Prebuilt integration
is not available for non-Innovation Group advanced fraud analytics solutions.
Innovation Group offers excellent support for catastrophe management, with automated
identification of catastrophe and noncatastrophic event claims, and support for unique assignment
rules and workflows. The system supports outbound communications to policyholders, and offers
prebuilt integration with SpatialKey to provide dashboards and mapping with real-time data for more
informed claims decisions. Visualization tools are not fully integrated and directly assessable within
the system at the task level. Innovation Group also has not yet productized mobile offerings for
catastrophe management.
Innovation Group has extensive experience supporting large numbers of insurers in its BPO
operations. The company maintains four data centers in the U.S. and the U.K., and is hosting
approximately 20% of its Insurer Claims customers.
The system is positioned for international operations with support for multiple currencies and
multiple languages. Innovation Group lacks regional partners outside of Deloitte in the U.S. and IBM
and Deloitte in Europe, however, and has no customers in production in Central and South America,
the Middle East and Africa, and China, Asia/Pacific and Japan.

Insuresoft (Diamond Claims)


Insuresoft offers Diamond Claims as part of its Diamond Suite for P&C insurers. Insuresoft is in the
process of rolling out full, graphical user interface (GUI)-based configuration through its Composer
configuration tool and has completed work on rules, workflow and forms configuration. Work on UI
configuration is not planned to be completed until the end of 2015. Business process management
capabilities include a business rule editor and the ability to manage manual and system-generated

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tasks. The system offers support for unique workflows, but it does not offer a process flow view or
editor.
Diamond Claims includes a portal for both agents and policyholders that is in production.
Insuresoft's portal has been mobile-enabled. It is testing mobile native apps, although these are not
yet in production. The system includes prebuilt integration for agency upload/download and data
sources for VIN or prefill.
Supply chain management is limited, with Insuresoft reporting that most customers address this
outside the system. Diamond Claims offers the ability to assign work to third parties (such as repair
shops) through basic email notification or through custom integration. It does not offer a supply
chain partner portal.
Diamond Claims offers the user simple tools for fraud management. The system has prebuilt
integration with OFAC, ISO ClaimSearch and ISO ClaimDirector, and can be configured to store
fraud scores returned by third parties. Business rules can be configured by customers to provide a
means to flag potentially fraudulent claims. The system can be integrated with other third-party
solutions for advanced fraud analytics, but this integration is not prebuilt. The system does not offer
full case management functionality, but it does provide the ability for SIU to make a clone of the
claim file for use in investigations.
The system provides prebuilt catastrophe management reports and enables manual assignment of
catastrophe codes to claims. Automatic assignment of catastrophe codes is not supported. Unique
workflows are also not supported instead, the system uses a standard set of assignment rules for
overflow claims. Integration is prebuilt with Pitney Bowes for address verification, and integration is
prebuilt for geocoding and mapping. The system does not offer prebuilt mapping or data
visualization for catastrophe management, and it does not include a mobile adjusting app.
Insuresoft has had success with several customers with hosted deployments, which have been
more readily accepted by the Tier 3 insurers that make up its primary target market (see Note 2).
The company partners with Marias Technology to offer hosting through its data center in Ohio. Four
of Diamond Claims' customers are hosted. Each hosted customer is a separate instance; no
computing resources are shared.
Diamond Claims does not support multiple currencies, but it does offer limited support for multiple
languages (English and Spanish). The focus of Insuresoft has historically been on the North
American market.

Keylane (QIS Claims Management)


Keylane offers the claims management module QIS Claims Management. The system offers very
comprehensive configuration tools, and Keylane has been successful in keeping the majority of its
customers on current versions of the system. Business process management capabilities include a
business rule editor and the ability to manage manual and system-generated tasks. The system
offers support for action sequences, unique workflows and next-step processing. It also includes a

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process flow view of business processes, and this process flow view can be configured to support
editing.
Keylane includes a portal and mobile Web applications for both agents and policyholders that are in
production. The system contains reusable components that can be integrated in a native mobile
app, but this would require custom development. The system includes prebuilt integration for
agency upload/download and data sources for VIN or prefill.
The system offers core functionality for managing a supplier network and assigning work.
Management of licenses and prerequisites and supply partner analysis/scoring is limited in the base
system. QIS Claims Management also does not include a supply chain partner portal.
QIS Claims Management supports fraud management through business-rule-based identification of
potential fraud. The system supports automated referral to SIU and case management functionality
for investigations. Prebuilt interfaces are available for third-party fraud analytics packages.
The system offers limited catastrophe management functionality. QIS Claims Management enables
manual assignment of catastrophe codes to new claims. Automatic and bulk assignment of
catastrophe codes is supported for existing claims in the base system. Unique workflows,
catastrophe reporting, catastrophe collaboration portals, and catastrophe analytics and visualization
tools are not offered in the base system. Catastrophe reporting is available through the QIS Data
Mart, but this would require custom report development.
Keylane can provide sandbox environments for prospects and hosted deployments for customers
through its data center in the Netherlands. Keylane is hosting one QIS Claims Management
customer in production.
QIS Claims Management is positioned for international operations with support for multiple
currencies and multiple languages, and is being used by European customers in the Netherlands,
Switzerland and France, and by one customer in the Caribbean. Keylane's smaller size and limited
partnerships will likely constrain growth outside of Europe.

Majesco (Majesco Claims)


Majesco offers the claims management module Majesco Claims. The system includes two sets of
configuration tools one set designed to enable business users to perform simple, day-to-day
changes, and a full configuration studio that equips technical users and IT developers to perform
complex configuration and integration. It includes a business rule editor and supports unique
workflows, configuration of action sequences and system-generated tasks. The system can also be
integrated with third-party solutions to support review and editing within a process flow view,
although this integration is not prebuilt.
Majesco offers a direct-to-consumer portal and mobile Web applications that have been deployed
in production by customers. The company also offers mobile native applications that have not been
deployed in production. The system has prebuilt integration for agency upload/download, with
external data sources for VIN and prefill.

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The system offers core functionality for managing a supplier network and assigning work. Supply
partner analysis/scoring is not offered in the base system, and Majesco Claims does not have
prebuilt integration to external supply networks. The system does not include a supply chain partner
portal.
Fraud management within Majesco Claims is supported through business-rule-based identification
of potential fraud, and prebuilt integrations with OFAC and ISO ClaimSearch. The system supports
automated referral to SIU and capture of information during fraud investigation. It can also be
configured to support case management functionality for investigations, but this has not yet been
deployed to production. Custom integration work is necessary for the use of third-party fraud
analytics packages.
Catastrophe management is supported by Majesco Claims through custom workflows, manual
assignment, and automatic and bulk assignment of catastrophe codes. The system has prebuilt
integrations for address verification and geocoding. Majesco Claims is integrated with Cognos for
reporting, includes prebuilt reports for catastrophe management, and is also preintegrated with
Majesco Analytics. The system includes mapping, catastrophe analytics and visualization tools, and
also includes a mobile adjusting app. However, neither the catastrophe analytics nor the mobile app
have been deployed to production.
Majesco has significant experience supporting alternative delivery options, with 13 of its 20
customers in production being hosted within its data center in the U.S. The company can support
hosting of separate instances in which no computing resources (including hardware) are shared or
hosting in which application containers and databases remain separate, but hardware and virtual
infrastructure are shared.
In the long term, the company plans to expand into other regions. The system supports multiple
currencies through configuration and supports multiple languages, although these capabilities have
not been deployed to production. Majesco's historical focus has been on the P&C insurance market
in North America, but it is investing in the product to make it appropriate for global use, and it is
targeting Europe and Latin America for expansion.

SAP (SAP Claims Management)


SAP's claims management module, SAP Claims Management, offers comprehensive configuration
tools, with 90% of configuration accomplished through a GUI-based configuration toolset. The
system provides access suitable for business users for business rules and Q&A configuration. SAP
Claims Management also offers end users a wide array of configuration and personalization options
for their day-to-day workspace. The system also offers excellent business process management
capabilities, with support for complex workflows and the ability to view and edit workflows visually
in a process-flow UI.
SAP offers separate portals for multichannel support. These are mobile-enabled and in production.
SAP also has developed mobile applications for distributors and direct consumers, and these have
been deployed to production for direct consumers. Prebuilt integration is available for agency
upload/download, but SAP does not have production experience with integration for VIN or prefill.

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The system provides core supply chain management functionality for managing a supplier network
and assigning work, and includes flexible portal functionality that enables the user to quickly set up
portals for collaboration with supply chain partners. SAP Claims Management also supports supply
partner analysis/scoring and prebuilt integration to external supplier networks. However, these
supply chain management portals and capabilities have not yet been deployed to production by
customers.
SAP Claims Management supports the Hana in-memory database and contains basic fraud
management capabilities, such as business-rule based fraud identification and analysis of historical
data. The system also offers prebuilt integration with OFAC and ISO ClaimSearch. Comprehensive
fraud management, including fraud analytics, automated referrals, and case management
functionality is available under a separate license with SAP Fraud Management for Insurance.
Prebuilt integration with other third-party fraud analytics solutions is not available.
SAP offers excellent catastrophe management capabilities, with support for automated catastrophe
and other event code assignments. The system supports unique workflows and offers portals that
can enable collaboration among different internal and external parties. However, these capabilities
have not been deployed to production. SAP offers a mobile app for use by adjusters responding to
an event. The system offers prebuilt integration with third-party data sources for address
verification, geocoding, mapping and catastrophe risk management. The system also supports
mapping of claim and policy details with layers of other data (such as weather data).
SAP offers hosting through two data centers in the U.S. and two in Europe, with additional data
centers planned in Asia. All SAP Claims Management customers in production have deployed the
system on-premises. One customer currently implementing the system will be hosted by SAP in
Australia.
The system supports multiple currencies and multiple languages, and SAP has established a large
partner network that gives it a presence in every region across the globe. The company has
experienced slower growth in North America, but it is supporting customers in production in North
America, Europe, and the Middle East and Africa, and it has new customers currently implementing
in all other regions.

Context
The P&C claims management module market is relatively mature. Every system reviewed in this
report includes configuration tools that enable the user to modify the system independent of the
vendor. The vendors have gained experience from multiple deployments, and ship the systems with
prebuilt content and workflows that minimize configuration required during implementation. With
one exception, every vendor is offering its claims module with complementary modules for policy
and billing that enable their customers to choose a single vendor to provide a full suite of core
modules for their modernization needs.
Although the claims management market is mature, buyer preferences are shifting. Gartner is seeing
via client inquiry that insurance buyers are looking beyond core claims modernization to other
capabilities and technologies, such as the concept of digital business and the Internet of Things, to
meet their strategic objectives and remain competitive in the long term. Claims management
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modules are increasingly viewed as systems of record that provide little in the way of competitive
differentiation especially as they are being widely adopted across the industry. IT and business
leaders feel more urgency to complete claims management module implementations quickly to that
they can invest in more impactful technologies. There is a significant appetite for revising business
processes to match functionality provided by the vendors, and much less patience for
customization beyond what is absolutely necessary to adopt these systems.
Claims management modules have been mostly heavily adopted within the North American market,
where they have become the near-universal choice for legacy modernization and claims
transformation. Although adoption in other regions has lagged in the past in favor of in-house
solutions or local incumbents, in client inquiry Gartner, has seen a spike in interest from insurance IT
leaders in other regions that is reflected in the new customer wins reported by these vendors. The
number of new customers in North America fell from 27 in 2013 to 23 in 2014, while the number of
new customers outside of North America grew dramatically from 7 in 2013 to 22 in 2014.
In response to these shifting attitudes and priorities among buyers growing acceptance of core
claims management as a commodity function, and increasing interest from outside of North
America vendors continue to invest in advanced functionality and capabilities outside of core
claims processing to address buyer needs and better differentiate their products. They are placing
greater emphasis on building out or partnering for capabilities such as advanced workflow and
business process management, catastrophe management, supply chain management, and
advanced fraud analytics. All vendors offer portals for consumers and agents or distributors, and all
are introducing or improving support for mobile devices. Nearly all vendors are expanding their
hosting services, and all vendors are enhancing or investing in support for international expansion.
As Gartner surveyed these trends, we focused our assessments on the capabilities and use cases
where we saw the most differentiation among the vendors. For example, because every vendor in
this research offers a system that has a component-based architecture, is scalable and provides full
support for claim life cycle management, we did not focus on these capabilities. Instead, we
addressed capabilities such as configuration, where accessibility by business users for frequent,
minor changes and support for advanced workflows remain key differentiators. Given the emphasis
on the customer experience, we assessed the degree to which vendors offered multichannel
support via customer portals and mobile device support. We assessed the degree to which vendors
were enabling automation and collaboration within their supply chains, and the degree to which they
were incorporating scoring, analytics and case management to combat fraud. We assessed how
well the systems supported challenging scenarios like catastrophes with automated identification,
custom workflows, and data visualization and mapping for better decision making. We evaluated
the vendors' abilities to host their solutions, as this is becoming a more attractive (and sometimes
necessary) option for many insurance CIOs, and we assessed the vendors' abilities to support
international operations. We also assessed how vendors were using partners to address various
capabilities, such as advanced fraud analytics or international operations, that fall outside the scope
of core claims management or require skills and expertise beyond the scope of most vendor
organizations.

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Product/Service Class Definition


Gartner has defined "claims management modules" as solutions to manage the life cycle of an
insurance claim. These modules are often sold as independent software applications supporting
claims management functions only. They may also be integrated with other stand-alone modules,
such as policy and billing, to form a suite of modular core solutions.
Gartner distinguishes claims management modules from policy administration systems, which have
been commonly deployed in the past. Policy administration systems support end-to-end insurance
operations including claims, billing and other administrative functions in a single, monolithic
system. Claims management modules differ from claims functionality provided by broader policy
administration systems because, as stand-alone modules, they address core claims management
only.

Critical Capabilities Definition


Configuration
This is the capability for insurers to adapt the module to their needs without support from vendors.
This includes modifying workflows, business rules and processes; changing the sequence and
layout of user screens; adapting system attributes and parameters; and integrating with external
systems.

Multichannel Support
This is the capability to support different claim service channels such as call centers, the Internet
or mobile channels. Customers and agents are able to access portals with self-service functions
from any device and initiate claims, track status and assist in managing the claims process.

Supply Chain Management


This is the capability to maintain a network of suppliers (such as repair shops), track their
performance, facilitate referrals, and provide for collaboration among the suppliers and other
stakeholders (such as claimants and adjusters) in the claims management process.

Fraud Management
This is the ability to support various techniques for identifying fraud both within the claims
module and through integration with specialized packages and the management of
investigations. Fraud assessment should take place in real time in addition to separate analysis over
the life of a claim.
Claims management modules should offer basic workflow and business-rule-based fraud
identification capabilities, as well as tools to support investigation such as case management.
Prebuilt interfaces for best-of-breed fraud analytics tools (such as predictive modeling and fraud
analytics, which support more advanced data mining for early fraud scoring and social network
analysis for better fraud ring detection) are increasingly expected by buyers. More advanced
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vendors have production experience with prebuilt integrations with best-of-breed fraud analytic
tools, and in some cases, are offering additional data visualization and geospatial analysis for
identifying fraud.

Catastrophe Management
This is the ability to minimize the impact of catastrophic events through alternative processes during
pre-event, event and postevent stages. The system should support automated linking of claims to
catastrophes and provide insight via analytics that enable the visualization of key data.

Alternative Delivery
This is the ability to support deployment models beyond a traditional on-premises implementation.
These deployments may be more traditional hosting with managed application services or more
sophisticated offerings that are truly SaaS. In nearly all cases, the ability to deploy quickly is
paramount.

Internationality
This is the ability to support operations in multiple geographic regions. The system must support
multiple currencies and languages, and provide configuration tools that enable it to be localized for
each region's unique regulatory environment and common business practices.

Use Cases
Process Definition
Modify out-of-the box process flow, layout of user screens and supporting business rules to meet
the requirements of a client-specific version of a process.

New Claim Submission and Tracking


Submit and track the status of a claim across multiple channels from the perspective of various
stakeholders (e.g., policyholder, claims adjuster and supply chain partner).

Catastrophe Management
Support alternative claim processes during pre-event, event and postevent stages. Link claims to
defined catastrophes, and provide insight via analytics and reports.

Fraud Identification and Investigation


Use a mix of techniques (such as business rules or predictive analytics) to identify a potentially
fraudulent claim and refer it to SIU. Provide support for the investigation.

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Hosted Deployment
Implement the system as quickly as possible using a vendor-hosted deployment. Use prebuilt
content and functionality to speed implementation.

Multiregional Support
Deploy the system across multiple regions that do not share a common language or a common
currency.

Vendors Added and Dropped


Added
Keylane, with its claims management module QIS Claims Management, was added to this report.

Dropped
No vendors were dropped from this report.

Inclusion Criteria
This Critical Capabilities report uses the same inclusion criteria as the "Magic Quadrant for Property
and Casualty Insurance Claims Management Modules." This report includes only claims
management modules that are offered stand-alone (for example, not coupled with a policy system
or available only as part of a comprehensive policy administration suite).
For inclusion in the Magic Quadrant, each solution must have:
1.

At least 10 customers that have deployed the claims solution to production as of 31 December
2014. Each organization is counted once, even if there are multiple deployments for different
lines of business within a single company.

2.

At least one new customer in 2014 (excluding upgrades or expansion within existing
customers).

Not included in this report are vendors that supply only front-office functionality for claims (that is,
they lack claims financials), solutions sold exclusively to workers' compensation product lines with
no capability to support commercial and personal-line functions, and those vendors that have fewer
than 10 customers in production as of December 2014. For this report, Gartner selected seven
critical capabilities and defined six use cases (see Table 1).

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Multiregional Support

Hosted Deployment

Catastrophe Management

Fraud Identification and Investigation

Critical Capabilities

New Claim Submission and Tracking

Process Definition

Table 1. Weighting for Critical Capabilities in Use Cases

Configuration

60%

50%

20%

30%

10%

25%

Multichannel Support

10%

15%

10%

5%

0%

5%

Supply Chain Management

10%

15%

10%

5%

0%

5%

Fraud Management

5%

5%

5%

55%

0%

5%

Catastrophe Management

10%

10%

45%

5%

0%

5%

Alternative Delivery

0%

0%

10%

0%

90%

10%

Internationality

5%

5%

0%

0%

0%

45%

100%

100%

100%

100%

100%

100%

Total
As of July 2015
Source: Gartner (July 2015)

This methodology requires analysts to identify the critical capabilities for a class of products/
services. Each capability is then weighed in terms of its relative importance for specific product/
service use cases.

Critical Capabilities Rating


Each of the products/services has been evaluated on the critical capabilities on a scale of 1 to 5; a
score of 1 = poor (most or all defined requirements are not achieved), while 5 = outstanding
(significantly exceeds requirements).

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CSC (Riskmaster Accelerator)

Guidewire (ClaimCenter)

Innovation Group (Insurer Claims)

Insuresoft (Diamond Claims)

Keylane (QIS Claims Management)

Majesco (Majesco Claims)

SAP (SAP Claims Management)

Critical Capabilities

Accenture (Accenture Duck Creek Claims)

Table 2. Product/Service Rating on Critical Capabilities

Configuration

3.8

2.6

3.9

3.8

2.5

3.8

3.0

3.4

Multichannel Support

3.1

2.0

3.3

2.8

2.4

3.1

3.2

2.8

Supply Chain Management

2.9

3.1

3.3

3.2

2.1

2.2

2.6

2.8

Fraud Management

2.8

3.2

3.6

3.0

2.3

2.4

2.7

3.8

Catastrophe Management

3.8

2.4

4.5

3.8

2.2

2.0

2.8

3.6

Alternative Delivery

3.0

3.3

2.2

3.5

3.3

2.8

3.5

2.8

Internationality

3.0

2.2

4.2

3.3

1.5

2.3

2.2

3.6

As of July 2015
Source: Gartner (July 2015)

Table 3 shows the product/service scores for each use case. The scores, which are generated by
multiplying the use case weightings by the product/service ratings, summarize how well the critical
capabilities are met for each use case.

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CSC (Riskmaster Accelerator)

Guidewire (ClaimCenter)

Innovation Group (Insurer Claims)

Insuresoft (Diamond Claims)

Keylane (QIS Claims Management)

Majesco (Majesco Claims)

SAP (SAP Claims Management)

Use Cases

Accenture (Accenture Duck Creek Claims)

Table 3. Product Score in Use Cases

Process Definition

3.55

2.58

3.84

3.58

2.36

3.25

2.91

3.33

New Claim Submission and Tracking

3.47

2.58

3.78

3.50

2.34

3.13

2.90

3.27

Catastrophe Management

3.51

2.60

3.87

3.57

2.39

2.59

2.93

3.33

Fraud Identification and Investigation

3.17

2.92

3.71

3.28

2.35

2.83

2.82

3.57

Hosted Deployment

3.08

3.23

2.37

3.53

3.22

2.90

3.45

2.86

Multiregional Support

3.23

2.51

3.82

3.43

2.08

2.75

2.66

3.40

As of July 2015
Source: Gartner (July 2015)

To determine an overall score for each product/service in the use cases, multiply the ratings in Table
2 by the weightings shown in Table 1.

Gartner Recommended Reading


Some documents may not be available as part of your current Gartner subscription.
"How Products and Services Are Evaluated in Gartner Critical Capabilities"
"Magic Quadrant for Property and Casualty Insurance Claims Management Modules"

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Note 1 Definition of Regions


Gartner asked vendors to respond with data on customers in production and sales for the following
six regions:

North America (U.S. and Canada)

Latin America

Europe

Middle East and Africa

China, Asia/Pacific region and Japan

Australia and New Zealand

Note 2 Definition of Tiers

Tier 1: More than $5 billion (or equivalent) in direct written premium (DWP)

Tier 2: $1 billion to $5 billion in DWP

Tier 3: Less than $1 billion in DWP

Critical Capabilities Methodology


This methodology requires analysts to identify the critical capabilities for a class of
products or services. Each capability is then weighted in terms of its relative importance
for specific product or service use cases. Next, products/services are rated in terms of
how well they achieve each of the critical capabilities. A score that summarizes how
well they meet the critical capabilities for each use case is then calculated for each
product/service.
"Critical capabilities" are attributes that differentiate products/services in a class in
terms of their quality and performance. Gartner recommends that users consider the
set of critical capabilities as some of the most important criteria for acquisition
decisions.
In defining the product/service category for evaluation, the analyst first identifies the
leading uses for the products/services in this market. What needs are end-users looking
to fulfill, when considering products/services in this market? Use cases should match
common client deployment scenarios. These distinct client scenarios define the Use
Cases.
The analyst then identifies the critical capabilities. These capabilities are generalized
groups of features commonly required by this class of products/services. Each
capability is assigned a level of importance in fulfilling that particular need; some sets of
features are more important than others, depending on the use case being evaluated.

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Each vendors product or service is evaluated in terms of how well it delivers each
capability, on a five-point scale. These ratings are displayed side-by-side for all
vendors, allowing easy comparisons between the different sets of features.
Ratings and summary scores range from 1.0 to 5.0:
1 = Poor or Absent: most or all defined requirements for a capability are not achieved
2 = Fair: some requirements are not achieved
3 = Good: meets requirements
4 = Excellent: meets or exceeds some requirements
5 = Outstanding: significantly exceeds requirements
To determine an overall score for each product in the use cases, the product ratings are
multiplied by the weightings to come up with the product score in use cases.
The critical capabilities Gartner has selected do not represent all capabilities for any
product; therefore, may not represent those most important for a specific use situation
or business objective. Clients should use a critical capabilities analysis as one of
several sources of input about a product before making a product/service decision.

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