FINEOS Claims for Workers' Comp offers insurance carriers, TPAs, self-insureds, state funds and other government entities complete claims lifecycle management, including intake, payments, reserves, provider management, and other claims processes, according to the vendor. It includes rules and workflow capabilities that are flexible enough to easily accommodate changes to product definition, U.S. regulatory requirements and internal processing policies, FINEOS says, as well as a powerful case structure, which is vital for managing workers' comp claims, where multiple parties are typically involved (nurse case managers, medical staff, claims handlers etc).

Capabilities developed specifically for the U.S. market include preconfigured business content in areas such as compliance, fraud detection and medical management. In addition, it can integrate with decision-support databases to help organizations evaluate claims status against accepted rehabilitation timeframes.

According to Michael Kelly, FINEOS' CEO, "We believe that this is an underserved market that will benefit from the world-leading capabilities that FINEOS Claims can offer. U.S. workers' compensation is also an industry with significant environmental issues including medical inflation, indemnity costs, and regulatory challenges. Using FINEOS Claims will enable carriers' and state funds' efforts to offer a claims service that is consistent and transparent, ultimately creating mutually beneficial outcomes for employers, providers, workers' compensation writers, and injured workers," he said in a press release.

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