JDi Data Claims Manager Overview

James [email protected]

Kevin Smith National Accounts [email protected]

2400 E. Commercial Blvd Suite 322Ft. Lauderdale, FL 33308954.938.9100 (phone)954.351.9838 (fax)

About JDi Data CorporationWe innovate and empower.For 30 years, JDi Data Corporation has innovated software development. As a proven leading technology solution provider and developer, we specialize in standard and customized insurance management software solutions that streamline your work processes.

We pride ourselves on listening to what you say, and responding with some of the top products available in the market. Our integrated software delivers accuracy, claims audit solutions, and improves workforce productivity to support insurance carriers, third party administrators, and municipal entities in claims administration for multiple lines of insurance. Our MissionOur mission is to actively pursue and innovate intuitive solutions with creativity and a passion to exceed expectations. We do that by listening to your needs and responding with comprehensive insurance software that fits and improves how you do business.

Software components:JDi Data relies on the latest Microsoft technologies, including .NET 4.0, C#, and ASP.NET and future revisions. Microsoft SQL Server 2008 R2 Standard Edition (or better) including SQL Server Reporting ServicesMicrosoft Office or compatible office suiteAdobe Acrobat reader and compatible file printer driver Hardware Components:Minimum requirements 4 GB of RAM, Microsoft Windows Server 2003 and Microsoft SQL Server 2005, however JDi Data recommends:

Server (virtual or physical):Dual-core, server-class CPU, 6 GB of RAM, 500 GB of redundant storage space.Microsoft SQL Server 2008 and Microsoft Windows Server2008 R2 w/ Internet Information Services (IIS) enabledInternet/Intranet connectivity

Client Workstation(s)Any device capable of running Internet Explorer (version 8 or later), Mozilla Firefox (version 2 or later), Apple Safari, or Google Chrome. iPad and smart phone accessible

System Requirements

JDi Data supports both options with the same level of service. In a cloud environment, services include maintain/upgrade/support of all functionality. In a client-hosted environment, client would provide JDi Data virtual server access thereby limiting client IT intervention except for hardware maintenance.

1. Software to be hosted on client-provided infrastructureJDi Data recommends :Microsoft Windows 2008-based infrastructure with adequate hardware redundancy (hardware RAID, redundant power supplies, etc.).

2. Software to be hosted on cloud-based infrastructureCloud solutions allow us to easily grow the hosting infrastructure with minimal additional cost, administrative overhead and downtime. As your user-base grows, cloud-based infrastructure can easily grow with it by simply allocating additional computer resources (disk space, memory, etc.). For added peace of mind, regular application data backups can be scheduled.

Hosted or Non Hosted Solutions

• Multiple lines of business in a single database • Multiple Insurers/Clients in same database, a

great solution for Pools and TPA.• Policy Administration uses same database to

eliminate duplication and allows tight integration.• Powerful user Access Rights, including limited

view only for Brokers/Reinsurers/Producers/Agents.

• Powerful Time Log/Diary/Alarms/Claim Notes • Captures pictures, videos, recordings• User defined, client dependent reference lists

Reserves, Payment Type, Features/Kind of Loss, Type and the cause of Loss, Reporting Codes, Diary and Note description types to aid adjusters while producing Reporting Consistency.

• Comprehensive reporting Loss Runs, spreadsheets, Bordereaux, Dashboards, Triangulation, all available in common file format exports.

• Client specific ad hoc reports generated on demand.

• AccessADoC Document Depositary for easy retrieval of faxes, correspondence, invoices, pictures, videos, recordings, notes and diaries.

• Microsoft SQL database provides easy access for interfacing with companion programs like HR,

accounting and compliance.• Statistical reporting capability to ISO, NCCI and

NISS as required • Letter designer and a mail merge with populated

database fields.• PDF, including state forms library populated from

database.• Check writing, accounting interface and

electronic bank reconciliation • Browser based web access • Smart phone and tablet applications for mobile

access• Client or Cloud hosting options• Mainstream components, Microsoft SQL,

Windows and .NET using software as a service (SaaS) business model to keep you up to date.

Key Claims Manager® Features

The following are a few screenshots that illustrate the dynamic interface design, workflow, and layout of the Claims Manager® system.

• Multiple application instances to bounce between claims

• Enter new claim, retrieve existing claim using filtering of LOBs, clients, programs, departments

• Audit trail documentation of entries allows multiple users to access single claims

The claim status options are open, closed, reopened, reclosed, as well as incident and void. All Claims Manager® drop down selection boxes are user defined for complete control of content. Because of this infrastructure, incident reporting is actually part of the claim system and may be converted to an open claim as required.

Claim sub statuses are client hierarchy based which means different sub statuses “schemes” are available for different clients. Claims Manager® uses a hierarchy field selection system to be sure data flows down correctly. Related claims search, important for workers comp allows users to find additional claims for same claimant.

Claimant Tab

The Financials tab captures all financial activities associated with the claim. There are two financial screenshots, one with the print reserve worksheet opened and the other closed. The print reserves worksheet works like a mini loss run and allows transaction selection based on clicking dollar amounts.

Financials Tab

All transactions are color coded to indicate the type of payment, and the Claims Manager® system supports bucket reserves (one reserve for entire reserve category) or payment category reserves where individual payment categories with in a reserve category may be reserved individually. Mix or match!

Invoices may be uploaded through the vendor portal to conform with the billing requirements, manually entered, imported from medical bill review provider, or a workflow approach can be customized specifically for the user.

JDi Data interfaces with bill review providers, including CompIQ, Xerox, and others. We can perform ACH debits and credits, positive pay functions, recurring daily routines, import/export or data synchronization with other programs.

The goal of the Claims Manager® product is to minimize clerical work, duplication of entry, and streamline workflow. The Invoices screen accomplishes all of that. Invoicing also supports multiple dollar amounts associated with the workflow. The requested amount is the actual invoice amount, adjusted is the assigned amount of the invoice i.e. a medical review change to comply with state payment amounts.

Invoices Tab

The Notes section of the Claims Manager® acts as a central location from where you can add notes and comments about the status of the claim, reasons for denial or any other information pertaining to the claim. Using the functions available in this section you can add a new claim note, edit existing claim notes, print a claim note and delete claim notes.

Notes Tab

Using the functions available in the Diaries section you can add a new claim diary/alarm, edit existing diaries/alarms, and delete diaries/alarms. There are also diaries which are automatically added when a new claim is created, these are user defined diaries.

Diaries Tab

The Docs section of the Claims Manager® system is available under the Docs tab in the Claim Details screen. This section acts as a central location where you can add and manage all the documents related to the claim. Using these functions gives you the ability to upload documents i.e. spreadsheets, PDF’s, audio files, movie files, pictures, and relate them to data transactions within the claim.

Documents Tab

Access rights and authority levels to control user activity

Claims Manger® allows you or JDi Data to add, change, edit or delete codes which address all drop down menus in the system.

With today’s technology, Google type searches, instant retrieval, and information over flow, sophisticated users are demanding. We EXPECT to be able to find things immediately. JDi Data Corporation’s AccesADoC document depositary tool is designed to supplement and aid in document storage.

While there are many sophisticated document depositary products available, and oftentimes already in use in our clients’ environment, AccesADoC may interface with other products. Documents may be stored anywhere, the challenge is to ensure Claims Manager® can find them and bring them to you immediately. This obligation is being met in the overall configuration and integration into the client environment using the best tools available to provide the desired result.

Document Depository

Workflow Procedure

Loss Run Report Example

YTD Loss Report Example

Comprehensive solutions, real time delivery.

Claims Manager® insurance claims software, powers your claims management and boosts efficiencies in all lines of business. Claims Manager® provides fully integrated workers compensation and also critical claim data for Property & Casualty, including:

• Specialty lines • Construction Defects• Difference in Condition• Excess Liability• Public Entity• Law Enforcement• Employment• Public Officials

The result: More productivity throughout the claims lifecycle.

Our newest product, policy administrator completes the suite of products and is fully integrated with claims.

http://www.jdidata.com