ONESHIELD MARKET SOLUTIONS / CLAIMS

Faster claims, start to close

Run claims on a carrier-grade platform delivered as a managed service, from FNOL intake through reserve management and resolution. AI-powered document analysis speeds handling while OneShield manages the system for you.

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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:

• 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

Our annual fee includes the software license, maintenance, hosting, support, implementation, and a defined number of annual managed service hours. Upgrades ship monthly, so you're always on the latest version, with known costs upfront, and none of the “sticker shock” of typical time-and-materials implementation and support models.

• No large upfront implementation fees
• Annual service hours allotment
• Monthly upgrades and enhancements