# 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